Chapter 37: Diuretics

Question 1

K wasting diuretics

Answer 1

1. Thiazide
   chlorothiazide (Diuril)
   hydrochlorothiazide (Microzide)
   work in the distal tubule
2. Loop
   furosemide (Lasix) -common inpatient med
   bumetanide (Bumex) -common outpatient med (less SE and one time dosage)
   Torsemide (Demadex)
   work in the loop of henle

Question 2

K sparing diuretics

Answer 2

Spironolactone (Aldactone)
Triamterene (Dyrenium)
Amiloride (Midamor)
work in the collecting tubule
weak diuretics

Question 3

osmotic diuretics

Answer 3

mannitol
use for cerebral edema
work in the proximal tubule

Question 4

Carbonic anhydrase inhibitors

Answer 4

used for glaucoma and alt. sickness. Do not promote urine excretion, promote loss of bicarb. Ex. Acetazolamide
work in proximal tubule

Question 5

thiazide diuretic MOA

Answer 5

Inhibits distal tubule sodium and chloride reabsorption -> inhibits water reabsorption

Question 6

thiazide diuretic use

Answer 6

Treats HTN and Peripheral Edema

Question 7

thiazide diuretic SE

Answer 7

FVD (dehydration)
Orthostatic hypotension
Dizziness, fainting
Muscle cramps
Hypokalemia,
Hyponatremia
Hypomagnesemia
Hypercalcemia,
Hyperglycemia, Hyperuricemia, Hyperlipidemia

*keep in mind losing E and water

Question 8

thiazide diuretic contraindications

Answer 8

Ineffective in someone who has low GFR. Need adequate kidney function to take thiazide.

Question 9

loop diuretic MOA

Answer 9

Inhibits loop of Henle and proximal and distal tubule sodium and chloride reabsorption. Rapid Loss of Na, Cl, K, Mg, Ca, H20
LOH is very hypotonic and pulls lots of water and E and does not let it get reabsorbed

Question 10

loop diuretic use

Answer 10

Edema, Pulmonary edema, HTN, CHF
Can be used in someone who has impaired renal function
Most effective -60x more potent than thiazide

Question 11

loop diuretic admin

Answer 11

PO, IV
After PO admin diuresis should begin in 60 min and lasts about 6hr. Make sure they take these in the AM

Question 12

loop diuretic SE

Answer 12

FVD
Hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia,
Orthostatic hypotension (med needs to be held or d/c)
Dysrhythmias (dt hypoK, esp. ventricular)
Ototoxicity (large doses, usually temp)

Question 13

loop diuretic drug interactions

Answer 13

Digoxin* -r/o toxicity. Dig stays in blood longer with hypoK (inverse relationship)

Question 14

Prescribing considerations for K wasting diuretics: therapeutic goal

Answer 14

tx of HTN and edema. Low dose: ~ 20mg/day. Start there and see how therapeutic it is.

Question 15

Prescribing considerations for K wasting diuretics: baseline data

Answer 15

Weight VS, electrolytes
Administer in the AM

Question 16

prescribing considerations for K wasting diuretics: identifying high risk patient

Answer 16

Use cautiously with CV patients , renal patients, DM, patients taking with Digoxin and other HTN meds (hypotension)

Question 17

Prescribing considerations for K wasting diuretics: evaluating therapuetic effects

Answer 17

Pat should weigh themselves daily and evaluate for decreased edema. Monitor for S/S of hypokalemia
Minimizing Effects: Initiate with low doses, adjust doses carefully.

Question 18

food sources of K

Answer 18

yogurt, bananas, spinach, acorn squash, fish, white bean,. oranges, tomatoes, avocados, mushrooms, dried apricots, baked potato

Question 19

K sparing diuretics MOA

Answer 19

Blocks Aldosterone (mineralocorticoid) in distal tubule decreasing Na and water reabsorption and increasing K retention

Question 20

K sparing diuretics use

Answer 20

Edema, HTN, diuretic induced hypokalemia, CHF

Question 21

K sparing diuretics SE

Answer 21

FVD
Electrolyte abnormalities
Hyperkalemia*** (S&S)
Endocrine effects: Gynecomastia, Hirsutism, Menstrual irregularities, Impotence, Deepening of the voice

Question 22

prescribing considerations for K sparing diuretics

Answer 22

Similar to K wasting EXCEPT:

Effects may take up to 48 hours
Tell pt to avoid foods high in potassium
Monitor SS of hyperkalemia and K level (no salt substitute)