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nurs 252 > diuretic drugs > Flashcards

diuretic drugs Flashcards

1
Q

What are Diuretic drugs

A

Drugs that increase the rate of urine formation resulting in the excretion of sodium and water

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2
Q

Purpose of diuretic drugs

A

Used to treat hypertension and heart failure. Also used to prevent kidney damage during acute kidney injury

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3
Q

How much sodium/water is reabsorbed to the bloodstream by the proximal convoluted tubule

A

60-70%

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4
Q

How much sodium/water is reabsorbed in the ascending loop of henle

A

20-25%

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5
Q

How much sodium is reabsorbed in the distal convoluted tubule

A

5-10%

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6
Q

5 categories of diuretic drugs

A
  • Carbonic anhydrase inhibitor(used for glaucoma)
  • Loop diuretics
  • Osmotic Diuretics
  • Potassium sparing diuretics
  • Thiazide and thiazide like diuretics
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7
Q

Most common carbonic anhydrase inhibitor

A

Acetazolamide

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8
Q

Should Acetazolamide be used in pregnant women

A

Yes it should be used as the benefits out weight the potential fetal risks

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9
Q

What does the carbonic anhydrase ENZYME do?

A

The enzyme makes H+ more available which then increases the transport of water and sodium back into the blood

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10
Q

What does the carbonic anhydrase INHIBITOR do?

A

decreases the concentration of the enzyme which then blocks the production of H+ decreasing the transportation of water and sodium leading to more bicarbonate, sodium water and potassium to be excreted

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11
Q

Indications of carbonic anhydrase inhibitors

A
  • open angle glaucoma and secondary glaucoma
  • Lower intraocular pressure before eye surgery
  • Edema (secondary to HF)
  • High altitude sickness
  • Epilepsy
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12
Q

Carbonic Anhydrase inhibitor contraindictions

A
  • drug allergy
  • Hyponatremia (low levels of sodium)
  • Hypokalemia (low levels of potassium)
  • Severe kidney/liver dysfunction
  • Adrenal gland insufficiency
  • Cirrhosis (liver scarring/damage)
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13
Q

Carbonic Anhydrase inhibitor adverse effects

A
  • Acidosis (decreases bicarbonate absorption which makes blood less acidic)
  • Hypokalemia
  • Drowsiness
  • Anorexia
  • Paresthesias
  • Hematuria
  • Urticaria
  • Photosensitivity
  • Melena (blood in the stool)
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14
Q

Carbonic Anhydrase inhibitor interactions

A
  • can cause hypokalemia so when used with digoxin, may cause toxicity
  • Used with corticosteroids can cause hypokalemia
  • Increases effects of amphetamines, carbamazepine, cyclosporine, phenytoin, and quinidine sulphate
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15
Q

Loop diuretic drug Ex

A

Furosemide (Lasix)

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16
Q

Loop diuretics MOA

A
  • Effects kidney, cardiovascular and metabolism
  • Act directly on the ascending loop of henle to block chloride and sodium reabsorption
  • Increases kidney prostaglandins leading to dilation of blood vessels reducing kidney, pulmonary and systemic vascular resistance
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17
Q

Loop diuretics onset/duration

A

rapid onset that last 2 hrs

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18
Q

Loop Diuretics drug effects

A
  • Increases fluid loss leading to a reduction in BP, pulmonary/systemic vascular resistance, central vascular resistance, left ventricular end diastolic pressure
  • potassium/sodium depletion and small calcium loss
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19
Q

Loop Diuretics indication

A
  • Edema associated with HF and liver/kidney disease
  • Control hypertension
  • hypercalcemia
  • HF from diastolic dysfunction
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20
Q

Loop Diuretics Adverse effects

A

CNS: Dizziness, headache tinnitus, blurred vision
GI: Nausea, vomiting, diarrhea
Hematological: agranulocytosis, neutropenia, thrombocytopenia
Metabolic : hypokalemia, hyperglycemia, hyperuricemia

21
Q

Loop Diuretics interaction

A
  • neuro/nephrotoxic
  • Cause an increase of uric acid, glucose, alanine aminotransferase and aspartate aminotransferase
  • With thiazide can cause nephron blockage
  • NSAIDs may decrease the reduction of vascular resistance
22
Q

Uses for Furosemide (lasix)

A
  • Most commonly used loop diuretic
  • Uses: pulmonary Edema, edema associated with HF, liver disease, nephrotic syndrome, ascites and and hypertension
23
Q

Most commonly used osmotic diuretics

A

Mannitol

24
Q

Where are Osmotic Diuretics effective

A

Works all along the nephron but mostly in the proximal tubule and the descending loop of henle

25
Q

MOA of Osmotic Diuretics

A
  • It is nonabsorbable so it sits in the nephron pulling water in from the surrounding tissues using osmosis
  • inhibit tubular reabsorption of water and solutes
26
Q

Osmotic Diuretics drug effects

A
  • Increase GFR and renal plasma flow preventing kidney from overworking itself during an acute kidney injury
  • Reduce intracranial pressure or cerebral edema associated with head trauma (reduce pressure in the head)
  • Reduce intraocular pressure (reduce pressure in the eye)
27
Q

Osmotic Diuretics indications

A
  • Early oliguric phase of acute kidney injury
  • Needing to excrete toxic substance
  • Reduce intracranial pressure
  • Treatment of cerebral edema
28
Q

Osmotic Diuretics adverse effects

A

Convulsions
Thrombophlebitis (blood clots)
Pulmonary congestion
Other: headaches, chest pains, tachycardia, blurred vision, chills, and fever

29
Q

Mannitol route

A
  • IV use only
  • May develop crystals due to low temp. Must be stored in warm temp
  • Need a filter
30
Q

Potassium sparing diuretics aka…

A

Aldosterone inhibitor diuretic

31
Q

Potassium sparing diuretics most common

A

spironolactone

32
Q

where are Potassium sparing diuretics used

A

Collecting ducts and dsital convoluted tubules

33
Q

Potassium sparing diuretics MOA

A
  • Interferes with sodium-potassium exchange blocking the sodium and water to the aldosterone secretion
34
Q

Potassium sparing diuretics drug effects

A
  • Weaker compared to thiazide and loop diuretic
  • Block’s aldosterone and promotes excretion of sodiom and water
35
Q

Potassium sparing diuretics indications of Spironolactone

A
  • Hyperaldosteronism
  • Hypertension
  • Reversing potassium loss caused by potassium using diuretics
  • Some cases of HF
    Amiloride
  • Similar to ^ but less effective long term
36
Q

Potassium sparing diuretics Adverse effects

A

CNS: Dizziness and headache
GI cramps nausea, vomiting, and diarrhea
Other Urinary frequency, weakness and hyperkalemia

37
Q

spironolactone (Aldactone®) adverse effects

A

Gynecomastia
Amenorrhea
Irregular menses
Postmenopausal bleeding

38
Q

Potassium-Sparing Diuretics interactions

A

Lithium (increased toxicity), ACE, potassium and NSAID

39
Q

Thiazide diuretics (most common)

A

Hydrochlorothiazide

40
Q

Thiazide diuretics MOA

A
  • Stops the reabsorption of sodium, chloride and potassium ions leading to water staying in the nephron and being excreted
  • Also dilates the arterioles by direct relaxation decreasing preload and afterload
  • Helps with reabsorption of calcium
41
Q

Where are Thiazide diuretics effective

A

Primarily in the distal convoluted tubule

42
Q

Normal creatinine levels

A

125mL/min

43
Q

Thiazides should not be used if creatinine is…

A

Less than 30-50ml/min

44
Q

Thiazide diuretics indications

A
  • Hypertension
  • Edema
  • Idiopathic hypercalciuria (calcium in the urine)
  • Diabetes insipidus (peeing alot)
  • HF because of diastolic dysfunction
45
Q

Thiazide diuretics adverse effect

A

CNS: dizziness, headache, blurred vision
GI: anorexia, nausea, vomiting, diarrhea
GU: erectile dysfunction
Hematological: jaundice, leukopenia, agranulocytosis
Integumentary: Urticaria, photosensitivity
Metabolic: hypokalemia, glycosuria, hyperglycemia, hyperuricemia, hypochloremic alkalosis

46
Q

What time of day should patients take diuretics

A

in the morning to avoid sleep disturbances

47
Q

Lab values that should be assessed

A

Potassium levels during therapy

48
Q

Why shouldn’t one eat excessive licorice when on thiazides

A

Can lead to hypokalemia

49
Q

Foods high in potassium

A

bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, legumes

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