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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Diuretic Drugs - Ch. 44 > Flashcards

Diuretic Drugs - Ch. 44 Flashcards

1
Q

Diuresis

A

Increased water loss

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2
Q

What do diuretic drugs do?

A

Increase urine output
Remove excess fluid
Accelerate the rate of urine formation

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3
Q

What are first-line diuretics used for?

A

Heart failure
Hypertension
-acute edematous states

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4
Q

How do most diuretic drugs work?

A

By excretion of sodium and water

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5
Q

How do diuretics affect blood pressure?

A

They control sodium and chloride which controls how much water is excreted, and the volume of ECF which controls BP

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6
Q

Sodium controls the movement of what?

A

Water
-Where sodium goes, water follows

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7
Q

20% to 25% of all sodium is reabsorbed in which part of the nephron?

A

Loop of Henle

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8
Q

7% of all sodium is reabsorbed in which part of the nephron?

A

Distal tubules

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9
Q

1-2% of all sodium is reabsorbed in which part of the nephron?

A

Collecting ducts

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10
Q

What happens if water is not reabsorbed?

A

It is excreted as urine

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11
Q

What happens when Na reabsorption is blocked?

A

Excessive fluid loss (dehydration)
Acid-base imbalances
Altered electrolyte levels

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12
Q

What are the types of diuretics?

A

Loop diuretics
Thiazide and thiazide-like diuretics
Potassium-sparing diuretics
Osmotic diuretics

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13
Q

Which types of diruetics block NaCl reabsorption?

A

Loop diuretics
Thiazide and thiazide-like diuretics
Potassium-sparing diuretics

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14
Q

What are examples of Loop diuretics?

A

!! Furosemide (Lasix)
Bumetanide (Burinex)
Ethacrynic acid (Edecrin)

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15
Q

Loop diuretics are also known as?

A

‘high ceiling’ diuretics

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16
Q

Which part of the nephron do Loop diuretics act in?

A

Ascending Loop of Henle

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17
Q

What is the mechanism of action of Loop Diuretics?

A

Inhibits sodium and chloride transporter on luminal membrane so it gets secreted into nephron fluid

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18
Q

Furosemide

A

Significant diuresis
-Causes significant fluid loss

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19
Q

What does decreased fluid volume cause?

A

Reduced edema
Reduced venous return (reduced CO)

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20
Q

What is Furosemide used for?

A

Edema associated with heart failure or hepatic or renal disease
Control of hypertension
Increase renal excretion of calcium in clients with hypercalcemia

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21
Q

What adverse effects are associated with Furosemide?

A

Excessive fluid loss
-Low Na, Cl
-Water loss —> Dehydration
—> Hypotension
—> thrombosis/embolism

Potassium depletion!! Hypokalemia
Hyperuricemia (may lead to gout)
Hyperglycemia

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22
Q

What levels of potassium are considered hypokalemic?

A

Below the normal range of 3.5-5mmol/L

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23
Q

How is Hypokalemia treated?

A

-Treated with K supplements or K-sparing diuretic

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24
Q

Hypokalemia symptoms?

A

irregular heartbeat
-Potentially fatal dysrhythmias
Muscle weakness/lethargy
Leg cramps
GI disturbances (constipation)

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25
Q

How does Furosemide interact with Digoxin?

A

Patients need to be monitored for hypokalemia
Increased digoxin toxicity
Increases hypokalemia with other diuretics, glucosteroids

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26
Q

How does furosemide interact with aminoglycosides?

A

Ototoxicity

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27
Q

How does Furosemide interact with lithium?

A

May increase the effects of lithium
-Used for bipolar

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28
Q

How does furosemide interact with antidiabetic drugs?

A

May decrease hypoglycemic effect and cause hyperglycemia

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29
Q

Where in the nephron do Thiazide/Thiazide-like diuretics take place?

A

Distal convoluted tubule

30
Q

What is the mechanism of action of Thiazide diuretics?

A

Inhibit reabsorption of sodium and chloride ions which results in excretion of water, sodium and chloride
(reduced blood volume)

31
Q

What do Thiazides have that is different from loop diuretics?

A

Different protein targets

32
Q

Which diuretics are more powerful, loop or thiazide?

A

Loop diuretics are MORE powerful

33
Q

Thiazide diuretics are also know as?

A

‘Low ceiling’ diuretics

34
Q

Examples of thiazide/thiazide-like diuretics?

A

Hydrochlorothiazide
Chlorthalidone
metolazone

35
Q

How is Hydrochlorothiazide administered?

A

PO

36
Q

What are thiazide diuretics used for?

A

Hypertension
-First-line treatment
-single or combo therapy

Edematous states
-Adjunct agents in the treatment of HF, hepatic cirrhosis

37
Q

What adverse effects are associated with Thiazide Diuretics?

A

Hypokalemia
Hyperuricemia
Hyperglycemia (inhibits insulin secretion)
Impotence (erectile dysfunction)

38
Q

How do Thiazide diuretics interact with Digoxin?

A

Increased risk or toxicity due to hypokalemia (same as loop)

39
Q

How do Thiazide diuretics interact with anti-diabetic drugs?

A

Reduces hypoglycemic effect, so may lead to hyperglycemia

40
Q

Where in the nephron do Potassium-sparing diuretics take place?

A

Collecting tubules

41
Q

Why do Pottasium-sparing diuretics have limited effectiveness when used on their own?

A

Collecting tubule site of action only accounts for 1-2% of Na reabsorption

42
Q

Examples of Potassium-sparing diuretics?

A

Spironolactone (Aldactone)
Amiloride (midamor)
Triamterene (available only in combination with
hydrochlorothiazide - Riva-Zide)

43
Q

What does Spironolactone (aldactone) block?

A

Aldosterone receptors

44
Q

What do Amiloride (midamor) and Triamterene block?

A

Na channels

45
Q

When is the onset of Spironolactone?

A

Onset: 24-48 hours

46
Q

When is the peak of Spironolactone?

A

2-3 days

47
Q

What is the mechanism of action of Spironolactone?

A

Antagonist at aldosterone receptors
-Blocks the reabsorption of sodium and water usually induced by aldosterone

Reduces sodium-potassium exchange
-Body retains potassium

48
Q

What is Spironolactone used for?

A

Edema associated with heart failure
Hypertension
Reversing the potassium loss caused by potassium-losing drugs (combination therapy)
Hyperaldosteronism

49
Q

What adverse effects are associated with spironolactone?

A

Hyperkalemia
-Above 3.5-5mmol/L
Sex-hormone like effects

50
Q

Hyperkalemia symptoms?

A

Cardiac dysrhythmias (tachycardia)
Muscle weakness
Gi disturbances (Cramps, nausea, vomiting, diarrhea)

51
Q

What sex hormone like effects do Spironolactone cause?

A

Amenorrhea (absence of menstruation)
Irregular menses
Postmenopausal bleeding
Gynecomastia (increase breast tissue in males)

52
Q

What drugs do potassium-sparing drugs have interactions with?

A

Other heart failure drugs that increase plasma K+
RAAS drugs e.g, ACE inhibitors
Potassium supplements

53
Q

When should a patient take diuretics?

A

In the morning to avoid interference with sleep patterns

54
Q

What should a nurse monitor in a patient on diuretics?

A

Serum potassium levels during therapy

55
Q

What should a nurse teach a patient who is on diuretics?

A

Eat more potassium-rich foods when taking loop or thiazide diuretics

56
Q

What are some foods high in potassium?

A

Bananas
Oranges
Raisins
Plums
Fresh vegetables
Legumes
Potatoes

57
Q

What should a nurse monitor in a patient who is taking diuretics and digoxin?

A

Digoxin toxcitity

58
Q

Symptoms of digoxin toxcity?

A

Fatigue
GI problems
Changes in heart rate/rhythm
Loss of appetite (anorexia)
Visual disturbances

59
Q

What should diabetic patients who are taking thiazide and/or loop diuretics monitor?

A

Monitor blood glucose and watch for elevated glucose levels

60
Q

Patients should notify a physician if they experience what while taking diuretics?

A

Rapid heart rate or syncope (reflects hypotension and fluid loss)
Rapid weight loss

61
Q

What should the nurse teach the patient to do to prevent dizziness and possible fainting related to orthostatic hypotension?

A

Change positions slowly and to rise slowing after sitting or lying down

62
Q

What kind of therapeutic effects should a nurse monitor for?

A

Reduction in edema, fluid volume overload, Heart failure
Reduction of hypertension; ICP

63
Q

What is a kind of osmotic diuretic?

A

IV mannitol

64
Q

What is the mechanism of action of IV mannitol?

A

Produces an osmotic force in nephron fluid
(Not reabsorbed)
Inhibits tubular reabsorption of H2O, producing a RAPID diuresis

65
Q

Where in the nephron does IV mannitol take place?

A

Proximal tubule

66
Q

How does IV mannitol affect electrolytes?

A

Causes only slight loss of electrolytes

67
Q

What are osmotic diuretics used for?

A

Early ARF (acute renal failure)
-keeps fluid moving
Non-renal treatments

68
Q

What non-renal treatments are osmotic diuretics used for?

A

Reduction of intracranial pressure (ICP)
Cerebral edema (Fluid from brain entering blood)
Reduces excessive intraocular pressure

69
Q

Osmotic diuretics are contraindicated for patients who?

A

Have a known drug allergy
Severe kidney disease
Pulmonary edema (loop diuretics instead, greater fluid reduction)
Active intracranial bleeding

70
Q

What adverse effects are associated with osmotic diuretics?

A

Convulsions
Thrombophelbitis
Pulmonary congestion
Headaches, nausea, vomiting, chest pain, tachycardia, blurred vision, chills and fever

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (31 decks)

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