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Pharm II > Diuretic Medications-MJ > Flashcards

Diuretic Medications-MJ Flashcards

1
Q

What is the major mechanism by which most all diuretics work?

A

They make you pee because they cause the kidney to excrete more Na (and water allows follows Na)

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2
Q

What are the indications for taking a diuretic?

A

Hypertension

Edema (HF, cirrhosis, kidney disease)

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3
Q

What are the 4 types of diuretics?

A

Loop
Thiazide
Potassium Sparing
Osmotic

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4
Q

What are the shared adverse effects of loop, thiazide, and potassium sparing diuretics?

A

Dehydration
Electrolyte imbalance
Muscle cramping

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5
Q

What is the site of action for the loop diuretics?

A

Loop of Henle

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6
Q

What is the MOA of loop diuretics?

A

Acts to block reabsorption of Na and Cl which prevents passive reabsorption of water

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7
Q

What is the name of the drug that is the loop diuretic?

A

Furosemide

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8
Q

How can furosemide (loop diuretic) be administered? Is this a weak or powerful diuretic?

A

PO or IVP; it is the MOST powerful diuretic!!

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9
Q

Furosemide (loop diuretic) is effective even if the patient has a decreased ____.

A

GFR; so furosemide is still going to work even if there is decreased blood flow to the kidneys

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10
Q

What kind of problems is furosemide (loop diuretic) generally reserved for: acute or chronic?

A

Acute

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11
Q

What are the 4 adverse effects of furosemide (loop diuretic)?

A
  • Dehydration (hyponatremia)
  • Hypokalemia–can lead to arrhythmias
  • Hypomagnesemia–effects cardiac rhythms
  • Ototoxicity (transient)
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12
Q

If a patient is on furosemide (loop), can we give another drug that has ototoxic effects?

A

NO!

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13
Q

What is an example of another drug class that has ototoxic effects?

A

Aminoglycosides

Ex: Gentemycin

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14
Q

If a patient is taking furosemide (loop diuretic), and they start to experience ototoxic effects, what effects may be presented and why?

A

They could be experiencing tinnitus or hearing loss (this is not permanent). They could have this because the higher the dose, the higher the risk of getting the ototoxicity effects OR these effects can occur by administering furosemide IVP too quickly.

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15
Q

Since furosemide has an adverse effect of hypokalemia, we need to teach the patient that they should try and eat foods rich in potassium..What are some examples of potassium rich foods?

A

Dried fruits, nuts, spinach, potatoes (most K rich food), bananas

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16
Q

What are the electrolyte changes when taking a loop diuretic?

A 
HYPOkalemia
HYPOchloremia
HYPOnatremia
HYPERglycemia
HYPOmagnesmia
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17
Q

What is the site of action for thiazide diuretics?

A

Early in the distal convoluted tubule

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18
Q

What is the MOA of thiazide diuretics?

A

Acts to block reabsorption of Na and Cl, which increases flow of urine

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19
Q

Thiazide diuretics are similar to loop diuretics, but max. dosage is ____ than loop diuretics

A

Lower

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20
Q

What is the name of the drug that is a thiazide diuretic?

A

Hydrochlorothiazide (HCTZ)

21
Q

How can HCTZ (thiazide diuretic) be administered?

A

PO only

22
Q

What ACE inhibitor is HCTZ combined with a lot?

A

Lisinopril

23
Q

HCTZ (thiazide diuretic) is often the drug of choice for _____.

A

Hypertension

24
Q

What 3 things does HCTZ increase?

A

Calcium
Glucose
Uric Acid

25
Q

If your patient is diabetic, should they take a thiazide diuretic like HCTZ since HCTZ increases glucose levels?

A

They can still take the diuretic, we just need to monitor their glucose or do patient education and tell them why they would need to keep an eye on their levels

26
Q

If your patient has gout, should they take a diuretic like HCTZ?

A

Its not the best option for those with gout since it increases uric acid levels

27
Q

HCTZ increases calcium. Is this a good or bad thing?

A

Depends; can be good for patients with osteoporosis, but would be bad for patients with kidney stones

28
Q

What are the adverse effects of HCTZ (thiazide diuretic)

A 
HYPOkalemia
HYPOnatremia
HYPOchloremia
HYPERuricemia
HYPERglycemia
29
Q

What site of action for potassium sparing diuretics?

A

Works on the late distal convoluted tubule

30
Q

Potassium sparing diuretics are ____ given alone.

A

Rarely; they are often combined with loop or thiazide

31
Q

Why are potassium sparing diuretics often combined with loop or thiazide diuretics?

A

To counteract potassium loss (since loop and thiazide have the effects of HYPOkalemia and potassium sparing “spares” potassium)

32
Q

Potassium sparing drugs have a ____ in potassium excretion.

A

Decrease!

33
Q

What is the name of the drug that is a potassium sparing diuretic?

A

Spironolactone

34
Q

How can spironolactone be administered?

A

PO only!

35
Q

What are the adverse effects of spironolactone (potassium sparing diuretic)

A
  • HYPERkalemia
  • Gynecomastia
  • Menstrual irregularities
  • Impotence
36
Q

What is the name of the only osmotic diuretic drug that is available?

A

Mannitol

37
Q

Mannitol is filtered by the _____, however it undergoes minimal reabsorption. Most of the filtered drug remains in the nephron, creating osmotic force that inhibits _____ of water.

A

Glomerulus; passive reabsorption

38
Q

What is the site of action for the osmotic diuretic?

A

Works at the beginning of the nephron

39
Q

How is mannitol (osmotic diuretic) administered?

A

IV and it must be kept warm so it won’t start to crystalize!

40
Q

Why is mannitol given?

A

It is given when a patient has cerebral edema, which is increased inter cranial pressure because mannitol decreases the pressure

41
Q

Why can’t potassium sparing drugs be given with an ACE inhibitor?

A

ACE inhibitors have an adverse effect of HYPERkalemia. Potassium sparing drugs “spare” potassium, so it basically doubles the risk for HYPERkalemia

42
Q

What is the normal range for serum potassium?

A

3.5-5 mEq/L

43
Q

If our patient is on a loop diuretic (furosemide), should we teach them to eat more potassium rich foods or avoid them?

A

Eat more potassium rich foods since furosemide has an adverse effect of HYPOkalemia

44
Q

If our patient is on a thiazide diuretic (HCTZ), should we teach them to eat more potassium rich foods or avoid them?

A

Eat more potassium rich foods since HCTZ has an adverse effect of HYPOkalemia

45
Q

If our patient is on taking spironolactone, should we teach them to eat more potassium rich foods or avoid them?

A

AVOID THEM! This drugs spares K and decreases the rate it is excreted. Avoid potassium rich foods! Avoid potassium supplements! Avoid salt substitutes!

46
Q

How should we educate our client in regards to the best time of the day they should be taking their diuretic?

A

Early in the day (not after 5 pm)

47
Q

What happens if the patient takes a diuretic too late in the day?

A

Nightime diuresis (notcuria) will occur. aka they will be up all night peeing

48
Q

If the diuretic is to be taking BID, what are the recommended times to take the medicine?

A

8am and 2pm; the effects last 6-8 hours after dosing

49
Q

Why is mannitol (osmotic diuretic) good for clients with head injuries?

A

Mannitol reduces ICP that has been elevated by cerebral edema; its presence in the blood vessels of the brain creates an osmotic force that draws fluid OUT of the brain and into the blood

Pharm II (37 decks)

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