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Diuretic Therapy Flashcards

1
Q

What are the functions of the kidneys

A

Regulate COLUME and make ECF, EXCRETE waste, ERYTHROPOLETIN, ACTIVATE Vit D, ACID-BASE balance, control BP

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2
Q

What are diuretics

A

Drugs that increase the output of urine

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3
Q

What are the primary uses for diuretics

A

Treat HYPERTENSION, move EDEMA out

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4
Q

What are the mechanisms of action

A

BLOCK dosium and chloride resbsorption, INCREASE osmotic pressure within the nephron, Prevent PASSIVE reabsorption of water

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5
Q

The higher the drug works does it pull off water better or worse

A

Better

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6
Q

Which drugs produce the greatest amount of diuresis

A

Drugs that BLOCK more solutes (sodium and chloride) reabsorption

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7
Q

T/F solutes in the nephron become progressively smaller as flow progresses from the proximal tubule to the collecting ducts

A

True

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8
Q

What produces the greatest diuresis

A

The proximal tubule

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9
Q

Do diuretics interfere with normal kidney function

A

Yes

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10
Q

What are the primary adverse effects of diuretics

A

HYPOVOLEMIA, ACID-BASE imbalance, altered ELECTROLYTE levels

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11
Q

How can you minimize the adverse effects of dieuretics

A

Use SHORT-acting diuretics, TIMING drug administration (promotes return of normal kidney FUNCATION between doses)

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12
Q

What are the different classifications of diuretics

A

LOOP, THIAZIDE, POTASSIUM-sparing, OTHER

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13
Q

What are the two types under potassium-sparing diuretics

A

non/aldosterone antagonists

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14
Q

What are the most frequently prescribed loop diuretic

A

Furosemide (lasix)

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15
Q

What is the mechanism of action of furosemide

A

Acts on the ASCENDING LOOP of henle to BLOCK reabsorption of SODIUM and CHLORIDE

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16
Q

What are the two routes of administration for furosemide

A

PO and IV

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17
Q

How long does furosemide PO work for

A

Begins in 60 mins lasts to 8 hours

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18
Q

How long does furosemide IV work for

A

Push over 2 mins, begining in 5 mins, lasts for 2 hours

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19
Q

How often would you take furosemide if you had CHF

A

Daily

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20
Q

How often would you take furosemide if you had edema from a flight

A

Once

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21
Q

What conditions require mobilization of fluid

A

Pulmonary edema (CHF), edematous states (liver, heart, or renal disease)

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22
Q

Why is furosemide useful in patients with renal impariment

A

Promotes diuresis even when renal blood flow and GFR are poor

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23
Q

What are the adverse effects of furosemide

A

Ototoxicity (push IV slowly), hyponatremia/kalemia/chloremia/magnesium (electrolyte imbalance), dehydration, hypotension, can elevate blood sugar

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24
Q

What should diabeteic who take furosemide do

A

Check sugar as it can rise

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25
What should you tell your pt to eat to prevent low K
Bananas, OJ, potatoe skins, almonds, spinach
26
What are the drug interactions of furosemide (6)
digoxin, ototoxic drugs, potassium-sparing diuretics, lithium toxicity, antihypertensive agents, NSAIDs
27
What do thiazides do
INCREASE renal EXCRETION of sodium, chloride, potassium, and water, ELEVATE levels of URIC acid and blood GLUCOSE
28
How does the max diuresis of thiazide compare to loop diuretics
Lower, acts on the distal convoluted tubule
29
When are thiazides not effective
When urine flow is poor
30
What is the most common thiazides diuretic
Hydrochlorothiazise (HCTZ) (hydroDIURIL) (microzide)
31
What is HCTZ used for
Treatment of hypertension
32
What is the mechanism of action of HCTZ
BLOCKS reabsorption of sodium and chloride in the DISTAL convoluted tubule
33
What is the route of administration for HCTZ
PO
34
How long does HCTZ work for
Begins in 2 hours, peak 4-6 hours, lasts up to 12 hours
35
What is the metabolism of HCTZ
Excreted unchanged in the urine
36
What are the therapeutic uses of HCTZ
Hypertension, edema (mild heart failure), diabetes insipidus (reduces urine production)
37
What are the adverse effects of HCTZ
HYPO electrolytes, dehydrratino, HYPERglycemia/uricemia, pregnancy
38
What are the drug interactions of HCTZ
Digoxin, lithium, NSAIDs, antihyperansive agents
39
What is the interaction between digoxin and HCTZ
Increased risk of digoxin toxicity by promoting POTASSIUM loss
40
What is the interaction between lithium and HCTZ
Reuce excretion of lithium by promoting SODIUM loss
41
What is the interaction between NSAIDs and HCTZ
can lessen diuretic effects
42
What is the interaction between antihypertensize agents and HCTZ
Both lower BP
43
What are the useful responses to potassium-sparing diuretics
Modest increase in URINE production, substantial decrase in POTASSIUM excretion
44
How are potassium-sparing diuretics administered
PO
45
What is the metabolism of potassium-sparing diuretics
metabolized in the LIVER excreted in the URINE
46
What is the common aldosterone antagonist drug
Spironolactone (Aldactone)
47
What is the derivative of spironolactone
Steroids
48
How long does spironolactone work
Beginins in 24-48 hours, last for 48-72 hours
49
What is the common nonaldosterone antagonists drug
Triamterene (Dyrenium)
50
How long does triamterene work for
Begins in 2-4 hours, lasts 12-16 hours
51
What is the mechanism of action of spironolactone (Aldactone)
BLOCKS aldosterone in the distal nephron, retension of POTASSIUM, increase EXCRETION of sodium and water
52
What are the therapeutic uses of spironolactone (Aldactone)
Hypertension, edema, heart failure, primary hyperaldosteronism
53
What are the adverse effects of spironolactone (Aldactone)
HYPERkalemia, benign adenoma of the thyroid and tests, ENDOCRINE effects (steroid derivative)
54
What are some of the endocrine effects of spironolactone (Aldactone)
Gynecomastia (breats in guys), menstrual irregularities, impotence
55
What are the drug interactions of spironolactone (Aldactone)
Thiazide and loop diuretics, agents that raise potassium levels
56
What does triamterene (Dyrenium) do
Disrupts sodium-potassium exchange in the DISTAL tubule. INHIBITS sodium reabsorption, REDUCES potassium excretion
57
Does triamterene (Dyrenium) act faster than spironolactone
Yes
58
Does triamterene (Dyrenium) have steroids in it
No
59
What is the common osmotic diuretic drug
Mannitol (Osmitrol)
60
What is mannitol (osmitrol)
A simple 6-carbon sugar
61
How does mannitol (osmitrol) work
Promotes diuresis by creating osmotic force within lumen of the nephron, blocks sodium and water reabsorption
62
What is the primary use of mannitol (osmitrol)
Reduce intracranial pressure
63
What is the route of administration for mannitol (osmitrol)
IV, may crystalize
64
How long does mannitol (osmitrol) work
Begins in 60 mins, lasts 6-8 hours
65
What is the metabolism of mannitol (osmitrol)
Undergoes MINIMAL metabolism, excreted intact in the urine
66
Does mannitol (osmitrol) make you pee alot
Yes
67
What are the adverse effects of mannitol (osmitrol)
Edema (elsewhere), headache, vomiting, cluid and elctrolyte imbalance
68
What should you assess before giving diuretics
Weight, cliud volume status, serum elctrolytes, vital signs
69
What should you evaluate for when giving diuretics
Current med list for potential drug interactions
70
What are the teaching implications of diuretics
Take in AM to avoid SLEEP disruption, FOODS to or not to eat, monitor cluid volume status, risk for FALLS, ADVERSE effects
71
Is it bad if your pt gains 2lbs in a day
Yes
72
What level of education should you teach at
5th grade

Pathopharm (19 decks)

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