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Pathopharm > Diuretic Therapy > Flashcards

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
Q

What should you tell your pt to eat to prevent low K

A

Bananas, OJ, potatoe skins, almonds, spinach

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26
Q

What are the drug interactions of furosemide (6)

A

digoxin, ototoxic drugs, potassium-sparing diuretics, lithium toxicity, antihypertensive agents, NSAIDs

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27
Q

What do thiazides do

A

INCREASE renal EXCRETION of sodium, chloride, potassium, and water, ELEVATE levels of URIC acid and blood GLUCOSE

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28
Q

How does the max diuresis of thiazide compare to loop diuretics

A

Lower, acts on the distal convoluted tubule

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29
Q

When are thiazides not effective

A

When urine flow is poor

30
Q

What is the most common thiazides diuretic

A

Hydrochlorothiazise (HCTZ) (hydroDIURIL) (microzide)

31
Q

What is HCTZ used for

A

Treatment of hypertension

32
Q

What is the mechanism of action of HCTZ

A

BLOCKS reabsorption of sodium and chloride in the DISTAL convoluted tubule

33
Q

What is the route of administration for HCTZ

34
Q

How long does HCTZ work for

A

Begins in 2 hours, peak 4-6 hours, lasts up to 12 hours

35
Q

What is the metabolism of HCTZ

A

Excreted unchanged in the urine

36
Q

What are the therapeutic uses of HCTZ

A

Hypertension, edema (mild heart failure), diabetes insipidus (reduces urine production)

37
Q

What are the adverse effects of HCTZ

A

HYPO electrolytes, dehydrratino, HYPERglycemia/uricemia, pregnancy

38
Q

What are the drug interactions of HCTZ

A

Digoxin, lithium, NSAIDs, antihyperansive agents

39
Q

What is the interaction between digoxin and HCTZ

A

Increased risk of digoxin toxicity by promoting POTASSIUM loss

40
Q

What is the interaction between lithium and HCTZ

A

Reuce excretion of lithium by promoting SODIUM loss

41
Q

What is the interaction between NSAIDs and HCTZ

A

can lessen diuretic effects

42
Q

What is the interaction between antihypertensize agents and HCTZ

A

Both lower BP

43
Q

What are the useful responses to potassium-sparing diuretics

A

Modest increase in URINE production, substantial decrase in POTASSIUM excretion

44
Q

How are potassium-sparing diuretics administered

45
Q

What is the metabolism of potassium-sparing diuretics

A

metabolized in the LIVER excreted in the URINE

46
Q

What is the common aldosterone antagonist drug

A

Spironolactone (Aldactone)

47
Q

What is the derivative of spironolactone

48
Q

How long does spironolactone work

A

Beginins in 24-48 hours, last for 48-72 hours

49
Q

What is the common nonaldosterone antagonists drug

A

Triamterene (Dyrenium)

50
Q

How long does triamterene work for

A

Begins in 2-4 hours, lasts 12-16 hours

51
Q

What is the mechanism of action of spironolactone (Aldactone)

A

BLOCKS aldosterone in the distal nephron, retension of POTASSIUM, increase EXCRETION of sodium and water

52
Q

What are the therapeutic uses of spironolactone (Aldactone)

A

Hypertension, edema, heart failure, primary hyperaldosteronism

53
Q

What are the adverse effects of spironolactone (Aldactone)

A

HYPERkalemia, benign adenoma of the thyroid and tests, ENDOCRINE effects (steroid derivative)

54
Q

What are some of the endocrine effects of spironolactone (Aldactone)

A

Gynecomastia (breats in guys), menstrual irregularities, impotence

55
Q

What are the drug interactions of spironolactone (Aldactone)

A

Thiazide and loop diuretics, agents that raise potassium levels

56
Q

What does triamterene (Dyrenium) do

A

Disrupts sodium-potassium exchange in the DISTAL tubule. INHIBITS sodium reabsorption, REDUCES potassium excretion

57
Q

Does triamterene (Dyrenium) act faster than spironolactone

58
Q

Does triamterene (Dyrenium) have steroids in it

59
Q

What is the common osmotic diuretic drug

A

Mannitol (Osmitrol)

60
Q

What is mannitol (osmitrol)

A

A simple 6-carbon sugar

61
Q

How does mannitol (osmitrol) work

A

Promotes diuresis by creating osmotic force within lumen of the nephron, blocks sodium and water reabsorption

62
Q

What is the primary use of mannitol (osmitrol)

A

Reduce intracranial pressure

63
Q

What is the route of administration for mannitol (osmitrol)

A

IV, may crystalize

64
Q

How long does mannitol (osmitrol) work

A

Begins in 60 mins, lasts 6-8 hours

65
Q

What is the metabolism of mannitol (osmitrol)

A

Undergoes MINIMAL metabolism, excreted intact in the urine

66
Q

Does mannitol (osmitrol) make you pee alot

67
Q

What are the adverse effects of mannitol (osmitrol)

A

Edema (elsewhere), headache, vomiting, cluid and elctrolyte imbalance

68
Q

What should you assess before giving diuretics

A

Weight, cliud volume status, serum elctrolytes, vital signs

69
Q

What should you evaluate for when giving diuretics

A

Current med list for potential drug interactions

70
Q

What are the teaching implications of diuretics

A

Take in AM to avoid SLEEP disruption, FOODS to or not to eat, monitor cluid volume status, risk for FALLS, ADVERSE effects

71
Q

Is it bad if your pt gains 2lbs in a day

72
Q

What level of education should you teach at

Pathopharm (19 decks)

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