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NSG 205 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the classes of diuretics?

A

Thiazides
Loop
Potassium sparing
Osmotic

The Lake Poured Out

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2
Q

Osmotic diuretics increase urine flow with _____ salt excretion.

A

low

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3
Q

Osmotic diuretics can cause an immediate inital ________ of the ECF.

A

expansion

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4
Q

Mechanism of action for osmotic diuretics.

A

Osmotics distribute throughout the ECF and water moves out of the cells down the osmotic gradient. Expansion of ECF increases renal blood flow.

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5
Q

Osmotic diuretics increases the excretion of which electrolytes?

A

All: Na, K, Ca, Mg, Cl, HCO3, PO4

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6
Q

Name a osmotic diuretic agent

A

Mannitol

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7
Q

Which osmotic diuretics are IV?

A

Mannitol

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8
Q

When is mannitol most commonly used?

A

Used in patients with acute kidney failure to reduce:

  • Reduce elevated intracranial pressure
  • Reduce elevated intraocular pressure
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9
Q

What is the first line diuretic (and antihypertensive)?

A

Hycholorothiazide

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10
Q

What are the loop diuretic agents?

A

furosemide (Lasix)
bumetanide (Bumex)
ethacrynic acid (Edecrin)
torsemide (Demadex)

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11
Q

For what conditions are loop diuretics commonly used?

A

edema
hypercalcemia
HTN unresponsive to thiazides
renal failure

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12
Q

Mechanism/site of action of loop diuretics

A

Blockade of the Na and Cl reabsoprtion (uptake) in the ascendling limb of the Loop of Henle

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13
Q

Loop diuretics promote __ _______, potentially to a serious level.

A

Potaasium excretion (causes hypokalcemia)

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14
Q

Along with K, what other electrolytes do loop diuretics promote excretion?

A

Ca and Mg (hypocalcemia and hypomagnesemia)

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15
Q

In the use of loop diuretics, is renin secretion suppressed or not?

A

Renin secretion is not suppressed

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16
Q

In the use of loop diuretics, GFR is/is not reduced.

A

GFR is not reduced

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17
Q

What are the adverse effects with loop diuretics?

A
  • Dehydration
  • Electrolyte abnormalities
  • Hypotension
  • Ototoxicity
  • Hyperuricemia
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18
Q

Which loop diuretic agent is most common cause of ototoxicity?

A

ethacrynic acid

19
Q

What condition can be revealed by loop diuretics and thiazides?

A

gout (hyperuricemia, increase in uric acid worsens gout symptoms)

20
Q

Loop diuretics cause ____ diuresis.

A

high/potent

21
Q

What are the K sparing diuretic agents?

A

Spironolactone
Eplerenone
Triamterene
Amiloride

22
Q

In what conditions are K sparing diuretics used?

A

Hypertension
Congestive heart failure (the heart cannot enough blood that it needs due to plaque hardening in the arteries
ascites (cirrhosis)
hypokalemia

23
Q

How/where do the K sparing diuretics Triamterene and Amiloride work?

A

Triamterene and Amiloride block the Na channel in the late distal tubule and collecting duct.

24
Q

K sparing diuretics are _____ effective than ARBs in African Americans.

A

more

25
Q

Triamterene and Amiloride are/are not dependent on aldosterone levels.

A

are not

26
Q

K sparing diuretics are most effective when combined with _______ ________.

A

other diuretics

27
Q

What are some nursing considerations for diuretics?

A
  • Monitor kidney fucntion by checking creatinine and BUN levels
  • Monitor intake and output
  • Teach patients to take their drug in the morning
  • Check for signs of adverse effects
  • Encourage patient to speak to their doctor about receiving potassium supplements
  • Be cautious with patients with a sulfa allergy (ethacrynic acid is suitable diuretic for patients with a sulfa allergy)
28
Q

What are adverse effects of thializide?

A
  • Electrolyte abnormailities
  • Hyperuricemia (uric acid could deposit in joints of the toe, and cause gout)
  • Hyperglycemia (for patients with diabetes inspidus)
  • Dehydration
29
Q

Mechanism of action for spironolactone

A
  • Given orally
  • Mimics the action of the aldosterone and Blocks aldosterone from binding to receptors in the distal convoluted tubule
  • Increased excretion of sodium (water follows) and retention of potassium
30
Q

Function of aldosterone

A

Aldosterone typically causes sodium retention and potassium excretion

31
Q

Therapeutic effects of Potassium-sparing diuretics

A
  • Provide small diuresis (small urine production)
  • Decreased potassium excretion
  • Reduce cardiac remodeling
32
Q

Adverse effects of spironolactone

A
  • Hyperkalemia
  • Endocrine effects like gynecomastia
33
Q

What drugs should not be paired with spironolactone?

A
  • ACE inhibitors
  • Angiotensin 2 receptor blockers (ARBs)
34
Q

Spironolactone diuretics need to be paired with either a _________ or a _____________.

A
  • Loop diuretics
  • Thializide diuretics
35
Q

What conditions could spironolactone treat?

A
  • Hypertension
  • Edema
  • Heart Failure
  • Acne
  • PCOS
36
Q

What type of K sparing diuretic is spironolactone (spiral notebook)?

A

Aldosterone anatagonist

37
Q

Name the non-aldosterone antagonist

A
  • Amiloride (Amelia-rider)
  • Triamterene (Tri-athlete)
38
Q

Function of Amiloride and Triamterene

A
  • Given orally
  • Direct inhibitor of the Na/K ion exchange transporter
39
Q

What conditions amiloride and triamterene could treat?

A
  • Hypertension
  • Edema
40
Q

Common drug -to-drug interactions with Loop diuretics

A
  • Digoxin
  • Ototoxic drugs
  • Potassium-sparing diuretics
  • Lithium
  • Anti-hypertensive drugs
  • NSAIDs
41
Q

Adverse effects of amiloride and triamterene

A
  • Hyperkalemia
42
Q

Common drug to drug interactions with thiazide diuretics

A
  • Digoxin
  • Potassium-sparing diuretics (desirable or a potential undesirable effect depending on the therapeutic goal)
  • Lithium
  • Anti-hypertensive drugs
  • NSAIDs
43
Q

Mechanism of action for thializide

A
  • Hypertension
  • Edema
  • Diabetes inspidus

NSG 205 (3 decks)

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