Diuretics

Question 1

What are the classes of diuretics?

Answer 1

Thiazides
Loop
Potassium sparing
Osmotic

The Lake Poured Out

Question 2

Osmotic diuretics increase urine flow with _____ salt excretion.

Answer 2

low

Question 3

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

Answer 3

expansion

Question 4

Mechanism of action for osmotic diuretics.

Answer 4

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

Question 5

Osmotic diuretics increases the excretion of which electrolytes?

Answer 5

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

Question 6

Name a osmotic diuretic agent

Answer 6

Mannitol

Question 7

Which osmotic diuretics are IV?

Answer 7

Mannitol

Question 8

When is mannitol most commonly used?

Answer 8

Used in patients with acute kidney failure to reduce:

• Reduce elevated intracranial pressure
• Reduce elevated intraocular pressure

Question 9

What is the first line diuretic (and antihypertensive)?

Answer 9

Hycholorothiazide

Question 10

What are the loop diuretic agents?

Answer 10

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

Question 11

For what conditions are loop diuretics commonly used?

Answer 11

edema
hypercalcemia
HTN unresponsive to thiazides
renal failure

Question 12

Mechanism/site of action of loop diuretics

Answer 12

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

Question 13

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

Answer 13

Potaasium excretion (causes hypokalcemia)

Question 14

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

Answer 14

Ca and Mg (hypocalcemia and hypomagnesemia)

Question 15

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

Answer 15

Renin secretion is not suppressed

Question 16

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

Answer 16

GFR is not reduced

Question 17

What are the adverse effects with loop diuretics?

Answer 17

• Dehydration
• Electrolyte abnormalities
• Hypotension
• Ototoxicity
• Hyperuricemia

Question 18

Which loop diuretic agent is most common cause of ototoxicity?

Answer 18

ethacrynic acid

Question 19

What condition can be revealed by loop diuretics and thiazides?

Answer 19

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

Question 20

Loop diuretics cause ____ diuresis.

Answer 20

high/potent

Question 21

What are the K sparing diuretic agents?

Answer 21

Spironolactone
Eplerenone
Triamterene
Amiloride

Question 22

In what conditions are K sparing diuretics used?

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

more

Question 25

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

Answer 25

are not

Question 26

K sparing diuretics are most effective when combined with _______ \_\_\_\_\_\_\_\_.

Answer 26

other diuretics

Question 27

What are some nursing considerations for diuretics?

Answer 27

* 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)

Question 28

What are adverse effects of thializide?

Answer 28

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

Question 29

Mechanism of action for spironolactone

Answer 29

* 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

Question 30

Function of aldosterone

Answer 30

Aldosterone typically causes sodium retention and potassium excretion

Question 31

Therapeutic effects of Potassium-sparing diuretics

Answer 31

* Provide small diuresis (small urine production) * Decreased potassium excretion * Reduce cardiac remodeling

Question 32

Adverse effects of spironolactone

Answer 32

* Hyperkalemia * Endocrine effects like gynecomastia

Question 33

What drugs should not be paired with spironolactone?

Answer 33

* ACE inhibitors * Angiotensin 2 receptor blockers (ARBs)

Question 34

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

Answer 34

* Loop diuretics * Thializide diuretics

Question 35

What conditions could spironolactone treat?

Answer 35

* Hypertension * Edema * Heart Failure * Acne * PCOS

Question 36

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

Answer 36

Aldosterone anatagonist

Question 37

Name the non-aldosterone antagonist

Answer 37

* Amiloride (Amelia-rider) * Triamterene (Tri-athlete)

Question 38

Function of Amiloride and Triamterene

Answer 38

* Given orally * Direct inhibitor of the Na/K ion exchange transporter

Question 39

What conditions amiloride and triamterene could treat?

Answer 39

* Hypertension * Edema

Question 40

Common drug -to-drug interactions with Loop diuretics

Answer 40

* Digoxin * Ototoxic drugs * Potassium-sparing diuretics * Lithium * Anti-hypertensive drugs * NSAIDs

Question 41

Adverse effects of amiloride and triamterene

Answer 41

* Hyperkalemia

Question 42

Common drug to drug interactions with thiazide diuretics

Answer 42

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

Question 43

Mechanism of action for thializide

Answer 43

* Hypertension * Edema * Diabetes inspidus