Diuretics

Question 1

Diuretics (MOA, Types)

Answer 1

• MOA: decrease blood volume by urinary excretion of water and electrolytes
• decrease arterial resistance
  Types: Thiazide, loop, potassium sparing

Question 2

Thiazide work on what

Answer 2

-Early distal convoluted tubule

Question 3

Furosemide work on what

Answer 3

Thick segmented ascending limb of Henle’s loop

Question 4

Spironolactone

Answer 4

Late distal convoluted tubule and collecting duct

Question 5

Furosemide will have greater effect

Answer 5

• due to higher concentration of solute

Question 6

Loop Diuretics Action

Answer 6

Action: Inhibits reabsorption of Na & Cl at loop of Henle-> resulting in BLOOD VOLUME
Most Effacacious

Question 7

Prototype: loop diuretic

Answer 7

Fuerosimide (LASIX)

Question 8

Pharmacokinetics for Lasix

Answer 8

PO: 1 hour
IV: 5 min

Question 9

SE of Furosemide

Answer 9

• electrolyte imbalances (Na, Cl, K+)
• hypotension, dehydration, postural hypotension
• ototoxicity
• increases risk of digoxin toxicity, lithium toxicity (acts like a salt)
• increases uric acid (gout)

Question 10

Thiazide Diuretic

Answer 10

Action:

1) reduce blood volume
- works on distal tubule
- Results in excretion of H20, Na, K+

2) reduces arterial resistance (over time)

Question 11

Thiazide Prototype:

Answer 11

hydrochlorothiazide (HCTZ)
- onset 2 hours, peak 4-6 hours, last 12 hours
MOST WIDELY USED diuretic

Question 12

HCTZ SE:

Answer 12

• electrolyte imbalances (K+, N, Cl)
• dehydration, hypovolemia
• Hyperglycemia (DM)
• increases uric acid (gout)
• risk for digoxin toxicity and lithium toxicity
• limited by kidney function

Question 13

Potassium sparing diuretics

Answer 13

-Competes with aldosterone at receptors in the distal tubule blocking aldosterone (fluid lost, K remains)

Question 14

Prototype for potassium sparing diuretics

Answer 14

spionolactone (Aldactone)

Question 15

Example of commonly ordered drug:

Answer 15

triamtriane

Question 16

Side Effects: spinolactone

Answer 16

• Risk for hyperkalemia
• Endocrine effects: gynecomastia
• Takes up to 48 hours to work
  NOT A RESCUE DRUG!

Question 17

Nursing considerations for hypokalemia (Thiazide/loop)

Answer 17

• check K levels before admin
• Teach high K+ foods
• Risk for dysrythmias
• Risk for digoxin & lithium toxicity

Question 18

Nursing considerations for hyperkalemia (Potassium sparing)

Answer 18

• check K levels before admin

- Typically, don’t admin. with RAAS drugs, K supplements

Question 19

Nursing considerations for Hydration status

Answer 19

I/O measurements, daily weights

• Risk for dehydration, hypovolemia
• Admin early in the day
• Not safe for pregnancy (Lasix)