Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Study cards 2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Diuretic Drugs

A

Accelerate the rate of urine formation

Removal of sodium and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mainstay of therapy for the treatment and prevention of

A

Hypertension & heart failure

Prevention of kidney damage during acute kidney injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sodium pathophysiology in the nephron

A

In the nephron, where sodium goes, water follows.

-60 to 70% of sodium and water is returned to the bloodstream by the proximal convoluted tubule.

-20 to 25% of all sodium is reabsorbed into the bloodstream in the ascending loop of Henle.

-5 to 10% is reabsorbed in the distal convoluted tubule.

-Collecting duct is the final common pathway for the filtrate that started in the glomerulus.

-If water is not absorbed, it is excreted as urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The Nephron & Diuretic’s sites of action

A

Afferent and efferent arterioles
Glomerulus
Proximal CT (Mannitol) (Acetazolamide)
Descending Loop (Mannitol)
Ascending Loop (Furosemide)
Distal CT (Thiazide) (Potassium sparring)
Collecting duct (Potassium sparring)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the 5 Diuretics and their important medications

A

Carbonic anhydrase inhibitors (Canada primary use is for glaucoma)
-acetazolamide

Loop diuretics
-furosemide
-bumetanide
-ethacrynic acid

Osmotic diuretics
-mannitol (Osmitrol®)
-Urea
-Organic acids
-Glucose

Potassium-sparing diuretics
-amiloride (Midamor®)
-spironolactone (Aldactone®)
-triamterene
-triamterene in combination with hydrochlorothiazide

Thiazide and thiazide-like diuretics
-Thiazide diuretics
~hydrochlorothiazide (Urozide®)
-Thiazide-like diuretics
~metolazone (Zaroxolyn®)
~chlorthalidone
~indapamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

acetazolamide (Acetazolam®)

  1. Drug class
  2. Benefit
A

Carbonic Anhydrase Inhibitor

Oral and parenteral forms

Potential benefits may warrant use in pregnant women despite potential fetal risks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Carbonic Anhydrase Inhibitors: Mechanism of Action

  1. Enzyme carbonic anhydrase:
  2. Carbonic anhydrase inhibitors:
A

Proximal tubules

For NA and water to be reabsorbed in blood, hydrogen must be exchanged for it. Without H, this process cannot occur (NA and water will be excreted)

Enzyme carbonic anhydrase: helps to make H+ ions available for exchange with sodium and water in the proximal tubules.

Carbonic anhydrase inhibitors: block the action of carbonic anhydrase, thus preventing the exchange of H+ ions with SODIUM and WATER.

Inhibition of carbonic anhydrase reduces H+ ion concentration in renal tubules.

As a result, there is increased excretion of bicarbonate, sodium, water, and potassium. (CAIs reduce formation of H and bicarbonate)

Resorption of water is decreased, and urine volume is increased.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Carbonic Anhydrase Inhibitors: Indications

  1. Adjunct for?
  2. Used with ____ to…
  3. Treatment of (3)
A

Adjunct drugs for: Open-angle glaucoma and secondary glaucoma (to increase outflow of aqueous humour)

Used with miotics to lower intraocular pressure before ocular surgery

Treatment of: Edema, secondary to heart failure & High-altitude sickness & Epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Carbonic Anhydrase Inhibitors: Contraindications

A

Known drug allergy
Hyponatremia
Hypokalemia
Severe kidney or liver dysfunction
Adrenal gland insufficiency
Cirrhosis

CAIs can increase glucose levels, R & M acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Carbonic Anhydrase Inhibitors: Adverse Effects

A

Acidosis
HYPOkalemia
Drowsiness
Anorexia
Paresthesias
Hematuria
Urticaria
Photosensitivity
Melena (blood in the stool)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Carbonic Anhydrase Inhibitors: Interactions

A

Digoxin toxicity due to hypokalemia

Corticosteroids- cause hypokalemia

Increased effects of amphetamines, carbamazepine, cyclosporine, phenytoin, and quinidine sulphate with concurrent use of carbonic anhydrase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

furosemide (Lasix®)

  1. Class?
  2. Systems it affects
  3. Useful in the treatment of?
  4. CC effect
A

Loop diuretics

Possess kidney, cardiovascular, and metabolic effects

Useful in treatment of edema

Has diuretic action even when CC is less than 25 mL/min (works even if kidney function is diminished)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Loop Diuretics:

3 Mechanism of Actions

A

Act directly on the ascending limb of the loop of Henle to block CHLORIDE and SODIUM resorption

Increase kidney prostaglandins, resulting in the dilation of blood vessels and reduced kidney, pulmonary, and systemic vascular resistance

Reduces preload and central venous pressure (filling PRESSURE of the ventricles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Loop Diuretics: Drug Effects

  1. ONSET, DURATION
  2. Potent ____ and subsequent ____ loss
  3. Decreased fluid volume causes a reduction in? (5)
  4. What electrolytes is decreased by furosemide? (3)
A

Rapid onset; last at least 2 hours

Potent diuresis and subsequent loss of fluid

Decreased fluid volume leads to a decreased return of blood to heart, and causes a reduction in:

Blood pressure
Pulmonary vascular resistance
Systemic vascular resistance
Central venous pressure
Left ventricular end-diastolic pressure

Potassium and sodium depletion

Small calcium loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Loop Diuretics: Indications

A

EDEMA associated with heart failure and liver or kidney disease

HTN (to control)

Kidney excretion of calcium in patients with HYPERCALCEMIA (to increase excretion)

(HF) Heart failure resulting from diastolic dysfunction

Liver cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Loop Diuretics: Adverse Effects

A

Central nervous system: Dizziness, headache, tinnitus, blurred vision

Gastrointestinal: Nausea, vomiting, diarrhea

Hematological: Agranulocytosis, neutropenia, thrombocytopenia

Metabolic: Hypokalemia (take K supplements), hyperglycemia, hyperuricemia

Treatment of overdose- fluid and electrolyte replacement

Contraindication: sulfa, anuria, hypovolemia, electrolyte depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Loop Diuretics: Interactions

A

Neurotoxic

Nephrotoxic

Increase serum levels of uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase.

thiazide (metolazone): sequential nephron blockade

(NSAIDs) may decrease the reduction of vascular resistance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Loop Diuretics: Furosemide (Lasix)

  1. Used in conditions such as (5)
A

Most commonly used loop diuretic

Uses:

pulmonary edema and the edema associated with heart failure

liver disease

nephrotic syndrome

ascites

hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

mannitol (Osmitrol®)

  1. Class
  2. Works in which part of the nephron?
A

Osmotic Diuretics

Most used osmotic diuretic

Entire nephron, major site of action is proximal tubule and descending limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Osmotic Diuretics: Mechanism of Action

A

Works along entire nephron but mostly in the proximal tubule and descending loop of Henle

Nonabsorbable, producing an osmotic effect (increases osmotic pressure in GF, pulls fluid into renal tubules)

Pull water into the renal tubules from the surrounding tissues

Inhibit tubular resorption of water and solutes, thus producing rapid diuresis

Reduces cellular edema and increases urine production (not for P. edema because it does not promote sufficient NA excretion)

21
Q

Osmotic Diuretics: Drug Effects (3)

A

Increase GFR and renal plasma flow; help to prevent kidney damage during acute kidney injury

Reduce intracranial pressure or cerebral edema associated with head trauma

Reduce excessive intraocular pressure

22
Q

Osmotic Diuretics: Indications

A

Treatment of:

  1. early, oliguric phase of acute kidney injury
  2. cerebral edema

Reduce intracranial pressure

Used as a genitourinary IRRIGANT in the preparation for transurethral surgical procedures

Promote excretion of toxic substances

23
Q

Osmotic Diuretics: Adverse Effects

A

Convulsions
Thrombophlebitis
Pulmonary congestion
Other: headaches, chest pains, tachycardia, blurred vision, chills, and fever

24
Q

Mannitol (Osmitrol)

  1. Class
  2. Form
  3. Storing instructions and why?
  4. What is needed in its preparation?
A

Osmotic diuretics

IV only

May crystallize when exposed to low temperatures. Therefore, vials are often stored in a warmer.

Use of a filter is required.

25
Q

spironolactone (Aldactone®)

  1. Class
  2. Also called?
A

Potassium-Sparing Diuretics

Aldosterone-inhibiting diuretics (competes with aldosterone)

Used in children HF

26
Q

Potassium-Sparing Diuretics: Mechanism of Action

A

Work in collecting ducts and distal convoluted tubules

Interfere with sodium–potassium exchange

Competitively bind to aldosterone receptors

Block resorption of sodium and water usually induced by aldosterone secretion

27
Q

Potassium-Sparing Diuretics: Drug Effects

A

Relatively WEAK compared with the thiazide and loop diuretics

Competitively BLOCK aldosterone receptors and INHIBIT their action

Promote the EXCRETION of sodium and water

28
Q

Potassium-Sparing Diuretics:

Indication of spironolactone and triamterene

Indication of amiloride

A

Hyperaldosteronism
Hypertension
Reversing potassium loss caused by potassium-wasting diuretics
Certain cases of heart failure: prevention of remodelling

amiloride- smiliar to spironolactone and triamterene but less effective long term

29
Q

Potassium-Sparing Diuretics: Adverse Effects

A

Central nervous system: Dizziness, headache

Gastrointestinal: Cramps, nausea, vomiting, diarrhea

Other: Urinary frequency,weakness, hyperkalemia

30
Q

spironolactone (Aldactone®) ADVERSE EFFECTS

A

Gynecomastia
Amenorrhea
Irregular menses
Postmenopausal bleeding

Treats ascites in high doses (liver cirrhosis)

Monitor K- hyoerkalemia is common

31
Q

Potassium-Sparing Diuretics: Interactions

A

Lithium
Angiotensin-converting enzyme inhibitors
Potassium supplements
NSAIDs

Contraindication: hyperkalemia (K greater than 5.5)

32
Q

hydrochlorothiazide (Urozide®)

A

Thiazide diuretics

Ceiling effect

Used in pregnancy

33
Q

Thiazide and Thiazide-Like Diuretics: Mechanism of Action

A

Inhibit tubular resorption of sodium, chloride, and potassium ions

Action primarily in the distal convoluted tubule

Result in osmotic water loss

Dilate the arterioles by direct relaxation, which reduces PVR

Decrease preload and afterload

34
Q

Thiazides should not be used if creatinine clearance is _____________________

(normal is 125 mL/min).

A

is less than 30 to 50 mL/min (normal is 125 mL/min)

As idney function decreases, efficacy of thiazides diminishes

DRUG: Metolazone remains effective to a creatinine clearance of 10 mL/min.

35
Q

Thiazide and Thiazide-Like Diuretics: Indications

A

Hypertension (one of the most prescribed group of drugs for this)
Edematous states
Idiopathic hypercalciuria
Diabetes insipidus
Heart failure caused by diastolic dysfunction

36
Q

Thiazide and Thiazide-Like Diuretics: Adverse Effects

A

Central nervous: Dizziness, headache, blurred vision

Gastrointestinal: Anorexia, nausea, vomiting, diarrhea

Genitourinary: Erectile dysfunction

Hematological: Jaundice, leukopenia, agranulocytosis

Integumentary: Urticaria, photosensitivity

Metabolic: Hypokalemia, glycosuria, hyperglycemia, hyperuricemia, hypochloremic alkalosis

37
Q

Nursing Implications

A

Assess baseline fluid volume status, intake and output, serum electrolyte values, weight, and vital signs (especially postural blood pressure).

Assess for disorders that may contraindicate or necessitate cautious use of these drugs.

Instruct patients to take the medication in the MORNING if possible to avoid interference with sleep patterns.

Monitor serum POTASSIUM levels during therapy.

Teach patients to maintain proper nutritional and fluid volume status.

Teach patients to eat more potassium-rich foods when taking any diuretics but the potassium-sparing drugs.

Foods high in potassium include bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes.

Patients taking diuretics along with digoxin should be taught to watch for digoxin toxicity.

Teach patients to change positions slowly and to rise slowly after sitting or lying, to prevent dizziness and fainting related to orthostatic hypotension.

Encourage patients to keep a log of their daily weight.

Instruct patients to notify their primary care provider immediately if they experience rapid heart rates or syncope (reflects hypotension or fluid loss).

Excessive consumption of LICORICE can lead to additive hypokalemia in patients taking thiazides.

38
Q

Signs and symptoms of hypokalemia includes: (6)

A

anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension.

39
Q

Monitor for adverse effects such as when taking diuretics:

A

Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alertness

40
Q

Monitor for _______ with potassium-sparing diuretics.

A

hyperkalemia

41
Q

Monitor for therapeutic effects:

A

Reduction of edema
Reduction of fluid volume overload
Improvement in manifestations of heart failure
Reduction of hypertension
Return to normal intraocular pressures

42
Q

Patients with diabetes mellitus who are taking _____ or ____ diuretics should be told to monitor blood glucose and watch for elevated levels.

A

thiazide or loop

43
Q

Diuretics

A

BP: arteriolar dilation, decreases PVR
reduce ECF, plasma volume, and CO, decreasing BP

diuretics exert their effects on nephrons

GFR- how well the kidneys are functioning as filters
-GFR below 60 for 3 months & GFR above 60 with kidney damage (high albumin levels in urine >chronic kidney disease

60-70%- promical tubule
20-25% - ascending loop of henle
5-10%-distal tubule (aldosterone selectively filters sodium in exchange to K and H ions)

Collecting duct: where ADH acts to increase absorption of water back into the bloodstream, prevents diuresis)

Potency-LOOP, osmotic, thiazide like, thiazide, K sparring
-the more water and sodium they stop from resorption, the greater the potency

Drug interactions with Sulfonamidse- CAIs (acetazolamide, furosemide, thiazide)

44
Q

Normal K levels

A

3.5 to 5

45
Q

Loop diuretics: possible interaction

Lab s to monito when taking loop and thiazide diuretics?

  1. Pt taking K sparring diuretic, what is a concern?
  2. Teaching for a pt taking spironolactone?
  3. PT with diabetes has a new order for thiazide diuretic
  4. Loop diuretic
  5. Effects of loop diuretic and aminoglycosides
A
  1. NSAIDS
  2. Decrease K levels
  3. Serum K level of 5.8
  4. avoid foods high in K
  5. Monitor BG because thiazide diuretic may cause the levels to increase
  6. Take the diuretic same time each am, position changes slowly due to dizziness, call doctor if you have muscle weakness/ increased dizziness
  7. Ototoxcity
46
Q

Aldosterone

A

Aldosterone’s primary function is to act on the late distal tubule and collecting duct of nephrons in the kidney, favoring sodium and water reabsorption and potassium excretion while also contributing to acid-base balance.

Aldosterone is a mineralocorticoid hormone primarily responsible for the renal regulation of sodium balance. Aldosterone binds mineralocorticoid receptors (MR) stimulating sodium reabsorption and potassium excretion by the renal tubules.

47
Q

ADH

A

Antidiuretic hormone (ADH) is a chemical produced in the brain that causes the kidneys to release less water, decreasing the amount of urine produced.

48
Q

ADH

A

Antidiuretic hormone (ADH) is a chemical produced in the brain that causes the kidneys to release less water, decreasing the amount of urine produced.

Study cards 2 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions