Diuretics

Question 1

Define diuretic drugs

Answer 1

Drugs that accelerate rate of urine formation

Question 2

Types of Diuretic Drugs

Answer 2

• Carbonic anhydrase inhibitors
  -Loop diuretics
  -Osmotic diuretic
  -Potassium sparing diuretics
  -Thiazide & thiazide-like diuretics

Question 3

What type of diuretic is acetazolamide (Acetazolam)

Answer 3

Carbonic anhydrase inhibitors

Question 4

Acetazolamide indication

Answer 4

Open angle Glaucoma. Adjunct therapy for secondary glaucoma

Question 5

Consideration for use in pregnant women

Answer 5

Talk to prescriber: potential benefits may warrant use in pregnant women despite potential fetal risk

Question 6

Other indications for Acetazolamide

Answer 6

Edema (secondary to HF)
High altitude sickness
Epilepsy

Question 7

Why are miotics used with Acetazolamide

Answer 7

Lower intraocular pressure before ocular surgery

Question 8

Acetazolamide contraindication

Answer 8

-drug allergy
-hyponatremia
-hypokalemia
-severe kidney or liver dysfunction
-adrenal gland insufficiency
-cirrhosis

Question 9

Acetazolamide adverse effects

Answer 9

-acidosis
-hypokalemia
-drowsiness*
-anorexia
-paresthesias
-hematuria
-urticaria
-photosensitivity
-melena (blood in stool)*

Question 10

Acetazolamide interactions

Answer 10

-Digoxin: digoxin toxicity (Acetazolamide causes hypokalemia)
-Corticosteroids: hypokalemia
-Amphetamines, carbamazepine, cyclosporine, phenytoin, quinidine sulphate: additive effects

Question 11

Main loop diuretic drug

Answer 11

Furosemide (Lasix)

Question 12

Primary use of furosemide

Answer 12

Edema

Question 13

Duration of furosemide

Answer 13

At least 2 hr

Question 14

Which drug is a potent diuretic

Answer 14

Furosemide

Question 15

Furosemide indication

Answer 15

-Edema (HF, liver or kidney diseasE)
-Hypertension (management)
-Hypercalcemia
-HF from diastolic dysfunction

Question 16

Furosemide adverse effects

Answer 16

CNS: dizziness, headache, tinnitus, blurred vision
GI: nausea, emesis, diarrhea*
Hematological: agranulocytosis, neutropenia, thrombocytopenia*
Metabolic: hypokalemia, hyperglycaemia*, hyperuricemia

Question 17

Furosemide interaction

Answer 17

Thiazide (metolazone): nephron blockage
NSAIDs: decrease effect

Question 18

Main osmotic diuretic

Answer 18

Mannitol (osmitrol)

Question 19

Mannitol indication

Answer 19

-Treatment in early, oliguric phase of acute kidney injury
-Decrease intracranial pressure
-Cerebral edema
-GI irrigant to prepare for transurethral surgery

Question 20

Mannitol adverse effects

Answer 20

-convulsion
-thrombophlebitis
-pulmonary congestion

Others: headache, chest pain, tachycardia, blurred vision, chills, fever

Question 21

Route used for mannitol

Answer 21

IV infusion only

Question 22

How should mannitol be stored

Answer 22

Stored in a warmer: may crystallize when exposed to low temp

Question 23

How should mannitol be used

Answer 23

With a filter

Question 24

Main potassium-sparing diuretic

Answer 24

Spironolactone (Aldactone)

Question 25

Compare strength of potassium sparing drugs to thiazide & loop diuretics

Answer 25

Potassium sparing drugs are relatively weaker

Question 26

Spironolactone indication

Answer 26

-Hyperaldosteronism -hypertension -reversing potassium loss from other diuretics -HF

Question 27

Potassium sparing diuretics general adverse effects

Answer 27

CNS: dizziness, headache GI: cramps, nausea, emesis, diarrhea Other: urinary frequency, weakness, hyperkalemia

Question 28

Spironolactone adverse effects

Answer 28

-gynecomastia -amenorrhea -irregular menses -postmenopausal bleeding

Question 29

Spironolactone interactions

Answer 29

Lithium, ACE inhibitors, potassium supplements, NSAIDS

Question 30

Main thiazide & thiazide-like drugs

Answer 30

Hydrochlorothiazide (Urozide)

Question 31

Range of creatinine clearance that indicates to not use Hydrochlorothiazide

Answer 31

Should not be less than 30-50 mL/ min (normal: 125 mL/min)

Question 32

Hydrochlorothiazide indication

Answer 32

-hypertension* -edema -idiopathic hypercalciuria -diabetes insipidus -HF

Question 33

Hydrochlorothiazide adverse effects

Answer 33

CNS: dizziness, headache, blurred vision GI: anorexia, nauseam emesis, diarrhea Geni': erectile dysfunction Integ': urticaria, photosensitivity Others: jaundice, leukopeaniy, agranulocytosis, hypokalemia, hyperglycaemia, hyperuricemia

Question 34

What time of day should you take diuretics & why

Answer 34

Morning: prevent inference with sleep patterns

Question 35

Main electrolyte to monitor during therapy

Answer 35

Serum potassium levels

Question 36

Patient education on nutrition for patients taking diuretics (except: potassium sparing drugs)

Answer 36

Potassium rich foods

Question 37

Types of potassium rich foods

Answer 37

Banana, orange, dates, apricots, raisin, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, legumes

Question 38

What to monitor for when taking diuretics with digoxin

Answer 38

Digoxin toxicity

Question 39

What to do if a s/s of digoxin toxicity is presented

Answer 39

-First: monitor for other s/s of digoxin toxicity -contact prescriber

Question 40

Patient education for patients with diabetes who are taking thiazide or loop diuretics

Answer 40

Monitor BCG & watch for hyperglycaemia

Question 41

What tool can you encourage patients to have to monitor their health

Answer 41

Log to monitor their daily weight

Question 42

Patient education on ways to prevent dizziness & fainting from orthostatic hypotension

Answer 42

Move position slowly

Question 43

What s/s indicate need to contact primary care provider

Answer 43

Nausea, emesis, diarrhea: indicates electrolyte imbalance can result

Question 44

S/S of hypokalemia

Answer 44

Anorexia, nausea, lethargy, muscle weakness, altered LOC, hypotension

Question 45

What s/s indicate IMMEDIATE need to contact primary care provider

Answer 45

Rapid HR, syncope: reflects hypotension or fluid loss

Question 46

Patient education on excessive liquorice consumption while taking thiazides

Answer 46

Hypokalemia