Diuretics Flashcards
Pharmacology Exam 1
What is the purpose of Diuretics?
To increase urine output
Increase sodium excretion
Prevent fluid retention
What are the 5 drug types of drugs for diuretics?
Thiazides and Thiazide like Diuretics
Loop Diuretics
Carbonic Anhydrase Inhibitors
Potassium- Sparing Diuretics
Osmotic Diuretics
What are the suffix(es) and possible outlier drugs for Thiazides and Thiazides like drugs?
“thiazides”
Hydrochlorothiazide
Chlorothiazide
Outlier : Chlorthalidone
What are the suffix(es) and possible outlier drugs for loop diuretics?
“mide”
Torsemide
Furosemide
Outlier : Bumetanide
What are the suffix(es) and possible outlier drugs for Carbonic Anhydrase Inhibitors?
“amide:
Acetazolamide
What are the suffix(es) and possible outlier drugs for Potassium Sparing Diuretics?
Two to remember
Spironolactone
Triamterene
What are the suffix(es) and possible outlier drugs for Osmotic diuretics?
Mannitol
How does Thiazides work?
By blocking the chloride pump in the distal tubule, this keeps chloride and sodium from being reabsorbed and consequently excreted in urine. This part of the tubule is impermeable to water so we do see an increase in urine output but not as much as some other diuretics. It is therefore considered a moderate diuretic
How does Loop Diuretics work?
By blocking the chloride pump in the loop of Henle, which leads to large amounts of sodium and chloride is excreted in urine.it is considered a strong diuretic
How does Carbonic Anhydrase Inhibitors work?
They block the effect of carbonic anhydrase which is the enzyme that catalyzes the conversion of co2 and water into bicarbonate. This slows down the movement of Hydrogen ions which means that more sodium and bicarbonate is lost in urine. This can make the urine alkaline
How does Potassium Sparing Diuretics work?
Spironolactone blocks Aldosterone in the distal tubule which excretes sodium while reabsorbing potassium
Triamterene blocks potassium secretion in the tubule. It retains potassium while excreting sodium.
How does Osmotic Diuretics work?
Mannitol is a large sugar that pulls water into the renal tubule without loss of sodium (osmotic pull) Pulls water from extravascular space into intravascular space.
What is Chlorothiazide used for?
It is given for hypertension and Edema associated with chronic heart failure, liver or renal disease
(Thiazades)
What is Furosemide used for?
Given for heart failure to reduce edema, renal disease to lower BP, Liver disease to reverse sodium retention and to treat cirrhosis and for hypertension to lower BP
(Loop Diuretic)
What is Acetazolamide used for?
Used as an adjunct to other diuretics and for glaucoma to decrease aqueous humor.
(Carbonic Anhydrase Inhibitors)
What is Spironolactone used for?
Usually given in adjunct with Thiazides or Loop Diuretics and is given for patients that need diuretics but are at risk for hypokalemia.
It is also used to treat hyperaldosteronism, for patients with cardiac arrythmias or patients who are taking Digoxin.
(Potassium-Sparing Diuretic)
What is Mannitol given for?
To treat increased cranial pressure.
Acute renal failure due to shock, drug overdose or trauma.
To decrease intraocular pressure before eye surgery or in acute glaucoma attacks
(Osmotic Diuretics)
What are some lifespan considerations that should be remembered when diuretics are prescribed to children?
Diuretics are usually prescribed for children who suffer from heart defects, hypertension or from edemas associated with lung or kidney disease.
What are some lifespan considerations that should be remembered when diuretics are prescribed to adults?
Adults on diuretics should weigh themselves daily and report and weight gain over 3lbs per day or 5lbs pr week.
They should be aware of situations that promotes further fluid loss, such as sweating, intense exercise, vomiting, diarrhea.
Should keep an adequate oral fluid intake.
Not to be used in lactation because it can get into the breastmilk.
Should only be used during pregnancy if benefit outweighs risk.
What are some lifespan considerations that should be remembered when diuretics are prescribed to older adults?
Older adults may have underlying renal or hepatic impariments which may affect drug metabolism and excretion.
Their fluid and electrolyte balance should be monitored.
They should keep an adequate oral fluid intake
Modify physical activity as needed
Avoid excessive salt.
Which patient factor contraindicates the use of Chlorthalidone?
Allergy to sulfonamides as they have similar composition as Thiazides.
Hypovolemia as the patient cannot lose any more fluid.
Severe renal disease
(Thiazide)
Which patient factor contraindicates the use of Torsemide?
Electrolyte depletion which could be worsened with extreme urine output
Severe renal failure
Liver failure
(Loop Diuretic)
Which patient factor contraindicates the use of Acetazolamide?
Allergy to sulfonamides and thiazides due to similar composition
(carbonic anhydrase inhibitors)
Which patient factor contraindicates the use of Triamterene?
Hyperkalemia, which means they would not need potassium sparing medication.
Sever renal disease.
Which patient factor contraindicates the use of Mannitol?
Pre-existing severe renal
disease
Pulmonary congestion and
edema
Intracranial bleeding (except
during surgery)
Dehydration
Heart failure
What cautions should be taken into account when prescribing Chlorothiazide to a patient?
Hypovolemia, Lupus (may worsen) and liver disease.
Diabetes and glucose tolerance abnormalities
Hypokalemia can lead to reduced insulin secretion
(thiazide)
What is an adverse affect to Chlorthalidone?
Electrolyte and glucose imbalance :Hypokalemia, Hypercalcemia, Hyperglycemia
Fluid loss which could lead to dizziness and weakness, fatigue
Alkalinized urine: Bladder infection, increased bicarbonates
(Thiazides)
What cautions should be taken into account when prescribing Bumetanide to a patient?
Electrolyte depletion and severe renal failure due to fluid loss.
Lupus, hyperglycemia
(Loop diuretics)
What are some adverse effect to look out for for a patient taking Furosemide?
Hypotension and dizziness due to fluid loss,
Hyperglycemia due to potassium increase
Hypokalemia/calcemia
Ototoxity
(loop)
What cautions should be taken into account when prescribing Acetazolamide to a patient?
Hepatic disease
Adrenocortical insufficiency
Respiratory acidosis/ COPD
(Carbonic Anhydrase inhibitor)
What are some adverse effects that a patient taking Acetazolamide may experience?
Metabolic acidosis, Hypokalemia,
CNS effect: Paresthesia of extremities
Confusion
Drowsiness
(Carbonic Anhydrase inhibitor)
What cautions should be taken into account when prescribing Triamterene to a patient?
Hyperkalemia and severe renal disease
(Potassium Sparing Diuretic)
What are some adverse effects that a patient taking Spironolactone may experience?
Hyperkalemia and Androgen effect
Gynecomastia - breast tissue in men
Irregular menses
Hirutism - coardse hair in women
Deepening of voice
Muscle weakness
ECG changes
Oliguria & Anuria
(Potassium Sparing Diuretic)
What cautions should be taken into account when prescribing Mannitol to a patient?
Fluid shift may worsen pre-existing renal disease.
Pulmonary congestion and edema
Intracranial bleeding because mannitol cannot differentiate between blood and fluid
Dehydration
Heart failure due to large fluid shift
What are some adverse effects that a patient taking Mannitol may experience?
Adverse effects are related to sudden drop in fluid levels.
Fluid and electrolyte imbalances
Nausea & vomiting, Hypotension, light headed
Confusion, headache, heart failure and pulmonary edema
What nursing assessment should be used for all diuretics?
History: Allergy, Pregnancy/lactation
Fluid and electrolyte diturbaces, hyperglycemia
Baseline for skin, mucous membranes, heart and lung sound
Intake and output; void patterns
Vitals and weight
Labs: renal and hepatic function tests, electrolyte & glucose
What nursing diagnosis should be used for all diuretics?
Risk for alterations in fluid volume
Risk for electrolyte disturbances
Hypotension risk
Knowledge deficit
What nursing implementation should be used for all diuretics?
Can be given with food or milk
Administer early in the day
Administer IV diuretics slowly and switch to oral
form ASAP
Assess weight daily
Assess for dehydration and electrolyte imbalance
Appropriate amount of potassium
Appropriate amount of fluid to prevent fluid
rebound
Safety precautions
Patient teaching
What nursing evaluation should be used for all diuretics?
Evaluate response to drug
Evaluate the effectiveness of the teaching plan
Evaluate the effectiveness of comfort and safety measures
Evaluate the compliance with the regimen
What are the main reasons diuretics are used?
Edema r/t congestive heart disease
Acute pulmonary edema
Liver disease
Renal disease
Hypertension
Hyperkalemia
What are the 6 L’s of Hypokalemia
Lethargy
Leg Cramp
Limp Muscles
Low Shallow Respirations
Lethal Cardiac Dysrhythmias
Lots of Urine
What does the abbreviation MURDER stand for when describing Hyperkalemia
Muscle Weakness
Urine - Oliguria, anuria
Respiratory Distress
Decreased Contractility
ECG changes
Reflexes - hyperreflexia or areflexia
Which diuretics come in pediatrics doses?
Thiazides, Loop diuretics and Spironolactone (potassium sparing diuretic)
What should you monitor for particularly in children who are taking diuretics?
Electrolyte imbalances and fluid imbalances as these can change very quickly in children.
What class of Diuretics belong to a chemical class called Sulfonamides?
Thiazides and Thiazide like diuretics
Why should we be cautious when prescribing diuretics to people with Lupus?
Lupus can often cause kidney problems and diuretics combined with lupus could potentially lead to renal failure.
Why should we be cautious with prescribing diuretics to people who have diabetes?
Because may diuretics increases blood glucose so this could lead to hyperglycemia.
Reason unknown but could de due to a decrease in potassium levels
Which diuretic block the chloride/sodium transport pump in the distal convoluted tubule in the kidney?
Thiazides
What is an adverse effect when the chloride/sodium transport pump in the distal convoluted tubule is blocked?
It may lead to Hypercalcemia and hypocalciuria because this pump in closely related to calcium reabsorption which means that more calcium goes into the blood and less out in the urine.
This happens with Thiazades.
Which Loop Diuretic is the most common due to its safety for home use?
Furosemide
What can worsen kidney failure and should be a consideration when giving patients strong diuretics?
Decreased blood volume because the kidneys need to be perfused at all times.
Why can some strong diuretics cause liver failure (the last stage of liver disease)?
Because strong diuretics can cause fluid and electrolyte imbalance which can make liver disease worse and push the disease into liver failure.
What adverse effect can we see when the potassium/chloride/sodium pump/transporter is blocked in the loop of Henle.
Blocking of this transporter results in a LOSS of calcium. So less calcium will go back into the blood which can result hypocalcemia and more calcium in excreted making the urine hypercalciuric.
This happens with Loop diuretics which work in the loop of henle.
What is Ototoxicity? And which diuretic may cause Ototoxicity?
Toxic effect to the odic nerve, nerve in the ear and can result in deafness.
This may happen when a patient is using Loop diuretic and reason is unknow, but a theory is that its a result from electrolyte depletion. In some cases it is reversable.
Which other drugs in combination with a loop diuretic increases the risk of Otoxicity?
Cisplatin and Aminoglycerides because these drugs also have an increased risk of otoxcity.
Which drug classes raises the potency of anticoagulants thus increasing the risk of bleeding?
Loop Diuretics
What does Acetazolamide do?
Its an enzyme responsible for the combination of sodium and bicarb which makes sodiumbicarbonate and excreting Hypdrogen (an acid)
Carbonic Anhydrase Carbonic Anhydrase
Why does Acetazolamide result in less hydrogen being excreted in the urine?
Because it blocks the absorption of bicarbonate, so less hydrogen is being excreted and more sodium and bicarb is excreted in urine making is more alkaline.
Acetazolamide = Carbonic Anhydrase Inhibitor
Which mild diuretic is often used in combination with other drug classes to have a stronger diuretic effect?
Acetazolamide/ Carbonic anhydrase Inhibitors are often combined with Thiazides.
What type of diuretic is also used to treat Glaucoma?
Acetazolamide/ Carbonic Anhydrase Inhibitors becuase it decreases secretion of Aqueous Humor in the eye.
What is Adrenocortical insufficiency?
A condition that affect the adrenal gland that affects aldosterone and aldosterone affects the sodium potassium and fluid balance.
This condition is a caution when a patient is taking Carbonic Anhydrase inhibitors/Acetazolamide
Which diuretic may cause acid/base imbalances?
Carbonic Anhydrase inhibitors/
Acetazolamide
What is Metabolic Acidosis
When we are loosing bicarb in the urine and the body now have more acid. This may make respiratory acidosis worse, and affect patients with COPD.
What common OTC drug decreased the diuretic effect of Acetazolamide
Aspirin
Which diuretic is a aldosterone antagonist?
Spironolactone
(Potassium sparing diuretic)
Which diuretic blocks potassium excretion through the distal tubule?
Triamterene
(Potassium sparing diuretic)
To remember what hyperkalemia does to an agent we use the acronym M.U.R.D.E.R what does this stand for?
M=Muscle Weakness
U = Urine - oliguria, anuria
R = Respiratory distress
D = Decreased cardiac contractility
E = ECG changes
R = Reflexes - Hyperreflexia or areflexia
Is Mannitol administered IV or orally?
Only via IV
Why doesn’t Mannitol get reabsorbed by the body?
Its a sugar molecule that is too large to be absorbed in the tubule.
Why can Mannitol be used during eye surgery or to treat Glaucoma?
It decreases inner ocular pressure in the eye by absorbing aqueous humor.
What is fluid rebound?
A reflex reaction if the body. It happens when a person is limiting their fluid intake and the body retains fluid to compensate.
