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pharm > diuretics > Flashcards

diuretics Flashcards

1
Q

diuresis

A

increased water loss

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2
Q

what do diuretic drugs do?

A
  • increase urine output
  • remove excess fluid
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3
Q

what are they used for?

A
  • hypertension
  • heart failure
  • edematous states
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4
Q

what are diuretics

A

drugs that accelerate rate of urine formation (excretion of sodium and water)

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5
Q

can water move out of the nephron on its own?

A

no; where sodium goes water follows (osmosis)

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6
Q

what parts of the nephron do drugs work

A
  • not proximal tubule
  • loop of henle (20-25% reabsorbtion)
  • distal convoluted tubule (7% reabsorption)
  • collecting ducts (1-2%
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7
Q

negatives of diuretics

A
  • excessive fluid loss (dehydration)
  • electrolyte imbalance
  • acid-base imbalance
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8
Q

types of diuretics

A
  • loop diuretics
  • thiazide (and related) diuretics
  • k sparing
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9
Q

loop diuretic example

A

furosemide

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10
Q

furosemide mechanism of action

A
  • in ascending loop of henle
  • inhibit Na transporter
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11
Q

is furosemide high or low ceiling

A

high ceiling diuretic: significant diuresis and quickly

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12
Q

furosemide indications

A
  • heart failure
  • hypertension: reduced venous return and CO (secondary choice)
  • hypercalcemia
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13
Q

furosemide adverse effects

A
  • excessive fluid loss (dehydrated and easier to have thrombosis/embolism, low Na/Cl and electrolyte imbalance)
  • hypokalemia
  • hypoglycemia (diabetes mellitus pt)
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14
Q

hypokalemia symptoms
- decrease in potassium (<3.5mmol/L)

A
  • irregular heartbeat (fatal dysrhythmias)
  • muscle weakness/lethargy
  • leg cramps
  • GI disturbances (constipation)
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15
Q

furosemide interactions

A
  • digoxin (heart failure drug) more toxic with hypokalemia
  • can have increased hypokalemia with other diuretics - glucocorticoids
  • ototoxicity (ear) with aminoglycosides
  • decrease hypoglycemic effect of diabetic drugs
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16
Q

thiazide diuretic example

A

hydrochlorothiazide (po)

17
Q

thiazide mechanism of action

A
  • distal convoluted tubule
  • inhibit sodium and chloride reabsorption
  • affect protein transporter
18
Q

why are thiazide diuretics low ceiling

A

less Na reabsorption in this area so drugs have less effect

19
Q

thiazide indications

A
  • hypertension (first choice drug)
  • edema

-indirect: HF, liver cirrhosis

20
Q

thiazide adverse effects

A
  • hypokalemia
  • hyperglycemia (diabetes pt - inhibit insulin secretion)
  • genitourinary system (impotence - no penile erection)
21
Q

thiazide interactions

A
  • digoxin more toxic with hypokalemia
  • antidiabetic drugs don’t work at well, lead to hyperglycemia
22
Q

k sparing diuretic example

A

spironolactone (aldactone)

23
Q

spironolactone mechanism of action

A
  • act on collecting ducts
  • aldosterone receptor blocker
  • affect hormonal control of sodium reabsorption
  • block reabsorption of sodium and water usually induced by aldosterone
  • reduce sodium-potassium exchange
24
Q

spironolactone indications

A
  • edema from HF
  • hypertension
  • reverse potassium loss from other diuretics (combo therapy)
  • hyperaldosteronism
25
Q

does spironolactone work slow or fast and why

A
  • not immediate effect
  • onset: 1-2 days
  • peak: 2-3 days
  • bc drug stop ald from making new proteins but doesn’t effect the existing ones
26
Q

spironolactone contraindications

A
  • hyperkalemia (>5mmol/L)
27
Q

spironolactone adverse effects

A
  • hyperkalemia
  • sex hormone-like effects: amenorrhea, irregular menses, postmenopausal bleeding, gynecomastia
28
Q

spironolactone interactions

A
  • other drugs that increase K+ levels (RAAS drugs like ACE inhibitors)
  • potassium supplements (do not give)
29
Q

nursing implications

A
  • diuretics in morning (pee lots, effect sleep)
  • monitor K+ levels
  • thiazide and loop eat potassium (bananas, oranges, raisins, plums, veg, legumes, potatoes)
  • watch for digoxin toxicity
  • watch for hyperglycemia on diabetes pt
  • change position slowly: orthostatic hypertension
  • tell physician if: rapid HR, weight loss
  • monitor therapeutic effect (reduce edema, hypertension)
30
Q

digoxin toxicity

A
  • fatigue
  • GI problems
  • changes in HR and rhythm
  • loss of appetite (anorexia)
  • visual disturbances

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