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HLSC 220 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Diuresis

A

Increased water loss

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2
Q

Diuretic drugs

A

-Increase urine output
-remove excess fluid
-First line drugs for (heart failure, hypertension)
-Acute edematous states
-Accelerate the rate of urine formation

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3
Q

How do diuretics control the rate of urine formation

A

-Mostly through excretion of Na+ and H2O
-Na+ and Cl- > control H2O > Control ECF volume > Part of BP control

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4
Q

The Nephron and what parts Na is absorbed

A

-Controls H2O movement (Follows Na)
-20-25% of all Na is absorbed in loop of Henle
-7% in distal tubules
-1-2% in collecting ducts

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5
Q

If H2O isn’t absorbed

A

gets excreted as urine

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6
Q

Diuretic Drugs

A

-Small blockade Na reabsorption can produce profound fluid loss
-Can produce
>Excess fluid loss
>Acid-base imbalances
>Alter electrolyte levels

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7
Q

Types of Diuretis

A

-Loop Diuretics
-Thiazide like diuretics
-Potassium-sparing diuretics
-Osmotic diuretics
-All block NaCl reabsorption

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8
Q

Loop Diuretics:

A

-Furosemide (Lasix)
-Bumetanide (Burinex)
-Ethacrynicacid (Edecrin)

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9
Q

Furosemide (Loop Diuretics): Mechanism of action

A

-Act in ascending loop of henle (inhibit Na+Cl transporter, secreted into nephron fluid)
-significant diuresis
-Decreased fluid volume causes (reduced edema, reduced venous return- reduced CO)

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10
Q

Furosemide (Loop Diuretics): indications

A

-Edema associated with heart failure, hepatic, or renal disease
-Control of hypertension
-Increase excretion of calcium in clients with hypercalcemia

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11
Q

Furosemide (Loop Diuretics): Adverse effects

A

-Excessive fluid loss (low Na, Cl)
-H2O dehydration
-Hypotension, thrombosis/embolism
-Potassium depletion (Hyperkalemia)
-Hyperuricemia (lead to gout)
-Hyperglycemia

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12
Q

What is important to watch for when taking diuretics

A

HypoKalemia

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13
Q

HypoKalemia Symptoms

A

-K below 3.5-5mmol/L
-Irregular heartbeat (potentially fatal dysrhythmias)
-Muscle weakness/lethargy
-Leg cramps
-GI Disturbances (constipation, nausea, vomiting, diarrhea)

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14
Q

Furosemide (Loop Diuretics): Interactions

A

-Patients using digitoxin need to be monitored for hypokalemia (can increase digoxin toxicity)
-Ototoxicity
-Increased levels of lithium (bipolar disorder)
-May decrease hypoglycemia effect of antidiabetic drugs = hyperglycemia

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15
Q

Thiazide Related Diuretics: Mechanism of action

A

-Inhibit reabsorption of Na and Cl ions
-Primarily in distal tubule
-different protein targets then loop diuretics
-less powerful then loop diuretics (low ceiling)

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16
Q

Furosemide (Loop Diuretics): cause

A

-excretion of H2O, Na,Cl
-reduce blood volume

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17
Q

Furosemide (Loop Diuretics): Drugs

A

-Hydrochlorothiazide
-Chlorthalidone
-Metolazone

18
Q

Furosemide (Loop Diuretics): Indications

A

-Hypertension (first line treatment, single or combination therapy)
-Edematous States (adjunct agents in treatment of Heart Failure, hepatic cirrhosis)

19
Q

Furosemide (Loop Diuretics): Adverse Effects

A

-Hypokalemia
-Hyperuricemia
-Hyperglycemia (inhibit insulin)
-Gentourinary system (Impotence)

20
Q

Furosemide (Loop Diuretics): Indications

A

-Digoxin (increase risk of toxicity due to hypokalemia, same as loop)
-Antidiabetic drugs (reduces effect from diabetic drugs- can lead to hyperglycemia)

21
Q

Potassium-Sparing Diuretics:

A

-Act of collecting tubules of nephron
-Only 1-2% of Na reabsorption
-Limited effectiveness when used on their own

22
Q

Potassium-Sparing Diuretics: Spironolactone (Aldactone)

A

-Aldosterone receptor blockers
-Onset 24-48h
-Peak 2-3 days

23
Q

Potassium-Sparing Diuretics: Na channel blockers

A

-Amiloride (Midamor)
-Triamterene (available only in combination with hydrochlorothiazide> Riva-zide)

24
Q

Potassium-Sparing Diuretics: Mechanism of Action

A

-Antagonist at aldosterone receptors (block Na and H2O reabsorption usually induced by aldosterone)
-Reduces Na/K exchange (body retains K)

25
Q

Potassium-Sparing Diuretics: Indications

A

-Edema associated with heart failure
-hypertension
-hyperaldosteronism
-reversing the K loss caused by K+ losing drugs (combination)

26
Q

Potassium-Sparing Diuretics: Contraindications

A

-Spironolactone
>hyperkalemia (above normal 3.5-5, withhold if above 5)

27
Q

Potassium-Sparing Diuretics: Adverse Effects

A

-Hyperkalemia
-Steroid like structures
-Amenorrhea
-Irregular menses
-Postmenopausal bleeding
-Gynecological concern in males

28
Q

Potassium-Sparing Diuretics: Spironolactone Steroid like structure causes

A

-Amenorrhea
-Irregular menses
-Postmenopausal bleeding
-Gynecological concern in males

29
Q

Potassium-Sparing Diuretics: Interactions

A

-Heart failure drugs (increase plasma concentrations)
-RAAS drugs (ACE inhibitors)

30
Q

Potassium-Sparing Diuretics: Do NOT Give

A

Potassium Supplements

31
Q

Diuretic Nursing Implications

A

-Instruct clients to take in the morning to avoid interruptions with sleep
-Monitor serum potassium
-Teach clients to eat more potassium rich foods when taking loop or thiazide diuretics

32
Q

High Potassium foods

A

-Bananas
-Oranges
-Raisins
-Plums
-Fresh veggies
-Legumes
-Potatoes

33
Q

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

A

-Fatigue
-GI problems
-Visual Disturbances
-Changes in HR and Rhythm
-Loss of appetite (anorexia)

34
Q

What should diabetic patients taking loop or thiazide diuretics be monitoring

A

for high blood glucose levels

35
Q

Instruct patients to notify physician immediately if they experience

A

-Rapid HR or Syncope (reflects hypotension or fluid loss)
-Rapid weight loss

36
Q

Teach patients to do what related to orthostatic hypotension

A

-slowly rise after sitting or laying to prevent dizziness

37
Q

Monitor for therapeutic effects

A

-Reduction in edema, fluid volume overload
-Heart failure
-reduction of hypertension, intercranial pressure (ICP)

38
Q

Loop vs. Thiazide

A

Both - Decrease K
Both - Increase Glucose
Both - Risk of digoxin toxicity
Loop - More power
Thiazide - Less power

39
Q

Low ceiling vs. high ceiling

A

range of capability being high or low

40
Q

How much diuretic is needed

A

only enough to reach the goal

HLSC 220 (10 decks)

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