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Pharmacology > Diuretics (44) > Flashcards

Diuretics (44) Flashcards

1
Q

Diuresis

A

Increased water loss

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2
Q

Diuretic drugs

A

Increased urine output and remove excess fluid

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3
Q

Diuretics are first line drugs for

A

Heart failure and hypertension

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4
Q

Diuretics are drugs that

A

Accelerate the rate of urine formation
-by excretion of sodium and water

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5
Q

Diuretics control the bodies

A

Sodium (and then Cl)
-which controls the bodies water, ECF volume and BP control

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6
Q

Where sodium goes…..

A

Water follows

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7
Q

What percentage of sodium is reabsorbed in the loop of henle

A

20 to 25%

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8
Q

What percentage of sodium is reabsorbed in the distal tubules

A

7%

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9
Q

What percentage of sodium is reabsorbed in the collecting ducts

A

1-2%

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10
Q

If water is not absorbed… it is

A

Excreted as urine

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11
Q

A small blockade sodium reabsorption can produce

A

Profound fluid loss

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12
Q

The small blockade Na reabsorption can produce profound fluid loss but can produce…

A

-excessive fluid loss (dehydration)
-acid base imbalances
-alter electrolyte levels

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13
Q

Example of loop diuretics

A

Furosemide

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14
Q

Furosemide acts in the

A

Act in ascending limb of loop of henle
-inhibits sodium and chloride transporter
-secreted into nephron fluid

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15
Q

Furosemide

A

-significant diuresis (significant loss of fluid)

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16
Q

Decreased fluid volume cases

A

-reduced edema
-reduced venous return (reduced CO)

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17
Q

Indications of furosemide

A

-edema associated with heart failure or hepatic or renal disease
-control of hypertension
-hypercalcemia (will inc renal excretion of calcium)

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18
Q

Adverse effects of furosemide

A

-Excessive fluid loss
-potassium depletion
-hyopkalemia
-hyperuricemia
-hyperglycemia

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19
Q

Adverse effects of furosemide: fluid loss

A

-lowers Na, Cl
-water (dehydration)

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20
Q

Adverse effects of furosemide: potassium depletion

A
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21
Q

Adverse effects of furosemide: hypokalemia

A

-below normal of 3.5 to 5 mmol/L
-treat with K supplements or K sparing diuretic

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22
Q

Adverse effects of furosemide: hyperuricemia

A

May lead to gout

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23
Q

Symptoms of hypokalemia

A

-irregular heartbeat
-muscle weakness/lethargy
-leg cramps
-GI disturbances

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24
Q

Dangerous interactions with furosemide: digoxin

A

Patients using digoxin need to be monitored for hypokalemia

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25
Q

Interactions of furosemide can increase

A

Digoxin toxicity
-digoxin used to improve heart function in HF

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26
Q

Dangerous interactions with furosemide: aminoglycosides

A

Ototoxicity

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27
Q

Furosemide may increase levels of

A

Lithium
-bipolar disorder
-patients with low Na

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28
Q

Furosemide may decrease

A

Hypoglycaemic effect of anti diabetic drugs which causes hyperglycemia

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29
Q

Thiazide diuretics mechanism of action

A

Inhibit reabsorption of sodium and chloride ions
-results in excretion of water, sodium and chloride

30
Q

Thiazide diuretics site of action

A

Primarily in the distal convoluted tubule
-different protein target to loop diuretics

31
Q

Thiazide diuretics are less powerful than

A

Loop diuretics
-low ceiling

32
Q

Thiazide example

A

Hydrochlorothiazide

33
Q

Hydrochlorothiazide

A

Is taken PO

34
Q

Indication of thiazide diuretics

A

-hypertension (first line treatment, single or combination therapy)
-edematous states (adjunct agents in treatment of HF, hepatic cirrhosis)

35
Q

Thiazide diuretics adverse effects:

A

-hypokalemia
-hyperuricemia
-hyperglycemia
-genitourinary system

36
Q

Thiazide diuretics adverse effects: hypokalemia

A

Below normal of 3.5 to 5 mmol/L
-treat with K supplements or K sparing diuretic

37
Q

Thiazide diuretics adverse effects: hyperglycemia

A

Inhibit insulin secretion

38
Q

Thiazide diuretics adverse effects: genitourinary system

A

Impotence

39
Q

Thiazide duiretics interactions

A

-digoxin
-anti diabetic drugs

40
Q

Thiazide duiretics interactions : digoxin

A

Increased risk of toxicity due to hypokalemia
-same as loop diuretics

41
Q

Thiazide duiretics interactions : anti diabetic drugs

A

Reduces effect from diabetic drugs so may lead to hyperglycemia

42
Q

Mechanism of action of potassium sparing diuretics

A

Act on collecting tubules of nephron
-only 1 to 2% of Na reabsorption
-therefore limited effectiveness used on their own

43
Q

Potassium sparing diuretics example

A

Spironolactone

44
Q

Spironolactone

A

Aldosterone receptor blocker

45
Q

Na channel blockers (2)

A

-amiloride
-triameterne (only in combination with hydrocholorothiazide)

46
Q

Spironolactone onset and peak

A

Onset: 24-48 hours, peak: 2-3 days

47
Q

Mechanisms of action: Spironolactone

A

Antagonist at aldosterone receptors
-blocks the reabsorption of sodium and water, usually induced by aldosterone

Reduces sodium potassium exchange
-body retains K+ (K sparing)

48
Q

Indications of Spironolactone

A

-edema associated with heart failure
-hypertension
-reversing the potassium loss caused by potassium losing drugs
-hyperaldosteronism

49
Q

Contraindications of Spironolactone

A

Hyperkalemia
-withhold if above 3.5-5 mmol/L

50
Q

Adverse effects of Spironolactone/potassium sparing diuretics:

A

-Hyperkalemia (>5 mmol/L)
-spironolactone
-sex hormone effects

51
Q

Hyperkalemia symptoms

A

-cardia dysrhythmias
-muscle weakness
-GI cramps, nausea, vomiting, diarrhea

52
Q

Adverse effects of Spironolactone: spironolcatone

A

Steroid like structure

53
Q

Adverse effects of Spironolactone: sex hormone like effects

A

-amenorrhea
-irregular menses
-post menopausal bleeding
-gynecomastisa

54
Q

Potassium sparing duiretics interactions

A

-other heart failure drugs that also increase plasma K+
-RAAS drugs (ACE inhibitors)
-potassium supplements

55
Q

Helpful to take diuretics in the morning why?

A

take in the morning to avoid sleep pattern disturbance

56
Q

Foods high in potassium

A

Bananas, oranges, raisins, plums, fresh vegetables, legumes, potatoes

57
Q

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

A

Digoxin toxicity
-fatigue, GI problems, changes in heart rate and rhythm, loss of appetite, visual disturbances

58
Q

Diabetic patients who are taking thiazide and or loop diuretics should monitor

A

Blood glucose and watch for elevated glucose levels

59
Q

Instruct clients to notify the physical immediately if they experience..

A

-rapid heart rates or syncope
-rapid weight loss

60
Q

Teach clients to change positions

A

Slowly and to rise slowly after sitting or lying to prevent dizziness and possible fainting related to orthostatic hypotension

61
Q

Monitor for therapeutic effects

A

-reduction in edem, fluid volume overload, HF
-reduction of hypertension and ICP

62
Q

Important for nurses to monitor

A

Serum potassium levels during therapy

63
Q

teach clients to eat more (when taking loop or thiazide diuretics)

A

Potassium rich foods when taking loop or thiazide diuretics

64
Q

Osmotic diuretic IV mannitol mechanism of action

A

inhibits tubular reabsorption of H2O producing a RAPID diuresis
-proximal tubule

65
Q

Osmotic diuretic IV mannitol is not reabsorbed

A

From nephron, produces an osmotic force in nephron fluid

66
Q

Osmotic diuretic IV mannitol causes only a slight loss of

A

Electrolytes

67
Q

Osmotic diuretics are used to treat

A

Early ARF - acutre renal failure
-keep the fluid moving

68
Q

Non renal treatments using osmotic diuretics

A

-reduction of intracranial pressure
-reduces excessive intraocular pressure

69
Q

Non renal treatments using osmotic diuretics: reduction of intracranial pressure

A

Treatment of cerebral edema
-fluid from brain into blood

70
Q

Osmotic diuretics contraindications

A

-known drug allergy
-severe kidney disease
-pulmonary edema
-active intracranial bleeding

71
Q

In pulmonary edema what drug is used primarily

A

Loop duiretics are used instead for greater fluid reduction

Pharmacology (23 decks)

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