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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
Interactions of furosemide can increase
Digoxin toxicity -digoxin used to improve heart function in HF
26
Dangerous interactions with furosemide: aminoglycosides
Ototoxicity
27
Furosemide may increase levels of
Lithium -bipolar disorder -patients with low Na
28
Furosemide may decrease
Hypoglycaemic effect of anti diabetic drugs which causes hyperglycemia
29
Thiazide diuretics mechanism of action
Inhibit reabsorption of sodium and chloride ions -results in excretion of water, sodium and chloride
30
Thiazide diuretics site of action
Primarily in the distal convoluted tubule -different protein target to loop diuretics
31
Thiazide diuretics are less powerful than
Loop diuretics -low ceiling
32
Thiazide example
Hydrochlorothiazide
33
Hydrochlorothiazide
Is taken PO
34
Indication of thiazide diuretics
-hypertension (first line treatment, single or combination therapy) -edematous states (adjunct agents in treatment of HF, hepatic cirrhosis)
35
Thiazide diuretics adverse effects:
-hypokalemia -hyperuricemia -hyperglycemia -genitourinary system
36
Thiazide diuretics adverse effects: hypokalemia
Below normal of 3.5 to 5 mmol/L -treat with K supplements or K sparing diuretic
37
Thiazide diuretics adverse effects: hyperglycemia
Inhibit insulin secretion
38
Thiazide diuretics adverse effects: genitourinary system
Impotence
39
Thiazide duiretics interactions
-digoxin -anti diabetic drugs
40
Thiazide duiretics interactions : digoxin
Increased risk of toxicity due to hypokalemia -same as loop diuretics
41
Thiazide duiretics interactions : anti diabetic drugs
Reduces effect from diabetic drugs so may lead to hyperglycemia
42
Mechanism of action of potassium sparing diuretics
Act on collecting tubules of nephron -only 1 to 2% of Na reabsorption -therefore limited effectiveness used on their own
43
Potassium sparing diuretics example
Spironolactone
44
Spironolactone
Aldosterone receptor blocker
45
Na channel blockers (2)
-amiloride -triameterne (only in combination with hydrocholorothiazide)
46
Spironolactone onset and peak
Onset: 24-48 hours, peak: 2-3 days
47
Mechanisms of action: Spironolactone
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
Indications of Spironolactone
-edema associated with heart failure -hypertension -reversing the potassium loss caused by potassium losing drugs -hyperaldosteronism
49
Contraindications of Spironolactone
Hyperkalemia -withhold if above 3.5-5 mmol/L
50
Adverse effects of Spironolactone/potassium sparing diuretics:
-Hyperkalemia (>5 mmol/L) -spironolactone -sex hormone effects
51
Hyperkalemia symptoms
-cardia dysrhythmias -muscle weakness -GI cramps, nausea, vomiting, diarrhea
52
Adverse effects of Spironolactone: spironolcatone
Steroid like structure
53
Adverse effects of Spironolactone: sex hormone like effects
-amenorrhea -irregular menses -post menopausal bleeding -gynecomastisa
54
Potassium sparing duiretics interactions
-other heart failure drugs that also increase plasma K+ -RAAS drugs (ACE inhibitors) -potassium supplements
55
Helpful to take diuretics in the morning why?
take in the morning to avoid sleep pattern disturbance
56
Foods high in potassium
Bananas, oranges, raisins, plums, fresh vegetables, legumes, potatoes
57
Patients taking diuretics along with a digoxin should be taught to monitor for
Digoxin toxicity -fatigue, GI problems, changes in heart rate and rhythm, loss of appetite, visual disturbances
58
Diabetic patients who are taking thiazide and or loop diuretics should monitor
Blood glucose and watch for elevated glucose levels
59
Instruct clients to notify the physical immediately if they experience..
-rapid heart rates or syncope -rapid weight loss
60
Teach clients to change positions
Slowly and to rise slowly after sitting or lying to prevent dizziness and possible fainting related to orthostatic hypotension
61
Monitor for therapeutic effects
-reduction in edem, fluid volume overload, HF -reduction of hypertension and ICP
62
Important for nurses to monitor
Serum potassium levels during therapy
63
teach clients to eat more (when taking loop or thiazide diuretics)
Potassium rich foods when taking loop or thiazide diuretics
64
Osmotic diuretic IV mannitol mechanism of action
inhibits tubular reabsorption of H2O producing a RAPID diuresis -proximal tubule
65
Osmotic diuretic IV mannitol is not reabsorbed
From nephron, produces an osmotic force in nephron fluid
66
Osmotic diuretic IV mannitol causes only a slight loss of
Electrolytes
67
Osmotic diuretics are used to treat
Early ARF - acutre renal failure -keep the fluid moving
68
Non renal treatments using osmotic diuretics
-reduction of intracranial pressure -reduces excessive intraocular pressure
69
Non renal treatments using osmotic diuretics: reduction of intracranial pressure
Treatment of cerebral edema -fluid from brain into blood
70
Osmotic diuretics contraindications
-known drug allergy -severe kidney disease -pulmonary edema -active intracranial bleeding
71
In pulmonary edema what drug is used primarily
Loop duiretics are used instead for greater fluid reduction

Pharmacology (37 decks)

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