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UNRS 113 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the basic functions of the kidney?

A

Cleansing of extracellular fluid (ECF); Excretion of metabolic wastes/foreign substances

Maintenance of extracellular volume and composition

Maintenance of acid-base balance

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2
Q

What are the basic processes of the kidney?

A

Filtration
Active secretion
Reabsorption

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3
Q

What is the normal urine output?

A

30 mL/hr

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4
Q

What are diuretics?

A

Drugs that promote formation of urine

Drugs that accelerate the rate of urine formation

Drugs/substances that promote the formation and excretion of urine

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5
Q

What are the major categories of diuretic drugs?

A

Loop diuretics
Thiazide diuretics
Osmotic diuretics
Potassium-sparing diuretics

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6
Q

What determines the potency of diuretics?

A

The location of where the drugs work in the nephron to inhibit sodium and water reabsorption

The more sodium and water they inhibit from reabsorption, the greater the amount of diuresis and therefore the greater the potency

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7
Q

What are 2 advantages to using diuretics?

A

Relatively low cost

Favorable safety profile

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8
Q

What is the main problem with diuretic use?

A

The metabolic adverse effects that can result from excessive fluid and electrolyte loss

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9
Q

What condition is diuretics a first-line drug for?

A

Hypertension

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10
Q

What do diuretics do to arteries?

A

Cause arteriolar dilation

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11
Q

What do diuretics do to the peripheral vascular system?

A

Arteriolar dilation decreases peripheral vascular resistance

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12
Q

What do diuretics reduce?

A

Extracellular fluid volume
Plasma volume
Cardiac output

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13
Q

What conditions can diuretics treat?

A

Hypertension

Heart failure

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14
Q

Which diuretic is the most potent?

A

Loop diuretic

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15
Q

What is the mechanism of action of loop diuretics?

A

Blocks reabsorption of sodium and chloride in the ascending limb of the loop of Henle which prevents reabsorption of water

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16
Q

What is diuresis?

A

Increased/excessive production of urine

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17
Q

When are loop diuretics particularly useful?

A

When rapid diuresis is needed because of their rapid onset of action

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18
Q

What are the drug effects of loop diuretics?

A

Extensive diuresis and loss of fluid

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19
Q

How long does the diuretic effect of a loop diuretic last?

A

At least 2 hours

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20
Q

What are the cardiovascular effects of loop diuretics?

A

Due to decreased fluid volume from diuresis, there is a decreased return of blood to the heart

  • Reduced blood pressure
  • Reduced pulmonary vascular resistance
  • Reduced systemic vascular resistance
  • Reduced central venous pressure
  • Reduced left ventricular end-diastolic pressure
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21
Q

What are indications for loop diuretics?

A

Pulmonary edema caused by heart failure or hepatic/renal disease

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22
Q

What are contraindications of loop diuretics?

A

End stage renal disease
Anuria (failure of kidneys to produce urine)
Hepatic coma
Severe electrolyte loss

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23
Q

What are the adverse effects of loop diuretics?

A 
Severe dehydration
Hypotension
Hypokalemia
Ototxicity (toxic to the ear)
Hyperglycemia
Hyperuricemia
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24
Q

What are the interactions with loop diuretics?

A

Digoxin - Hypokalemia results in increased digoxin toxicity

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25
Q

What are some loop diuretics?

A

Furosemide (Lasix)
Bumetanide (Bumex)
Torsemide (Demadex)

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26
Q

What are some nursing implications for loop diuretics?

A

Monitor blood pressure
Monitor electrolytes (especially K+)
Monitor urine output
Monitor fluid volume status

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27
Q

What are some things to educate the patient on concerning loop diuretics?

A

Monitor weight and blood pressure
Change positions slowly
Eat potassium rich foods
Take medication early in the day

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28
Q

What is the range/level of hyperkalemia?

A

Serum potassium > 5.5 mEq/L

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29
Q

What are the signs and symptoms of hyperkalemia?

A 
Generalized fatigue
Weakness
Paresthesia
Palpitations
Paralysis
30
Q

What is paresthesia?

A

Abnormal sensation (“pins and needles”) caused chiefly by pressure on or damage to peripheral nerves

31
Q

What is the most commonly used loop diuretic?

A

Furosemide (Lasix)

32
Q

What is the mechanism of action of thiazide diuretics?

A

Blocks reabsorption of sodium and chloride in the early distal convulated tubule which prevents reabsorption of water

33
Q

What is the drug effect of thiazide diuretics?

A

Maximum diuresis is less than loop diuretics

Results in osmotic water loss

34
Q

What are some thiazide diuretics?

A

Hydrochlorothiazide (HydroDiuril, HCTZ)

Chlorothiazide (Diuril)

35
Q

What are the indications for thiazide diuretics?

A

Hypertension

36
Q

Which diuretic is the first-line treatment for hypertension?

A

Thiazide diuretics

37
Q

What are the contraindications of thiazide diuretics?

A

Renal insufficiency

38
Q

What are adverse effects of thiazide diuretics?

A 
Dehydration
Hypotension
Hypokalemia
Hyperglycemia
Hyperuricemia
39
Q

What is hyperuricemia?

A

Excess of uric acid in bloodstream (40%)

40
Q

What is hypokalemia?

A

Potassium deficiency

Serum potassium level < 3.5 mEq/L

41
Q

What are nursing implications of thiazide diuretics?

A

Monitor blood pressure
Monitor electrolytes (especially K+)
Monitor fluid volume status

42
Q

What are some things to educate the patient on concerning thiazide diuretics?

A

Monitor weight and blood pressure
Change positions slowly
Eat potassium rich foods (drug is potassium wasting)
Take medication early in the day to avoid nocturia

43
Q

What is the mechanism of action of potassium-sparing diuretics?

A

Blocks the action of aldosterone in the distal tubule which results in potassium retention and the excretion of sodium and water

44
Q

What is the drug effect of potassium-sparing diuretics?

A

Counteracts the potassium-wasting effect of more powerful diuretics

Mild diuresis effect

45
Q

What are some potassium-sparing diuretics?

A

Spironolactone (Aldactone)
Amiloride (Midamor)
Triamterene (Dyrenium)

46
Q

What are indications for potassium-sparing diuretics?

A

Frequently combined with thiazide and loop diuretics to counterbalance potassium-wasting

47
Q

What are contraindications of potassium-sparing diuretics?

A

Hyperkalemia
Anuria
Renal failure

48
Q

What are adverse effects of potassium-sparing diuretics?

A

Hyperkalemia (if used alone)
Impotence
Gynecomastia (swelling of breasts is males)
Menstrual irregularities

49
Q

What are interactions with potassium-sparing diuretics?

A

Angiotensin converting enzyme (ACE) inhibitors, potassium supplements -> Hyperkalemia

Angiotensin receptor blockers (ARBs)
Direct renin inhibitors

50
Q

What are some nursing implications of potassium-sparing diuretics?

A

Monitor blood pressure
Monitor electrolytes
Monitor fluid and volume status

51
Q

What are some things to teach patients concerning potassium-sparing diuretics?

A

Avoid salt substitutes that contain potassium

Keep log of blood pressure and weight

52
Q

What is the mechanism of action of osmotic diuretics?

A

Decreases cerebral edema by raising serum osmolality which draws fluid into vascular space

Creates osmotic effect in nephron causing increased secretion of water

53
Q

What is the drug effect of osmotic diuretics?

A

The greater the amount of mannitol (osmotic diuretic) the greater the diuresis (available 5-25%)

54
Q

What are some osmotic diuretics?

A

Mannitol (Osmitrol)

55
Q

What are indications for osmotic diuretics?

A

Cerebral edema

Prevention of kidney injury in hypovolemic shock

56
Q

What is hypovolemic shock?

A

An emergency condition in which severe blood or fluid loss makes the heart unable to pump enough blood to the body

57
Q

What are contraindications of osmotic diuretics?

A

Renal failure

Pulmonary edema caused by heart failure

58
Q

What are adverse effects of osmotic diuretics?

A

Can precipitate heart failure and pulmonary edema

59
Q

What are some nursing implications of osmotic diuretics?

A 
Monitor blood pressure
Monitor electrolytes
Monitor fluid volume status
Use a filter in the IV tubing
Monitor signs/symptoms of heart failure
60
Q

What is normal serum potassium level?

A

3.5 - 5.0 mEq/L

61
Q

What are some evidences of normal kidney function?

A

Urine output of at least 30 mL/hr
Serum creatinine level between 0.6 - 1.2 mg/dL
BUN levels between 10 - 20 mg/dL

62
Q

What are the signs and symptoms of hypokalemia?

A 
Early:
Hypotension
Lethargy
Mental confusion
Muscle weakness
Nausea

Late:
Cardiac irregularities
Neuropathies
Paralytic ileus

63
Q

What are some potassium rich foods?

A 
Bananas
Potatoes
Dried fruit
Tomatoes
Spinach
Citrus fruits
64
Q

What is the effect of aldosterone on the distal tubule of the nephron?

A

Aldosterone regulates the filtration of sodium in exchange for potassium or hydrogen ions in the distal tubule

65
Q

Where in the nephron is the osmotic diuretic action site?

A

Proximal tubule

Descending loop of Henle

66
Q

Where in the nephron is the loop diuretic action site?

A

Ascending loop of Henle

67
Q

Where in the nephron is the thiazide diuretic action site?

A

Distal tubule

68
Q

Where in the nephron is the potassium-sparing diuretic action site?

A

Distal tubule to collecting duct

69
Q

How much sodium is reabsorbed back into the bloodstream in the proximal tubule?

A

60 - 70%

70
Q

How much sodium is reabsorbed back into the bloodstream in the ascending loop of Henle?

A

20 - 25%

71
Q

Where does the remaining 5 - 10% of sodium resorption take place?

A

Distal tubule

UNRS 113 (4 decks)

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