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Diuretics Flashcards

1
Q

natriuresis

A

sodium loss in the urine

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2
Q

the five categories of diuretics that are effective in removing water and sodium

A

TCLOP

T- thiazide and thiazide like
C- carbonic anhydrase inhibitor
L- loop or high ceiling
O- osmotics
- potassium-sparing
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3
Q

the three diuretics most commonly prescribed for hypertension and edema

A

thiazide, loop and potassium sparing diuretics

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4
Q

short acting thiazides

A

chlorothiazide
hydrochlorothiazide

hydro (HYPER) short acting

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5
Q

intermediate acting thiazides

A

bendroflumethiazide with Nadolol

BEN is in the middle between jojo and lauren, he’s intermediate about who to choose

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6
Q

long acting thiazides

A

methyclothiazide

meth takes a loonnggg time to get rid of

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7
Q

thiazide like diuretics

A

indipamide
chlorthalidone
metolazone

independent chloe’s metabolism is FAKE as fuuuccckkk (thiazide LIKE diuretics)

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8
Q

what was the first thiazide??

A

chlorthiazide

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9
Q

thiazides cause a loss of _____ _______ and ______ but they promote the reabsorption of _____

what can happen as a result???

A

cause a loss of sodium, potassium and magnesium but they promote the reabsorption of calcium

hypercalcemia may result

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10
Q

syptoms of severe kidney impairment

A

oliguria (marked decrease in urine output), elevated blood urea nitrogen and elevated serum creatinine

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11
Q

side effects/adverse reactions of thiazides

A

electrolyte imbalances (hypokalemia, hypERcalcemia, hypomagenesmia, bicarbonate loss)
hyperglycemia (bc thiazides affect the metabolism of carbs),
hyperuricemia (elevated serum uric acid level) and
hyperlipidemia (evelated blood lipid level)

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12
Q

thiazides are contraindicated in

A

renal failure

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13
Q

what is the most serious drug interaction with thiazide and why???

A

DIGOXIN. thiazides can cause hypokalemia which enhances the action of digoxin. it can also cause hypERcalcemia which also enhances the action of digoxin

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14
Q

what are the four serum electrolytes that must be monitored in thiazide diuretics

A

cholesterol, potassium, glucose, uric acid

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15
Q

what are the nursing interventions for thiazide diuretics

A
  1. monitor vital signs and serum electrolytes and report changes
  2. observe for signs and symptoms of hypokalemia (muscle weakness, leg cramps, cardiac dysrhythmias)
  3. monitor patient’s weight daily (weight gain of 2.2 lbs is equivalent to 1 L of body fluids)
  4. note urine output to determine fluid loss or retention

basically watching WEIGHT and ELECTROLYTES

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16
Q

PATIENT TEACHING FOR thiazide diuretics

A
  1. childproof bottles
  2. take hydrochlorothiazide early in the morning to prevent nocturia
  3. encourage adherence (patient may not feel better for a long time)
  4. inform pts that certain herbal products may interfere
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17
Q

pt teaching for thiazide diuretic side effects

A
  1. change positions slowly (hypotension)
  2. large doses increase blood sugar level, so advise pts with high BS to check it often
  3. suggest patients use sunblock for photosensitivity
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18
Q

pt. teaching thiazide diuretics DIET

A
  1. take it with food to prevent gastrointestinal upset

2. increase potassium in diet, may order potassium supplements

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19
Q

normal cholesterol lipid level

A

<200 mg/dL

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20
Q

normal LDL

A

<100 mg/ dL

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21
Q

normal triglyceride

A

10-190 mg/dL

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22
Q

normal uric acid

A

2.8-8.0 mg/dL

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23
Q

normal bicarbonate

A

24-28 mEq/L

24
Q

loop, or high-ceiling diuretics work on what part of the kidney?

A

loop diuretics work on the ascending loop to inhibit chloride transport of sodium into the circulation (they inhibit passive reabsorption of sodium)

25
loop diuretics are more effective/less effective for lowering blood pressure
they are LESS effective than thiazides
26
loop diuretics should NOT be prescribed if this can be use to _______ ________ _______ _______
if thiazides can alleviate body fluid excess, then loop diuretics should not be used
27
how do loop diuretics affect the kidneys?
they can increase the blood flow up to 40%
28
physiologic changes associated with loop diuretics
hypotension ototoxicity (hearing impairment, more common in use of ethacrynic acid, diuretics in other categories are not ototoxic. avoid taking loop diuretic with drugs that are ototoxic like aminoglycoside photosensitivity skin disturbances (purpura, pruritis, urticaria, exfoliative dermatitis) photosensitivity hypovolemia
29
lab changes associated with loop diuretics
1. hypocalcemia, hypomagnesemia, hyponatremia, hypochloremia, hypokalemia 2. thrombocytopenia and leukopenia. rare but should be monitored still 3. elevated BUN and creatinine due to hemoconcentration 4. hyperuricemia (common in patients susceptible to gout) 5. hyperglycemia (due to increased glycogenolysis. must monitor blood sugar levels of diabetics) 6. elevated lipids (there is an increase in low density liporproteins and an decrease in high density lipoproteins
30
Nursing interventions for loop diuretics
1. monitor urinary output ti determine body fluid gain or loss (output should be at least 30 mL/hr or 600 mL/24 hrs, notify HCP if does not increase, possible renal disorder 3. weigh patient to determine fluid loss or gain 4. monitor vital signs--be alert for marked decrease in blood pressure 5. administer FUROSEMIDE slowly; hearing loss may occur if injected rapidly! 6. observe for s/s of hypokalemia, monitor potassium level`
31
3 loop diuretics
BUM FUR-E TORSo (loop is the strongest diuretic 1. bumetanide 2. furosemide (lasix) 3. torsemide (demadex) 4. ethacrynic acid (edecrin)
32
osmotic diuretics
mannitol
33
carbonic anhydrase inhibitor
acetazolamide methazolamide ACETAmeniphen METHamphetine can cause a CARBONIC explosion -mide ending
34
osmotic diuretics are used to increase the _______ and ______ ________ in what part of the kidney? what is excreted?
increase the osmolality (concentration) and sodium reabsorption in the proximal tubule and loop of Henle. sodium, chloride potassium (lesser degree) are excreted
35
osmotic diuretics prevent this, decreases this and decreases this
kidney failure, decreases intracranial pressure (ICP) in cerebral edema, and decreases intraocular pressure (e.g. in glacuoma)
36
side effects of mannitol
fluid and electrolyte imbalance, pulmonary eema from rapid shift of fluids, N,V, tachycardia from rapid fluid loss and acidosis
37
mannitol should NOT be used if what is present?
crystals in the vial!!
38
carbonic anhydrase inhibitors block the action of ____ ______ which is needed to maintain? it causes increased excretion or reabsorption of these three
the action of carbonic anhydrase which is needed to maintain the body's acid base balance. causes increased sodium, potassium and bicarbonate excretion
39
carbonic anhydrase inhibitors are used primarily to do what?
decrease IOP in OPEN angle glaucoma. also for diuresis, management of epilepsy, and treatment of high altitude sickness
40
side effects of carbonic anhydrase
hemolytic anemia, renal calculi, metabolic acidosis, crystalluria
41
carbonic anhydrase is contrainidicated in
first trimester of pregnancy
42
potassium sparing diuretics act primarily in the
collecting duct renal tubules and late distal tubule to promot sodium and water excretion and potassium retention. interferes with the Na K pump controlled by aldosterone
43
as a result of spironolactone
the heart rate is more regular, and myocardial fibrosis possibility is decreased
44
potassium sparing diureitcs are used in combination with what drugs to reduce body fluid and sodium
hydrocholorthiazide and a loop idureitc
45
spironolactone, emiloride, triamterene, and eplerenone should not be taken with this class of drugs because they do what?
should not be taken with ACE inhibitors and angitoensin II receptor blockers bc they increase potassium levels
46
main side effect of potassium sparing diuretics
HYPERKALEMIA
47
nursing interventions for potassium sparing diuretics
1. note HALF life. with a long half life, drug dose is usually administered once, maybe twice a day 2. urinary output should increase 3. vital signs 4. hyperkalemia signs: nausea, diarrhea, abdominal cramps, numbness and tingling of hands, leg ramps, tachycardia and later bradycardia, peaked narrow T wave, or oliguria
48
thiazides work on the
distal tubule
49
thiazides promote calcium reabsorption or excretion?
reabsorption
50
first loop diuretic marketed usually reserved for patients who are
ethacrynic acid, seldom chosen. allergic to sulfa drugs
51
when taken with thiazide diuretics, which drug can increase blood pressure?
gingko
52
action of spironolactone
blocks the action of aldosterone and inhibits the sodium potassium pump (potassium is retained and sodium is excreted)
53
spironolactone has been prescribed for what types of patients?
pts with cardiac disorders because of its potassium retaining effect
54
metabolic acidosis can occur with prolonged use of what drug?
carbonic anhydrase inhibitor
55
which diuretic is OK ot use with low GFR
lasix
56
which is not ok for use with low GFR
thiazide diuretics

Pharmacology (10 decks)

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