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Pharm #3: DIU/HTN/CAD/HF/BLD > Diuretics Drug List > Flashcards

Diuretics Drug List Flashcards

1
Q

What are diuretics used to treat?

A

Edema/Volume Overload
Hypertension
Congestive Heart Failure
Can be used to prevent renal failure

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2
Q

What determines the effectiveness of a diuretic?

A

Effectiveness of diuretics depends on amt of Na/Cl blocked. Action early in nephron –> greater diuretic effect.

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3
Q

What’s the MOA of diuretics?

A

Block Na/Cl reabsorbtion in nephron, blocking passive H20 reabsorption

  • amt urine r/t amt of na/cl blocked
  • early in nephron = greatest effect
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4
Q

Describe the pharmacokinetics of diuretics.

A
  • Oral or Parenteral (rapid onset)
  • Effect @ diffferent sections of nephron
  • Excreted and metabolized in kidney in liver
  • Drug action specific to drug
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5
Q

What imbalances occur with diuretics?

A

Hypovolemia
Electrolyte:
- hyponatremia
- hypokalemia - give supplements, potassium rich foods)
- hypokalemia (dysrhythmia, muscle weakness, cramping, flaccid paralysis, leg discomfort, extreme thirst, confusion)
- hyperkalemia (if aldosterone is blocked)

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6
Q

What are the nursing implications for diuretics use?

A

Nursing implicatinos for diuretics usage:

  • Assess volume: output > input
  • Monitor weight loss 2.2lbs=1L=1kg
  • Assess / monitor mucus membranes, edema, skin turgor
  • Assess for orthostatic hypotension
  • Assess electrolyte abnormalities
  • Dose in AM prevent nocturia –> falls!
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7
Q

MANNITOL: Describe the type, MOA, location of action, uses, pharmacokinetics, side/adverse effects, and potential drug interactions.

A

Drug: Mannitol
Type: Osmotic diuretic

MOA:
suger solute, cant be filtered/absorbed, added to filtrate in nephron, causes water to pull into tubule via osmosis, results in diuresis.

Occurs in proximal tubule

Uses: Kidney protection: low flow, mannitol remains in nephron preserving urine flow preventing renal failure. Also, intracranial hypertension - Mannitol cant cross BBB, draws H20 out of brain: (intracranial hypertension
increased intraocular pressure)

Pharmacokinetics:

  • more mannitol present = more diuresis
  • must be given IV

Side / adverse effects:
Hypokalemia
Hypovolemia
Contraindicated in heart failure: vascular osmotic effect precedes renal diuretic effect, draws H20 into all blood vessels increasing HTN

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8
Q

What is the MOA of Mannitol?

A

MOA:
suger solute, cant be filtered/absorbed, added to filtrate in nephron, causes water to pull into tubule via osmosis, results in diuresis. Occurs in proximal tubule.

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9
Q

What is Mannitol used for?

A

Uses: Kidney protection: low flow, mannitol remains in nephron preserving urine flow preventing renal failure

Intracranial hypertension:
Mannitol cant cross BBB, draws H20 out of brain: (intracranial hypertension
increased intraocular pressure)

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10
Q

What are some PK notes on Mannitol?

A

Pharmacokinetics:

  • more mannitol present = more diuresis
  • must be given IV
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11
Q

What are some side effects of Mannitol?

A

Side / adverse effects:
Hypokalemia
Hypovolemia
Contraindicated in heart failure: vascular osmotic effect precedes renal diuretic effect, draws H20 into all blood vessels increasing HTN

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12
Q

FUROSEMIDE: Describe the type, MOA, location of action, uses, pharmacokinetics, side/adverse effects, and potential drug interactions.

A

DRUG: Furosemide
TYPE: Loop diuretic

MOA:

  • produce more loss of fluid/electrolytes than any other diuretic –> profound diuresis
  • can be used even when urine flow is SCANT

EFFECT:

  • blocks 20% of Na/Cl/H20 @ ascending loop
  • high ceiling diuretic

USES:

  • Fluid Overload (pulmonary edema, renal/cardiac)
  • Hypertension that cant be treated w/ other diuretics
  • All patients who need diuretic and have low renal blood flow

PK:
Oral or Parenteral (good if emergency)

Works with patients with renal failure ( antibiotics

DRUG INTERACTIONS:

  • Digoxin: hypokalemia, increase risk dysrhythmias
  • Aminoglycocides antibiotics: ototoxicity
  • Potassium sparing diuretics can be used to offset hypokalemia
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13
Q

What is the MOA of FUROSEMIDE? What is the effect?

A

MOA:

  • produce more loss of fluid/electrolytes than any other diuretic –> profound diuresis
  • can be used even when urine flow is SCANT
  • blocks 20% of Na/Cl/H20 @ ascending loop
  • high ceiling diuretic
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14
Q

What is FUROSEMIDE used for?

A

USES:

  • Fluid Overload (pulmonary edema, renal/cardiac)
  • Hypertension that cant be treated w/ other diuretics
  • All patients who need diuretic and have low renal blood flow
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15
Q

What are some PK notes on FUROSEMIDE?

A

PK:
Oral or Parenteral (good if emergency)

Works with patients with renal failure (<15-20ml/min, normal is 125ml/min) even if GFR is low

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16
Q

What are some side effects of FUROSEMIDE?

A

SIDE EFFECTS:

  • Hypokalemia: fatal dysrhythmias under 3.5
  • Hypovolemia
  • Hypotension (r/t loss volume and relaxing venous smooth muscle)
  • Severe dehydration (risk for thrombosis/embolism
  • Electrolyte imbalances:
  • hyponatremia (decrease Na causes a decrease in Cl)
  • hypochloremia
  • hypokalemia (decrease in K causes a decrease in Mg)
  • hypomagnesemia
  • Hyperglycemia: inhibits insulin release pancreas.
  • Hyperuricemia: uric acid esp w/ those at risk for gout
  • Altered fat metabolism (increase LDL, TG, decrease HDL)
  • Ototoxicity r/t high ceiling diuretic, esp w/ ototoxic drugs -‘mycin’ antibiotics
17
Q

What are the drug interactions of FUROSEMIDE?

A

DRUG INTERACTIONS:

  • Digoxin: hypokalemia, increase risk dysrhythmias
  • Aminoglycocides antibiotics: ototoxicity
  • Potassium sparing diuretics can be used to offset hypokalemia
18
Q

What drug is similar to FUROSEMIDE? What is a major way that it differs?

A

HYDROCHLOROTHIAZIDE (HCTZ) is similar to FUROSEMIDE but HYDROCHLOROTHIAZIDE can’t be used when urine is scant. Also, FUROSEMIDE is ototoxic, while HYDROCHLOROTHIAZIDE is NOT ototoxic.

19
Q

What drug is similar to HYDROCHLOROTHIAZIDE? What is a major way that it differs?

A

HYDROCHLOROTHIAZIDE (HCTZ) is similar to FUROSEMIDE but HYDROCHLOROTHIAZIDE can’t be used when urine is scant. Also, FUROSEMIDE is ototoxic, while HYDROCHLOROTHIAZIDE is NOT ototoxic.

20
Q

HYDROCHLOROTHIAZIDE (HCTZ): Describe the type, MOA, location of action, uses, pharmacokinetics, side/adverse effects, and potential drug interactions.

A

Drug: HYDROCHLOROTHIAZIDE (HCTZ)
Type: Thiazide

MOA:
Similar to furosemide but can’t be used when urine is scant (i.e. renal failure patients)

Diuresis effect is lower, no ototoxicity
cant be used w/ renal failure patients

Blocks 10% of Na, Cl, H20 @ early distal convoluted tubule

USES:
first line drug for HTN and Edema
* useful for AA HTN (salt sensitivity)”

PK:
oral only, and ineffective with renal failure (low glomerular filtration)

SIDE/ADVERSE EFFECTS:

Hypovolemia
Hypotension
hyponatremia
hypochloremia
hypokalemia
hypomagnesemia
Hyperglycemia
Hyperuricemia
hypercholesterolemia, triglyceridemia
NO OTOTOXICITY

DRUG INTERACTIONS:
- digoxacin: hypokalemia

  • combined w/ antihypertensives as a single pill to improve compliance
21
Q

What is the MOA of HYDROCHLOROTHIAZIDE? What is the effect?

A

Drug: HYDROCHLOROTHIAZIDE (HCTZ)
Type: Thiazide

MOA:
Similar to furosemide but can’t be used when urine is scant (i.e. renal failure patients)

Diuresis effect is lower, no ototoxicity

Blocks 10% of Na, Cl, H20 @ early distal convoluted tubule

22
Q

What is HYDROCHLOROTHIAZIDE used for?

A

USES of HYDROCHLOROTHIAZIDE:
First line drug for HTN and Edema
* useful for AA HTN (salt sensitivity)

23
Q

What are some PK notes on HYDROCHLOROTHIAZIDE?

A

PK of HYDROCHLOROTHIAZIDE:

  • oral only
  • ineffective with renal failure (low glomerular filtration)
24
Q

What are some side effects / adverse effects of HYDROCHLOROTHIAZIDE?

A

SIDE EFFECTS of HYDROCHLOROTHIAZIDE:

Hypovolemia
Hypotension

hyponatremia
hypochloremia
hypokalemia
hypomagnesemia

HYPERglycemia
HYPERuricemia
HYPERcholesterolemia
Triglyceridemia

NO OTOTOXICITY

25
Q

What are some drug interactions of HCTZ?

A

DRUG INTERACTIONS of HCTZ:
- digoxin: hypokalemia

  • combined w/ antihypertensives as a single pill to improve compliance
26
Q

SPIRONOLACTONE: Describe the type, MOA, location of action, uses, pharmacokinetics, side/adverse effects, and potential drug interactions.

A

DRUG: SPIRONOLACTONE
TYPE Potassium Sparing Diuretic

MOA:
inhibits ALDOSTERONE @ late distal tubule

EFFECT:
less Na/H20 excretion - mild diuresis
substantial K+ reabsorbtion
blocks 1-5% of Na, H20 - excretes potassium (aldosterone) @ later in distal convoluted tubule

USES:
Congestive Heart Failure r/t blocking aldosterone not r/t diuresis (aldosterone makes heart more fibrotic, stiffens blood vessels)

PK:
Effects are typically delayed 48 hours, blocks synthesis of NEW proteins, but does not stop existing transport proteins

SIDE / ADVERSE EFFECTS:
Hyperkalemia: aldosterone causes reabsorbtion of Na & excretion of K. By blocking aldosterone, K is re-absorbed: fatal dysrhythmias if above 5.5, insulin can temporarily control

DRUG INTERACTIONS:
used in combo w/ thiazide and loop diuretics to offset hyperkalemia

similar chem. structure to estrogen/testosterone - unpredictable effects

  • given w/ loops & thiazides
  • avoid drugs that increase K+
27
Q

What is the MOA of SPIRONOLACTONE? Where does it function? What are the physiological effects?

A

MOA:
inhibits ALDOSTERONE @ late distal tubule

EFFECT:
less Na/H20 excretion - mild diuresis
substantial K+ reabsorbtion
blocks 1-5% of Na, H20 - excretes potassium (aldosterone) @ later in distal convoluted tubule

28
Q

What are the uses of SPIRONOLACTONE?

A

USES:
Congestive Heart Failure r/t blocking aldosterone not r/t diuresis (aldosterone makes heart more fibrotic, stiffens blood vessels)

29
Q

What are the pharmacokinetics of SPIRONOLACTONE?

A

PK:

Effects are typically delayed 48 hours, blocks synthesis of NEW proteins, but does not stop existing transport proteins

30
Q

What are the side effects of SPIRONOLACTONE?

A

SIDE / ADVERSE EFFECTS:
Hyperkalemia: aldosterone causes reabsorbtion of Na & excretion of K. By blocking aldosterone, K is re-absorbed: fatal dysrhythmias if above 5.5, insulin can temporarily control

31
Q

What are the drug interactions of SPIRONOLACTONE?

A

DRUG INTERACTIONS:
used in combo w/ thiazide and loop diuretics to offset hyperkalemia

similar chem. structure to estrogen/testosterone - unpredictable effects

  • given w/ loops & thiazides
  • avoid drugs that increase K+

Pharm #3: DIU/HTN/CAD/HF/BLD (2 decks)

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