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Pharm > Diuretics, fluid and electrolytes > Flashcards

Diuretics, fluid and electrolytes Flashcards

1
Q

Diuretics are used for

A

Treatment of HTN and promotes the mvmt and excretion of edematous fluid to help prevent renal failure

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2
Q

MOA of the loop diuretics
FUROSEMIDE & TORSEMIDE

A

acts of the ascending loop of henle & blocks reabsorption of Na and Cl

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3
Q

What are the therapeutic uses of Furosemide and Torsemide

A

pulmonary edema
CHF
edema
HTN

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4
Q

what are the side effects of Furosemide and Torsemide

A

dehydration
electrolyte disturbance
–> hypokalemia, hyponatremia, hypocholoremia, hyperglycemia & hyperuricemia

Hypotension & tachycardia
1. Relaxation of venous smooth muscle

** Ototoxicity
If given IV push too fast (over 2 min)**

Contraindications:
—Do not use in pregnancy–

 Drug interactions: 1. 	Increases the action of: 2. 	Digoxin toxicity 3. 	Ototoxic drugs (aminoglycosides)  4. 	Potassium sparing diuretics  5.  Lithium 6.  HTN drugs 7. NSAIDs (blocks the action of the drug)

loop diuretics

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5
Q

Nursing//PT Education on Furosemide & Torsemide

A
  • Most effective in producing the greatest output
  • Most frequently prescribed loop diuretic is Lasix
  • Rapid onset; half-life approx. 6 hours
  • Effective even when glomerular filtration rate (GFR) is low
  • Monitor patient for physical symptoms:
    o CNS: Dizziness, headache, tinnitus, blurred vision
    o GI: N/V/D
  • Use with caution in patients who have DM or Gout
  • Monitor K levels
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6
Q

what is the MOA of Thiazide Diuretic
Hydrochlorothiazide

A

Acts in the distal convoluted tubule & blocks sodium reabsorption in the distal convoluted tubule

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7
Q

what is the treament for Hydrochlorothiazide

A

1st line treatment of HTN & is used for edema

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8
Q

what are the adverse effects of Hydrochlorothiazide

A
  1. dehydration
  2. Electrolyte disturbance
    (hypokalemia, hyponatremia, hypochloremia, hyperglycemia, hyperuricemia)
  3. Hypotension & Tachycardia
  4. loss of volume

This drug is contraindicted for:

Pregnancy & lactation
when used with digoxin

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9
Q

Nursing implication// PT teaching for hydrochlorothiazide

A

Most popular diuretic
- potassium is excreted to lesser extent
- moderate onset with a1/2 life of 4-6 hours
- ineffective if GRF is lesss than 15-20 ml/min
- impacts lipids, calcium and magnesium lvls
- monitor K levels

GRF levels above 15-20 works best
monitor k+ levels

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10
Q

MOA of spironolactone and Triamterene

potassoim sparing diruetric (aldosterone antagonist)

A

spironolactone blocks aldosterone in the distal nephron
Triamterene is a non-aldosterone antagonist

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11
Q

what is spironolactone and Triamterne used for

A

HTN, Edema, severe HF, primary hyperaldosteronism (only spironolactone)

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12
Q

what are the adverse effects of Spironolactone & Triamterence

A

hyperkalemia
blue urine
Dizziness, HA
abd. cramps, n//v//d
frequent urination
mm weakness
tumors of the sex organs

Drug Interactions: Thiazide and loop diuretics, when given together counteract teh potassium wasting effects

-watch out for agents that raise potassium lvls… ACE inhibitors

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13
Q

MOA of Mannitol

what does this drug do

Osmotic diuretic

A

acts in the proximal tubule lumen of the nephron & pulls fluid back into the blood vessles and nephrones from the surrounding tissue by increasing blood osmolarity

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14
Q

Therapeutic use of Mannitol

A
  • prophylaxis of renal failure
  • reduction of intracranial pressure
  • must be given IV
  • reduction of intraocular pressure
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15
Q

Nursing implications for Diuretics

ALL DIURETICS

A
  1. teach pt to maintain proper nutritional and fluid volume status
  2. teach pt to eat more K rich foods when taking any diuretic other than the potassium sparing agents
  3. Monitor K+ levels 3.5-5.0
  4. bananas, oranges, dates, raisins, plums, fresh veggies, potatoes, meat and fish are foods high in K+
  5. monitor FSBS for DM (hyperglycemia)
  6. take in the morning to avoid nocturia or early afternoon
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16
Q

Therapeutic Effects include:

A

reduction in edema, fluid volume overload, Hrt failure, HTN
& intraocula// intracrainial pressures return back to normal

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17
Q

what is an isotonic contration

A

volume contraction where sodium and water are lost in isotonic proportions
- Na loss=H2O loss

ex= Diarrhea and vomitting

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18
Q

what are the side effects of isotonic contraction

dehydration

A

thirst, dry mouth, lips and eyes
fatigue, dizzy, lightheaded
less urination, dark and strong smelling

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19
Q

Treatment for isotonic contractions

A

isotonic fluids

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20
Q

what is hypertonic contraction

A

loss of water exceeds loss of sodium

  • H2O loss > Na Loss
  • Example: sweating or burns
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21
Q

what are side effects of hypertonic contraction

A

thirst, dry mouth lips and eyes
fatigue, dizzy and lightheaded
urinating less than 4x day
dark yellow and strong smelling urine

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22
Q

treatment for hypertonic contraction

A

hypotonic fluids or fluids that contain none or few solute- 0.45% NS

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23
Q

Hypotonic contraction

A

loss of sodium exceeds loss of water
- Na loss> H20 loss
Ex: excessive loss of sodium through the kidney

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24
Q

side effects of Hypotonic contraction

A
  • Thirst, dry mouth, lips, eyes
  • Fatigue, dizzy, lightheaded
  • Urinating less or fewer than 4x daily, dark yellow and strong-smelling urine
25
Q

treatment for hypotonic contraction

A
  • Isotonic sodium chloride (moderate)
  • Hypertonic fluids (severe)
26
Q

volume expansion (volume overload)

A

overdose with therapeutic fluids or disease
EX: HRT disease, CHF, renal failure

27
Q

Side effects of volume expansion

A

edema, fluid overload and pulmonary congesiton

28
Q

Treatment for fluid overload

A

diuretics

29
Q

0.9% of sodium chloride Treatment use

isotonic solution w/ pH of 5.7

A
  1. isotonic hydration
  2. replaces sodium and chloride
  3. alkalosis
  4. used in blood transfusions
30
Q

5% Dextrose in water Treatment use

isotonic solution D5W pH of 5.0

A

isotonic hydration
provides some calories

31
Q

complications of 5% dextrose in water

A

*Water intoxication
* Dilution of body’s electrolytes with long/continuous infusion

32
Q

Ringers injection U.S.P. Treatment use

Isotonic solutoin pH of 5.8

A
  • electrolyte replacement
  • hydration
  • used to replace extracellular fluid loss
33
Q

complications fo Ringers injection

A
  • Rapid administration leads to excessive introduction of electrolytes
  • Leads to fluid overload and congestive conditions
  • Provides no calories and is not an adequate
    maintenance solution if abnormal fluid losses are present
34
Q

Lactated Ringers treatment

isotonic solution pH 6.6

A
  • isotonic hydration
  • replace electrolytes and extra-cellular fluid losses
  • mild to moderate acidosis
    o the lactate is metabolized into bicarbonate which counteracts the acidosis
35
Q

complications of Lactated Ringers

A
  • not enough electrolytes for maintenance
  • patients with hepatic disease have trouble metabolizing the lactate
  • do not use if lactic acidosis is present
36
Q

3% sodium chloride treatment use

hypertonic solution pH of 5.0

A
  • symptomatic hyponatremia (due to excessive sweating)
  • vomiting
  • renal impairment
  • excessive water intake
37
Q

complications of 3% sodium chloride

A
  • rapid or continuous infusion can result in hypernatremia or hyperchloremia
38
Q

5% sodium chloride treatment

hypertonic solution pH 5.8

A
  • symptomatic hyponatremia (due to excessive sweating)
  • vomiting
  • renal impairment
  • excessive water intake
39
Q

complications of 5% sodium chloride

A
  • rapid or continuous infusion can result in hypernatremia or hyperchloremia
40
Q

10% Dextrose in Water treatment

hypertonic solution ph 4.3 D10 W

A
  • hypertonic hydration
  • provides some calories
41
Q

complications of 10% dextrose in water

A
  • may be infused peripherally
  • water intoxication and dilution of body’s electrolytes with long/continuous infusions
42
Q
  • 5% Dextrose in 1/4 Strength (or 0.25%) Saline Treatment//Complications

Hypertonic solution D5¼NS pH 4.4

A
  • fluid replacement
  • replacement of sodium, chloride and some calories
  • vein irritation because of acidic pH
  • causes agglomeration (clustering) if used with blood transfusions
  • hyperglycemia with rapid infusion leading to osmotic diuresis
43
Q
  • 5% Dextrose in 0.45 Sodium Chloride treatment and complications

hypertonic solution D5½NS pH 4.4

A
  • hypertonic fluid replacement
  • replace sodium, chloride, and some calories

*vein irritation because of acidic pH
* causes agglomeration (clustering) if used with blood transfusions
* hyperglycemia with rapid infusion leading to osmotic diuresis

44
Q
  • 5% Dextrose in Normal Saline treatment and complications

hypertonic D5NS pH 4.4

A
  • hypertonic fluid replacement
  • replace sodium, chloride and some calories
  • vein irritation because of acidic pH
  • causes agglomeration (clustering) if used with blood transfusions
  • hyperglycemia with rapid infusion leading to osmotic diuresis
45
Q
  • 5% Dextrose in Lactated Ringer Injection treatment and complications

hypertonic solution D5LR pH 4.9

A
  • hypertonic hydration
  • provides some calories
  • replace electrolytes and extra-cellular fluid losses
  • mild to moderate acidosis
    o the lactate is metabolized into bicarbonate which counteracts the acidosis
  • the dextrose minimizes glycogen depletion
46
Q

0.45% Sodium Chloride treatement and complications

hypotonic solution ½NS pH 5.6

A
  • hypotonic hydration
  • replace sodium and chloride
  • hyperosmolar diabetes
  • if too much is mixed with blood cells during transfusions the cells will pull water into them and rupture
  • Contraindicated in TBI due to being hypotonic
47
Q

LAB VALUE– Normal–

A

Potassium 3.5- 5.5 mmol/L

Magnesium 1.5-2.4 mmol/L

Sodium 135-145 mEq/L

Calcium 8.5-10.5 mg/dL

Chloride 105-105 mEq/L

48
Q

hypermagnesium

mg greater than 2.5 meg/L

A

causes
* Acute or chronic renal disease
* PPIs
* Malnourishment
* ETOH use
* Hypothyroidism and cortico-adrenal insufficiency

Side effects
* CNS: sedation
* CV: hypotension
* Respiratory: respiratory paralysis occurs at levels of 12-15 meq/L (renal insufficiency)
* MSK: neuromuscular blockade (muscle weakness, depression or absent deep tendon reflexes)

ECG changes
* Prolongation of PR interval
* Prolongation of the QRS complex
* Prolonged QT interval
* Increased T wave

Treatment
IV calcium gluconate

49
Q

hypomagnesium

mg less than 1.8

A

**causes **
* Diarrhea
* Hemodialysis
* Kidney disease
* Prolonged IV feeding
* Chronic alcoholics
* DM & pancreatitis

**S/S **
* CNS/Neuro: disorientation, seizures
* MSK: Increased muscle excitability (tetany)

**ECG changes **
* Often associated with hypokalemia and hypocalcemia and ECG changes will reflect those electrolyte imbalances

**Treatment **
* Magnesium gluconate and magnesium hydroxide (MOM)
* Magnesium sulfate (IV or IM)

50
Q

Hyperkalemia

k greater than 5-7 meq/L

A

causes
* Severe tissue trauma
* Untreated Addison’s disease
* Acute acidosis
* Draws K out of the cell and into the serum
* Misuse of potassium sparing diuretics
* Overdose with IV potassium * CNS- irritability and anxiety

S/S
* CV- hypotension, dysrhythmias
* GI- abdominal cramping, diarrhea
* MSK- muscle twitching, cramps, paresthesia

EKC Changes
* Flat P
* Prolonged P-R interval
* Wide QRS
* Depressed ST segment
* Peaked T wave

Treatment
* Withhold foods that contain potassium
* Withhold medications that promote potassium accumulation
* Infusion of sodium bicarbonate, infusion of insulin and glucose
* Promotes uptake of potassium by the cells
* Kayexalate
* Oral or enema
* Promotes potassium excretion and sodium absorption in the large intestine

51
Q

hypermagnesium

A

**Cause **
* Tx with a thiazide or loop diuretic (most common)

S/S
* General- weakness, fatigue
* CNS- confusion, drowsiness, lethargy, irritability
* Respiratory- shallow respirations
* CV- arrhythmias (irregular rate), tachycardia, thready pulse
* GI- N/V, decreased intestinal motility, Ileus

**EKG Changes **
* Flat and inverted T wave (mild hypokalemia)
* Prolonged QT interval
* Visible U wave
* ST depression
* Torsades de points and ventricular tachycardia with severe hypokalemia

Treatment
Potassium salts
* Oral potassium chloride (K-Dur, Micro-K)
* IV potassium chloride
* Contraindications to potassium use
* Hyperkalemia, renal impairment
* Nursing education
* Never give potassium IV push = it will kill the patient
* No more than 10 meq/Hr IV
* No more than 40 meq/L to prevent vein irritation

52
Q

Erythropoientin (Epogen or Procrit) MOA

A
  • A recombinant erythropoietin drugs that work by stimulating the production of RBCs
  • Interacts directly with the EPO receptor on the RBC surface, triggering activation of transduction pathways resulting in the proliferation of RBCs
53
Q

therapeutic use//adverse effects of Erythropoientin

A

Therapeutic use
*Anemia and chronic renal failure

Adverse effects
* HTN

54
Q

Nursing Education for Erythropeientin

A
  • SQ injection once weekly
  • Can be given IV
  • Do not shake the bottle which could lead to denaturing of the protein molecule
  • Monitor RBC (hemoglobin) level twice weekly to once weekly
  • Hg goal is 10 -12 gm/dL
55
Q

packed red blood cells

A

MOA
* RBCs transport oxygen and carbon dioxide to and from the tissues

Therapeutic use//Adverse effects
* Contains RBC only * Anemia
* Replacement of traumatic or surgical blood loss

Nursing education
* must be given IV

56
Q

platelets

A

MOA
* Promotes blood clotting and wound healing

**Therapeutic use// Adverse effects **
* Used when patients are bleeding (hemorrhage)
* Replacement of lost or low platelets

Nursing education
* must be given IV

57
Q

Fresh frozen plasma

A

**MOA **
* Contains all coagulation factors
* No platelets
**Therapeutic use **
* Used in patients with bleeding problems
* Used after trauma or liver transplants

Nursing education
* Frozen products must thaw prior to use

58
Q

Albumin

A

**MOA **
* Albumin is a protein found in the blood
* produced in the liver and enters the bloodstream where it is carried to other parts of the blood
* Primary function is to keep fluid from leaking out of the blood and to carry substances like hormones, enzymes, and vitamins in the body

**Therapeutic use//Adverse effects **
* Used in blood volume replacement

Nursing education
* IV

59
Q

normal lab values

A

Potassium

3.5- 5.0 mEq/L

Magnesium

1.5-2.4 mEq/L

Sodium

135-145 mEq/L

Calcium

8.5-10.5 mg/dL

Chloride

95-105 mEq/L

Pharm (11 decks)

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