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Pharm 2 (diuretics & aldosterone antagonists) > diuretics updated > Flashcards

diuretics updated Flashcards

1
Q

Diuretics GOAL

A

increase rate of urine formation
Increase urine volume
net loss of solute (electrolytes) and water

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2
Q

Osmotic Diuretics GOAL

A

Increase osmotic pressure of tubular filtrate
fluid moved from ICF to ECF, inhibits renin release
Increases renal blood flow
excretion of electrolytes–Na, K, Ca, Mg, Cl, HCO3, Phosphate

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3
Q

Osmotic Diuretics
Mannitol (Osmitrol)

Uses

A
  • reduce CSF pressure– with cerebral edema or pre or post neuro surgery
  • Reduce intraocular pressure–glaucoma and pre-op
  • Increase urine flow to prevent nephrotoxicity–dilute toxic substances
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4
Q

Osmotic Diuretics
Mannitol (Osmitrol)

Adverse effects

A
  • Headache, nausea, vomiting
  • with CHF–risk of fluid overload by increased ECF
  • Contraindicated with CHF, renal failure, hepatic failure
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5
Q

Osmotic Diuretics
Mannitol (Osmitrol)

Nursing Implementations

A
  • Give IV via filter
  • Monitor output, BP
  • Lungs sounds
  • Serum osmolality, electrolytes
  • Intracranial pressure
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6
Q

Carbonic Anhydrase Inhibitors GOAL

A
  • Lower intracellular pressure (IOP)
  • Not increase urine production
    • urine alkalizes, metabolic acidosis a risk
    • marked potassium excretion
    • Reduce aqueous humor production by (Ca inhibition in ciliary processses of the eye
    • Reduce intraocular pressure
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7
Q

Carbonic Anhydrase Inhibitors
Acetazolamide (Diamox)

Uses

A
  • Glaucoma, eye surgery
  • Allalinize urine for drug excretion
  • Altitude sickness
    (low to Mod. Efficacy to mobilize edema)
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8
Q

Carbonic Anhydrase Inhibitors
Acetazolamide (Diamox)

Adverse Effects

A
  • Sulfoamide derivatives (watch for sulfa drug allergies)
  • Hypokalemia (cause to loose potassium)
  • Metabolic acidosis (contraindicated with COPD (Resp Acidosis))
  • Paresthesias (pins and needles)
  • Risk of renal calculus R/T CaPO4 precipitation in alkaline urine (stay hydrated)
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9
Q

Thiazide Diuretics Goal

A
  • Sulfonamide derivatives
  • Increase excretion of Na+ and H2O
  • Increase excretion of K+
  • Loss of Mg+
  • Retention of Ca++
    Some antihypertensive effect
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10
Q

Thiazide Diuretics
Hydrochlorothiazide(HCTZ, Hydrodiuril)

Uses

A
  • Edema in mild-Mod CHF
  • Treat Hypertension –Mild-Mod HTN –often first line drug
  • Edema in hepatic disease
  • early, mild renal disease – less effective with more advanced disease
  • Combo’s with antihypertensive–synergistic effects
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11
Q

Thiazide Diuretics
*Hydrochlorothiazide(HCTZ, Hydrodiuril)

Adverse effects

A
  • Electrolyte loss –esp K+
  • Loss of other electrolytes –Na+, Cl-, H+
  • Retain Ca++, Uric acid
  • Renal insufficiency aggravated
  • Hyperglycemia in diabetics–reduces effectiveness of oral agents and Insulin
  • Hyperlipidemia
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12
Q

Thiazide Diuretics
*Hydrochlorothiazide(HCTZ, Hydrodiuril)

Nursing interventions

A 
Monitor BP, K+, edema
monitor BG's for diabetics
May need potassium supplements
K+ containing foods: citrus, bananas, salt substitutes etc 
Check for sulfa allergy
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13
Q

Loop Diuretics –High Ceiling– Goals

A

inhibit electrolyte re absorption in ascending loop of Henle, weak carbonic anhydrase effects
increase renal blood flow
some decrease in BP–? Prostaglandidn effect
Increase loss of K+, Mg, acid, ammonia (liver failure)
Rapid onset, short duration–except in renal, hepatic disease
Sulfa derivatives (allergies)

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14
Q

Loop Diuretics
Furosemide (Lasix)

Uses

A

edema of cardiac, renal, hepatic origin
acute pulmonary edema
early renal failure, nephrotic syndrome
hypertension

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15
Q

Loop Diuretics
Furosemide (Lasix)

Adverse Effects

A

Electrolyte loss – K+, Na++
Sulfa Allergy (except Ethacrynic acid)
Ototoxicity – high dose–reversible (Ethacrynic acid worse)
Hypotension – high dose – Esp. IV
Diabetics – hyperglycemia ( up BG)
long term –Ca++ or Mg+ loss
Increased LDL, Cholesterol, Triglycerides

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16
Q

Loop Diuretics
Furosemide (Lasix)

Nursing implications

A

monitor I&O, BP, electrolytes– K+, may need K+ supplements
edema, daily weight
toxicity
provide means to void or cath (30 min)
PO – 8 hour duration– give early in the day
diabetics–monitor glucose

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17
Q

Aldosterone antagonists GOAL

A

Potassium sparing diuretics
competitive antagonists of aldosterone
loss of sodium, water: CONSERVATION OF POTASSIUM
SLOW ONSET 24-48 HOURS

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18
Q

Aldosterone antagonists
Spironalactone (Aldactone)

Uses

A

hypertension, edema
drug of choice for edema and ascites with hepatic disease
some use with CHF
treat primary hyperaldosteronism (adrenal tumors)

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19
Q

antagonists
Spironalactone (Aldactone)

Adverse Effects

A

hyperkalemia (affinity for progesterone and androgen receptors)
gynecomastia, impotence, menstrual irregularity (not with eplerenone)

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20
Q

antagonists
Spironalactone (Aldactone)

Nursing implementations

A

CAUTION WHEN COMBINED WITH OTHER DIURETICS, ACE INHIBITORS OR IN RENAL DISEASE, NO POTASSIUM SUPPLEMENTS

ALSO NOT SALT SUBSTITUTES( they contain KCl

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21
Q

Why Combos??

A

Better diuresis with 2 sites of action
usually less problem with K+
Effects vary **STILL MONITOR K+**

22
Q

Other Combos

A

thiazides with antihypertensives ***MUST KNOW OTHER COMBOS

23
Q

Nitrates Goals

A

Source of nitric oxide–leads to relaxation of vascular smooth muscle by
dilate arterial and venous smooth muscle
reduce myocardial oxygen demands/ dilate coronary vessels/reduce preload and afterload
No change in heart rate or force of contraction

24
Q

Nitrates has other effects

A

Dilate smooth muscle – GI tract – especially esophagus
Nitrate dependence/tolerance–mechanism not clear but is not universal.(some develop only partial tolerance)
Ideally, interrupt therapy for 8-12 hours/day

25
Q

Nitrate
Nitroglycerin (NTG)

Uses:

A

treat or prevent angina
chest pain with MI
may reduce the size of MI
adjunct therapy for CHG

26
Q

Nitrate
Nitroglycerin (NTG)

Adverse effects

A

Headache
flushing, dizziness, arteriole vasodilation
hypo tension – especially postural, worse with ETOH
treat with supine position
if Bp too low to provide adequate cardiac output can worsen ischemia

27
Q

Nitrate
Nitroglycerin (NTG)

Interactions:

A

with phosphodiesterase-5 inhibitors (Viagra)
These also increase nitric oxide
can cause extreme hypo tension (treat with fluids and alpha agonist )

MUST NOT USE NITRATES WITHIN 24 HOURS OF VIAGRA, ETC

28
Q

Nitrate
Nitroglycerin (NTG)

IV

A

titrate to reduce chest pain in ACS (MI, unstable angina)
Reduce preload–>reduce pulmonary congestion in acute CHF

Rapid onset/ short duration
maintain BP >100 systolic // min to min BP
observe for headache

29
Q

Nitrate
Nitroglycerin (NTG)

Sub lingual

A

Onset 1-2 min, relief in ~3 min (spray is faster)
DO NOT SWALLOW
rinse mouth if dry before giving tablets or spray
deteriorates in heat and light/ keep in dark, tightly closed container

30
Q

Angina teach

A

rest with pain
take NTG SL, repeat in 5 min if needed
if NO RELIEF after 3 NTG call 911

rise slowly
ETOH will increase any side effects

31
Q

Nitrate
Nitroglycerin (NTG)

Trans dermal patch

A

slow onset, peak 1-2 hours, lasts 24 hours
place where visible, non-hairy, not over bony prominences
change every 24 hours or so

32
Q

Nitrate
Nitroglycerin (NTG)

Paste

A 
relieve ACUTE angina
onset ~ 30-60 min, duration 4 hours
measured in inches
same placement as patch 
cover with occlusive material
33
Q

Nitrate
Nitroglycerin (NTG)

Oral Pills/ capsules

A

for more than occasional angina

some debate on effectiveness–requires high enough dose to develop tolerance and increase risk of adverse reaction

34
Q

Nitrate

Nitroprusside (Nipride) goal

A

relax arteriole and venous smooth muscle
reduce preload and afterload
releases cyanide ion from smooth muscle
worse over time (3-4 days) toxicity, worse in renal disease

35
Q

Nitrate
Nitroprusside (Nipride)

use

A

Treat hypertensive crisis

treat severe CHF (with inotropics)

36
Q

Nitrate
Nitroprusside (Nipride)

given

A 
IV--via pump, titrate to effect
     rapid onset (1-2) min
     short duration(3min)
37
Q

Nitrate
Nitroprusside (Nipride)

nursing interventions

A

monitor BP frequently (arterial cath)
Monitor thiocyanate levels

(IV pump usually only given in ICU setting)

38
Q

Inotropic Medications
Digoxin (Lanoxin)

Uses

A

used for CHF
to slow ventricular rate in atrial fibrillation and flutter
IT INCREASES CONTRACTILITY IN CHF

DUE TO POTENTIAL TOXICITIES, RESERVED FOR THOSE UNRESPONSIVE TO ACE INHIBITORS AND BETA BLOCKERS

39
Q

Inotropic Medications
Digoxin (Lanoxin)

Adverse Effects

A

High risk for Toxicity
narrow range of therapeutic index or range
risk increases with renal disease , hypokalemia

40
Q

Inotropic Medications
Digoxin (Lanoxin)

Toxicity

A 
nausea, vomiting, diarrhea
malaise, confusion
Bradycardia, leads to heart block 
ventricular tachycardia, fibrillation
***Visual effects : blurred vision, halos around lights, seeing yellow/red spots
41
Q

Inotropic Medications
Digoxin (Lanoxin)

treat toxicity

A

stop drug, treat dysrhythmias
get serum drug level
Digozin immune Fab (Digibing)
binds digoxin, readily excreted, monitor K+

42
Q

Inotropic Medications
Digoxin (Lanoxin)

Nursing implications

A

Can give PO or IV
digitalization–can take a week to reach steady state
use loading doses to reach steady state in 24 hours–not often used
monitor therapeutic blood levels
check apical pulse 1 min before giving
hold if 120
monitor K+ especially with diuretics
rapid digitalization requires cardiac monitoring

43
Q

Inotropic Medications
Dopamine (Intropin)

Goal

A

it is positively chronotropic
it is positively inotropic
increases cardiac output with minimal increase in myocardial oxygen consumption

44
Q

Inotropic Medications
Dopamine (Intropin)

Uses

A

treat hypotension in shock

Severe CHF or cardiogenic shock (short term)

45
Q

Inotropic Medications
Dopamine (Intropin)

nursing

A

given via IV pump in ICU setting
dose calculated by weight –mcg/kg/min–verify calculations
Arterial BP, cardiac output
IV site for extravasation–risk for tissue necrosis due to vasoconstriction
EKG for tachycardia
urine output for renal function

46
Q

Inotropic Medications
Dopamine (Intropin)

Doses

A 
low dose: affects Dopamine receptors
    dilate renal and mesenteric vessels
     improve response to diuretics
Mod dose: affect Beta 1 receptors
     increase heart rate, contracitlity
     some increase in BP due to norepinephrine release 
High dose:  affects Alpha receptors
     increase BP, vasoconstriction
     most useful in shock (sepsis, anaphylaxis)
47
Q

Nesiritide (Natrecor)

what is it

A

human b-type natriuretic peptide (hBNP)
Endogenous hBNP secreted by ventricles
in response to fluid and pressure overload

48
Q

Nesiritide (Natrecor)

Goal

A

reduce preload and afterload
natriuresis, diuresis,
suppress renin-angiotensin system
lowers norepinephrine effects

enhances endogenous hBNP function
reduces pulmonary capillary wedge pressure and dyspnea
can see hypotension

can use for acute CHF treatment–given IV
can be combined with diuretics, others CHF meds

49
Q

Also remember

A

ACE inhibitors–reduce afterload, decrease ventricular remodeling (first line drugs for CHF

50
Q

And remember this too

A

Beta-Blocker –Carvedilol –(mixed alpha 1 and Beta) reduce afterload

antiproliferative properties

Pharm 2 (diuretics & aldosterone antagonists) (1 decks)

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