Diuretics (week 5)

Question 1

How do diuretics lower blood pressure?

Answer 1

decrease blood volume by removing water from specific areas (dependent upon the type of diuretic)

Question 2

Loop diuretics lower blood pressure by

Answer 2

decreasing blood volume by removing water from the loop of henle

Question 3

Thiazide diuretics lower blood pressure by

Answer 3

decreasing blood volume by removing water from the distal tubule - causes vasodilation directly

Question 4

Potassium Sparing diuretics lower blood pressure by

Answer 4

decreasing production of aldosterone that excretes more electrolytes

Question 5

Which two diuretics have weak or minimal diuretic effects?

Answer 5

Potassium sparing and thiazide

Question 6

Potassium sparing diuretics lead to retention of potassium by

Answer 6

decreasing sodium reabsorption

Question 7

What are the FDA approved indications for loop diuretics?

Answer 7

edema, high blood pressure

Question 8

What are the adverse effects associated with loop diuretics?

Answer 8

photosensitivity, dizziness, dehydration, hypokalemia, elevated uric acid (concern in gout)

Question 9

What are the drug interactions for loop diuretics?

Answer 9

NSAIDs (ibuprofen) decrease the effects

Question 10

What is the box warning for loop diuretics?

Answer 10

fluid/electrolyte loss - must be closely monitored for signs of dehydration and supervise dose adjustments

Question 11

What are the contraindications for loop diuretics?

Answer 11

sulfa drug allergy and kidney dysfunction/lack of urine production

Question 12

What are the patient counseling points for loop diuretics?

Answer 12

increased urination (significant change, avoid taking at night), watch for dehydration, caution of standing too quickly (orthostasis)

Question 13

What is the brand name of furosemide?

Answer 13

Lasix (loop diuretic)

Question 14

What is the brand name of HCTZ?

Answer 14

Microzide (thiazide diuretic)

Question 15

What is the brand name of spironolactone?

Answer 15

Aldactone (potassium sparing diuretic/aldosterone antagonist)

Question 16

What is the brand name of triamterene HCTZ?

Answer 16

Dyazide, Maxzide (potassium sparing diuretic)

Question 17

What are the FDA approved indications for thiazide diuretics?

Answer 17

edema (less effective compared to loop diuretics) and high blood pressure (usually first line agent)

Question 18

What are the adverse effects associated with thiazide diuretics?

Answer 18

photosensitivity (more common than loop), dizziness, hypokalemia (less common than loop), elevated uric acid and blood glucose (concern for diabetic patients)

Question 19

What are the drug interactions for thiazide diuretics?

Answer 19

NSAIDs - decrease effects

Question 20

What is the boxed warning for thiazide diuretics?

Answer 20

no boxed warning

Question 21

What are the contraindications for thiazide diuretics?

Answer 21

kidney disfunciton/lack of urine production, sulfa drug allergy

Question 22

What are precautions for thiazide diuretics?

Answer 22

risk for gout attack with a dose higher than 25 mg

Question 23

What are patient counseling points for thiazide diuretics?

Answer 23

increased urination wears off typically after 30 days, caution about time spent in the sun, take in the morning (due to increased urination)

Question 24

What are the FDA indications for potassium sparing diuretics?

Answer 24

edema and high blood pressure

Question 25

Heart failure and low potassium are indications that are approved for which potassium sparing diuretic only?

Answer 25

spironolactone

Question 26

What are the adverse effects associated with potassium sparing diuretics?

Answer 26

hyperkalemia

Question 27

What are the adverse effects associated with spironolactone?

Answer 27

gynecomastia, impotence or irregular menses

Question 28

What are the drug interactions for potassium sparing diuretics?

Answer 28

potassium supplements, ACE-I and ARBs

Question 29

What is the box warning for potassium diuretics?

Answer 29

for triamterene only, fatal hyperkalemia, especially in those with kidney dysfunction, diabetes and severe illness

Question 30

What are precautions for potassium sparing diuretics?

Answer 30

patients with electrolyte abnormalities or kidney dysfunction

Question 31

What are the contraindications for triamterene?

Answer 31

potassium supplementation (boxed warning for fatal hyperkalemia)

Question 32

What are patient counseling points for potassium sparing diuretics?

Answer 32

minimizing potassium intake, counsel on symptoms of dehydration and low blood pressure

Question 33

General diuretic counseling points

Answer 33

take in the morning due to increased urination, signs of dehydration and low blood pressure (orthostasis)

Question 34

The extended release capsule for potassium chloride comes in what brand names?

Answer 34

Klor-Con, Sprinkle, Micro-K

Question 35

The packet form of potassium chloride comes in what brand names?

Answer 35

K-Vescent, Klor-Con

Question 36

The solution form of potassium chloride comes in what brand names?

Answer 36

K-Sol

Question 37

The extended release tablet comes in what brand name?

Answer 37

K-tab, Klor-Con

Question 38

What are the adverse effects of potassium chloride supplements?

Answer 38

cardiac conduction issues and GI (NVD)

Question 39

What are drug interactions for potassium chloride supplements?

Answer 39

ACE-I, ARB, potassium sparing diuretics, Mrs. Dash

Question 40

What are patient counseling points for potassium chloride supplements?

Answer 40

take each dose with full glass of water and meal to minimize GI irritation, SR dosage forms should not be crushed, many dosage forms contain wax matrix that can be seen in the stool, capsules can be sprinkled on foods like pudding