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pharm exam 3 > drug therapy for fluid volume excess > Flashcards

drug therapy for fluid volume excess Flashcards

1
Q

anasarca

A

generalized massive edema; entire body completely swollen

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2
Q

anuria

A

no urine output

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3
Q

ascites

A

fluid volume overload in the abdomen (distention looking/ beer belly)

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4
Q

edema

A

general swelling/ excess fluid buildup in the body

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5
Q

extracellular fluid

A

fluid outside the cell, not circulating through the cells

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6
Q

dependent edema

A

dependent on the lowest point of the body; if sitting, you might see feet and ankles swelling; if arm is dangling, you might see the hand start to swell

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7
Q

intracellular fluid

A

fluid inside the cells, going to be circulating around

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8
Q

renal physiology composed of

A

kidneys, ureters, bladder, urethra

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9
Q

primary function of kidneys

A

regulate volume, composition of urine, regulate pH, eliminating waste, BP regulation, RBC production, vitamin D conversion

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10
Q

kidneys receive what % of cardiac output (CO)

A

25%

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11
Q

erythropoietin is responsible for

A

stimulating the production of new RBCs, which will increase volume

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12
Q

25% of CO enter the kidneys through

A

the afferent arteriole right of the aorta

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13
Q

the blood will exit from the kidneys through

A

efferent arteriole

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14
Q

renal capsule

A
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15
Q

the three layers of kidneys

A

outer cortex, inner medulla, renal pelvis

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16
Q

outer cortex you see

A

part of the nephron

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17
Q

inner medulla you can see

A

loop of henle and collecting ducts

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18
Q

renal pelvis, the most inner part of the kidney you

A

take newly made urine and get ready to enter the utters and bladder

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19
Q

nephron functions

A

glomerular filtration, tubular secretions, tubular reabsorption

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20
Q

glomerular filtration is what

A

the passage of components of blood and fluid thru glomerulus (Na, K, protein; stay in blood/ extra meds, electrolytes will get filtered out)

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21
Q

tubular secretions is what

A

active movement of substances from blood thru renal tubule

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22
Q

tubular reabsorption is what

A

movement of substances from renal tubule back to vascular system

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23
Q

glomerular filtration in detail

A

arterial blood enters glomerulus via afferent arteriole; blood is coming in in high pressure pushing water, electrolytes and other solutes out -> bowmans capsule -> proximal tubule; GFR 125 ml/min; blood leaves the glomerulus via efferent arteriole

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24
Q

glomerular filtration rate (GFR)

A

125 ml/min = end product about 2 L of urine/ day

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25
Q

nephron

A

kidneys has millions

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26
Q

filtrate composition

A

h2o, NaCl, HCO3, H, urea, glucose, amino acids, some drugs

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27
Q

Whereis the loop of henle found

A

nephron; the nephron is the functional unit of the kidney. each nephron contains a tubule and a glamorous. there are about 1 millions nephrons in the kidney

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28
Q

conditions requiring diuretic agents/ alters in renal function

A

cardiovascular, renal, hepatic, burns, trauma, allergies, inflammatory reactions

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29
Q

clinical manifestions/ symptoms

A

edema, alterations in fluid or electrolyte balance (kidneys unable to control volume, composition, and pH of body)

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30
Q

types of edema

A

dependent edema, pulmonary edema (in the lungs), anasarca (massive generalized edema)

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31
Q

T or F. Edema occurs only when the heart no longer functions efficiently

A

false; edema is the excessive accumulation of fluid in body tissues. it is the symptom of many disease processes and may occur in any part of the body

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32
Q

diuretics do what

A

increase renal secretion of water, sodium, and other electrolytes (increase urine formation and output)

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33
Q

5 classes of diuretics

A

loop, thiazide, potassium sparing, osmotic, carbonic anhydrase

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34
Q

example of loop diuretic

A

furosemide (act in loop of henle)

35
Q

example of thiazide/ thiazide like diuretic

A

hydrochlorothiazide (HCTZ)/ metolazone (act in distal convoluted tubule)

36
Q

example of potassium sparing diuretic

A

spironolactone/ act in collecting duct

37
Q

example of osmotic diuretic

A

mannitol

38
Q

example of carbonic anhydrase inhibitor

A

acetazolamide (act in proximal convoluted tubule)

39
Q

principles of therapy diuretics

A

drug selection and dosing depend on the patients condition; loop diuretic is preferred when rapid diuretic effect is necessary or when renal impairment is present; potassium sparing diuretic may be used concurrently to prevent or manage hypokalemia

40
Q

pharmacokinetics of loop diuretic

A

PO/ IV/ IM

41
Q

mechanism of action of loop diuretic

A

inhibit Na+/ Cl- reabsorption, work in ascending loop of henle, produce significant fluid loss

42
Q

uses of loop diuretics

A

management of pulmonary edema, CHF, hepatic and renal disease/ combination for tx of HTN/ pts with renal impairment and hepatic impairment/ critically ill pts

43
Q

adverse effects of loop diuretics

A

fluid and electrolyte imbalances (you’ll see hyponatremia, hypokalemia, fluid volume deficit/ low BP), ototoxicity (ringing of the ears, permanent hearing loss)

44
Q

contraindications of loop diuretics

A

anuria, allergy to sulfonamides

45
Q

drug-drug interactions of loop diuretics

A

ahminoglycosides, cephalosporins, corticosteroids, digoxin

46
Q

drug-drug interactions of loop diuretics

A

ahminoglycosides, cephalosporins, corticosteroids, digoxin

47
Q

nursing implications of loop diuretics

A

**slow push 20mg/min, check labs: Na, K, baseline/ daily weight, accurate I & Os, monitor vitals (watch for hypotension)

48
Q

patient teaching about loop diuretics

A

low Na diet, high K diet, record daily weight, change position slowly, take in morning

49
Q

thiazide & thiazide like diuretics pharmacokinetics

A

PO

50
Q

mechanism of action of thiazide & thiazide like diuretics

A

decreases reabsorption of Na, Cl, H2O, HCO3, in the distal convoluted tubule

51
Q

uses of thiazide & thiazide like diuretics

A

first line tx of HTN, edema associated with CHF or nephrotic syndrome, or pts with renal impairment

52
Q

adverse effects of thiazide & thiazide like diuretics

A

hypotension, dizzy, hypokalemia, hyperglycemia, diarrhea, weakness

53
Q

contraindications for thiazide & thiazide like diuretics

A

allergy to sulfonamides and renal failure/ anuria

54
Q

nursing implications of thiazide & thiazide like diuretics

A

checks labs: Na, K, glucose, renal function/ baseline & daily weights, I & Os, vitals, given in AM

55
Q

patient teaching for thiazide & thiazide like diuretics

A

low Na diet, high K diet, daily weights, change positions slowly, take in the morning

56
Q

prevent and management of potassium imbalances: hypokalemia

A

low dosing of diuretics, using supplemental potassium, use potassium- sparing almond with potassium losing medication, increase food intake of potassium, restrict dietary sodium intake

57
Q

s/sx of hypokalemia

A

confusion ,weakness, heart palpatations (dysrhythmias), GI upset, SOB

58
Q

what assessment finding in a patient with heart failure receiving furosemide would indicate an improvement in fluid volume status?

A

absence of crackles on auscultation of Lungs; crackles usually indicate fluid in the alveoli, hearing no crackles would indicate there is no excess fluid remaining in the lungs

59
Q

pharmacokinetics of potassium sparing diuretics

A

slow onset and peak 24-48 hrs/ 6 weeks for maximum effect

60
Q

mechanism of action for potassium sparing diuretics

A

blocks effects of aldosterone, weak diuretic effect, use in combination with other diuretics

61
Q

uses for potassium sparing diuretics

A

tx of heart failure, ascites in liver disease, hypokalemia, mild-moderate HTN, hyperaldosteronism

62
Q

adverse effects of potassium sparing diuretics

A

dizziness, diarrhea, androgen like effects, increase risk of GI bleed, BLACK BOX warning for tumorigenic with chronic toxicity

63
Q

contraindications for potassium sparing diuretics

A

renal insufficiency, hyperkalemia

64
Q

drug-drug interactions for potassium sparing diuretics

A

ACE inhibitors, ARBs, K+ containing drugs

65
Q

nursing implications of potassium sparing diuretics

A

check labs: K, renal function, daily weights, I & Os

66
Q

patient teaching of potassium sparing diuretics

A

low salt, low K diet, daily weight, monitor abd girth (liver disease), take in morning with food

67
Q

prevention and management of potassium imbalances: hyperkalemia

A

potassium sparing along with potassium wasting medications, avoid potassium supplements, avoid salt substitutes, maintain urine output

68
Q

s/sx of hyperkalmeia

A

muscle cramps, EKG changes, low BP, diarrhea, death, weakness, dysrhythmias

69
Q

osmotic diuretics pharmacokinetics

A

IV- in glass bottle

70
Q

mechanism of action of osmotic diuretics

A

increases solute load (osmotic pressure) of glomerular filtrate, pulls from extracellular into blood, decreases reabsorption of H2O and electrolytes

71
Q

uses of osmotic diuretics

A

reduction of intracranial pressure, reduction of intraocular pressure, effective in decreased renal circulation and GFR

72
Q

adverse effects for osmotic diuretics

A

hyperosmolar non-ketotic coma, confusion, HA, cardiac dysrhythmias, severe dehydration

73
Q

contraindications of osmotic diuretics

A

severe dehydration, pulmonary edema, older adults, abdominal pain

74
Q

nursing implications of osmotic diuretics

A

baseline physical exam of vitals, I & Os, monitor vitals

75
Q

antidote for mannitol (osmotic diuretic)

A

hyaluronidase

76
Q

pharmacokinetics of carbonic anhydrase inhibitors

A

IV/ eye gtt (eye drop)

77
Q

mechanism of action of carbonic anhydrase inhibitors

A

inhibits carbonic anhydrase to reduce formation of aqueous humor and lower IOP

78
Q

uses of carbonic anhydrase inhibitors

A

open angle glaucoma, secondary glaucoma

79
Q

adverse effects of carbonic anhydrase inhibitors

A

**metabolic acidosis, Stephen Johnson syndrome, flaccid paralysis, blood dycrasias

80
Q

contraindications of carbonic anhydrase inhibitors

A

renal/ hepatic disease, Addisons disease, chronic non-congestive angle closure glaucoma

81
Q

nursing implications for carbonic anhydrase inhibitors

A

baseline vision exam, eye drop administration

82
Q

how to give eye drops

A

head back and look up, pull lower eyelid down and squeeze prescribed number of drops in the pocket (lower conjuctiva)

83
Q

a nurse is instructing a pt on dietary considerations while taking spironolactone. which of the following statements made by the patient indicates further teaching is necessary ?

A

I should use salt substitutes instead of regular salt; most sale substitutes use potassium chloride as it tastes like salt. foods high in potassium should be avoided with spironolactone which is a potassium sparing diuretic

pharm exam 3 (5 decks)

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