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Pharm 1 > drug therapy for fluid volume excess > Flashcards

drug therapy for fluid volume excess Flashcards

1
Q

what is anasarca

A

generalized severe edema

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2
Q

what is anuria

A

no urine output

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3
Q

what is ascites

A

fluid build up in abdomen

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4
Q

what is edema

A

-swelling, excess build up of fluid in body tissue
-can be dependent (builds up in lowest point of body)

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5
Q

what is extracellular fluid

A

-fluid outside of the cells
-build up may lead to edema

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6
Q

what is intracellular fluid

A

-fluid inside the cell
-circulates around

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7
Q

what is the renal system composed of

A

-kidneys
-ureters
-bladder
-urethra

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8
Q

how much cardiac output do kidneys receive?

A

25%

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9
Q

name some primary functions of the kidneys

A

-regulate volume
-composition of urine
-regulate pH
-eliminating wastes
-BP regulation
-RBC production (stimulate erythropoietin)
-vitamin D conversion

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10
Q

describe blood supply of the kidneys

A

-blood enters kidneys through the afferent arteriole (right off the aorta)
-blood leaves kidneys and goes back out to the body through the efferent arteiole

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11
Q

what is the renal capsule

A

fibrous tissue layer that protects kidneys

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12
Q

what are the regions of the kidney and describe them just a little

A

-outer cortex (has nephrons)
-inner medulla (contains loop of henle)
-renal pelvis (takes urine and send it to the ureter)

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13
Q

whats a nephron

A

-found in renal cortex
-functional unit of the kidney
-each kidney has about a million of these fuckers

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14
Q

name three nephron functions

A

-glomerular filtration
-tubular secretions
-tubular reabsorption

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15
Q

describe glomerular filration

A

-passage of components of blood and fluid through glomerulus
-filter out the good shit and send it back to the body (some Na+, K+, protein) and sends the rest of it to the ureter

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16
Q

describe tubular secretions

A

active movement of substances from blood through renal tubule

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17
Q

describe tubular reabsorption

A

movement of substances from renal tubule back to the vascular system

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18
Q

how does blood eneter the glomerulus

A

afferent arteriole

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19
Q

is glomerular filtration a high or low pressure system?

A

high pressure (70mmHg)

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20
Q

describe the path of glomerular filtration

A

-high pressure system pushes water, electrolytes, and other solutes out
-then it goes to bowman’s capsule which catches stuff and weaves it to the proximal tubule
-proximal tubule is where the refinement of urine occurs

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21
Q

what is normal GFR? what happens if its low?

A

-125ml/min
-end product about 2L of urine/day
-decreased GFR = decreased UOP

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22
Q

how does blood leave the glomerulus?

A

efferent arteriole

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23
Q

where is the loop of henle found?

A

nephron
rationale:the nephron is the functional unit of the kidney. each nephron contains a tubule and a glomerulus

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24
Q

what are some conditions that may require diuretic agents?

A

-alterations in renal function
-causal conditions:
cardiovascular
renal
hepatic
burns
trauma
allergies
inflammatory responses

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25
Q

name three causes of edema and how would you treat them?

A

-increase capillary permeability
-increased hydrostatic pressure
-decreased plasma oncotic pressure

tx: diuretic

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26
Q

describe increased capillary permeability

A

-part of response to tissue injury or allergic response
-caps open up and let fluid flow from vessels to extravascular space, leading to swelling

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27
Q

describe increased hydrostatic pressure

A

-increased fluid volume and increased venous pressure
-pushes fluid out of capillaries
-seen with fluid overload

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28
Q

describe decreased plasma oncotic pressure

A

-result from low plasma proteins
-lets fluid leak into external tissue

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29
Q

what are some clinical manifestations of fluid volume excess?

A

-edema (symptom of many disease processes)
-alterations in fluid/electrolyte balance (kidneys control volume, composition, and pH of body fluids)

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30
Q

name some different types of edema

A

-dependent
-pulmonary
-anasarca

diuretics can be used for all

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31
Q

true or false?

edema only occurs when the heart no longer functions efficiently

A

false
rationale: edema is the exvessive accumulation of fluid in body tissues. it is the sx of many disease processes and may occur in any part of the body

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32
Q

what do diuretics do?

A

-increases renal secretion of water, sodium, and other electrolytes
-increases urine formation and output

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33
Q

name some different diuretic classes

A

-loop diuretics (furosemide)
-thiazide/ thiazide-like diuretics (HCTZ/metolazone)
-potassium sparing diuretics (spironolactone)
-osmotic diuretics (mannitol)
-carbonic anhydrase inhibitors (acetazolamide)

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34
Q

drug selection and dosing with diuretics is dependent on…

A

-the patient’s condition
-is it acute or chronic?

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35
Q

which diuretic is preferred when rapid diuretic effect is necessary or when renal impairment is present?

A

loop diuretic

36
Q

which diuretic may be used concurrently to prevent or manage hypokalemia?

A

potassium-sparing diuretic

37
Q

name some examples of loop diuretics

A

-furosemide
others:
-bumetanide
-torsemide

38
Q

how can loop diuretics be administered

A

-PO
-IV (fastest and strongest)
-IM

39
Q

describe the action of loop diuretics

A

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

40
Q

what are some uses of loop diuretics

A

-management of pulmonary edema, CHF, hepatic and renal disease
-given alone/combination for treatment of HTN
-patients w renal impairment
-patients w hepatic impairment
-critically ill patients
-home care pts

41
Q

what are some adverse effects of loop diuretics

A

-fluid/electrolyte imbalances (hyponatremia, hypokalemia, fluid volume deficit)
-ototoxicity (plasma drug levels >50 mcg/ml)

42
Q

what is ototoxicity

A

-ringing in ears
-can cause permanent hearing loss

43
Q

what are some contraindications of loop diuretics

A

-anuria
-allergy to sulfonamides

44
Q

what are some drug-drug interactions with loop diuretics

A

-aminoglycosides, cephalosporins (increase diuretic effect)
-corticosteroids, digoxin (increased risk of low potassium)

45
Q

wha are some nursing implications of loop diuretics

A

-slow push: 20mg/min
-check labs, especially Na+, K+, renal function
-baseline weight and daily weight
-accurate I and Os
-closely monitor vitals, watch for hypotension
-give PO in AM
-monitor safety r/t dizziness

46
Q

why would you give loop diuretics slow push?

A

to prevent ototoxicity

47
Q

describe pt teaching for loop diuretics

A

-low sodium diet
-high potassium diet
-record daily weight
-change position slowly
-take in morning

48
Q

give two examples of thiazide and thiazide like diuretics

A

-hydrochlorothiazide (HCTZ)
-metolazone (thiazide like)

49
Q

how are thiazide and thiazide like diuretics given

A

PO
(not nearly as powerful as loop diuretics - good for at home maintenance)

50
Q

describe the action of thiazide and thiazide like diuretics

A

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

51
Q

describe the use of thiazide and thiazide like diuretics

A

-first line of treatment for mild-moderate HTN
-edema associated CHF or nephrotic syndrome
-patients with renal impairment

52
Q

what are some adverse effects of thiazide and thiazide like diuretics

A

-hypotension
-dizziness
-hypokalemia
-hyperglycemia
-weakness
-diarrhea/constipation

53
Q

what are some contraindications of thiazide and thiazide like diuretics

A

-allergy to sulfonamides
-renal failure/anuria

54
Q

what are some nursing implications r/t thiazide and thiazide like diuretics

A

-check labs esp: Na, K, glucose, renal function
-baseline weight and daily weight
-accurate I & Os
-closely monitor vitals, watch for hypotension
-give in AM
-monitor safety r/t dizziness

55
Q

what are some important things to include with patient teaching for thiazide and thiazide like diuretics

A

-low sodium diet
-high K diet
-record daily weight
-change position slowly
-take in morning

56
Q

describe the signs and symptoms of hypokalemia

A

-K below 3.5
-confusion
-weakness
-heart palpitations
-GI upset

can cause serious cardiac arryhtmias and death

57
Q

describe the prevention of hypokalemia

A

-low dosing of diuretics
-using supplemental potassium
-use potassium sparing along with potassium losing medications
-increase food intake of potassium
-restrict dietary sodium intake

58
Q

which 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
B) complaints of nocturnal dyspnea
C) bounding radial pulse
D) decreased hematocrit

A

A) absence of crackles on auscultation of lungs

crackles usually indicate fluid in alveoli, hearing no crackles would indicate there is no excess fluid remaining in the lungs

59
Q

give an example of potassium-sparing diuretics

A

spironolactone

60
Q

describe the pharmacokinetics of potassium-sparing diuretics

A

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

61
Q

describe the action of potassium-sparing diuretics

A

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

62
Q

describe the use of potassium-sparing diuretics

A

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

63
Q

what are the adverse effects of potassium-sparing diuretics

A

-dizziness
-diarrhea
-androgen like effects (breast growth in males, irregular periods in females)
-increase risk of GI bleed

black box warning: tumorigenic with chronic toxicity

64
Q

what are some contraindications of potassium-sparing diuretics

A

-renal insufficiency
-hyperkalemia

65
Q

what are some drug-drug interactions with potassium-sparing diuretics

A

-ACE-I
-ARBs
-K+ containing drugs

66
Q

what are some nursing implications r/t potassium-sparing diuretics

A

-check labs esp: K+, renal function
-baseline weight and daily weight
-accurate I&Os
-monitor safety r/t dizziness

67
Q

describe patient teaching for potassium-sparing diuretics

A

-avoid salt substitutes
-low k diet
-record daily weight
-monitor abd girth (liver disease)
-change position slowly
-take in morning with food

68
Q

describe some signs and symptoms of hyperkalemia

A

-K+ greater than 5
-muscle cramps
-EKG changes
-hypotension
-cardiac arrythmias

can be fatal

69
Q

describe the prevention of hyperkalemia

A

-potassium sparing along with potassium wasting meds
-avoid potassium supplements
-avoid salt substitutes
-maintain urine output

70
Q

give an example of osmotic diuretics

A

mannitol

71
Q

describe how osmotic diuretics are given

A

IV - in glass bottle

usually in critical care areas

72
Q

describe the action of osmotic diuretics

A

-increase solute load (osmotic pressure) of glomeruler filtrate
-pulls from extravascular into blood
-decreases reabsorption of H2O and electrolytes

73
Q

what are some uses of osmotic diuretics

A

-reduction of intracranial pressure
-reduction of introcular pressure
-effective in decreased renal circulation and GFR

74
Q

what are some adverse effects of osmotic diuretics

A

-hypersmolar non-ketotic coma
-confusion
-headache
-syncope
-cardiac dysrhythmias
-severe dehydration

75
Q

what are some contraindications of osmotic diuretics

A

-severe dehydration
-abdominal pain
-appendicitis
-pulmonary edema
-severe cardiac decompensation
-older adults

76
Q

what are some nursing implications for osmotic diuretics

A

-baseline physical exam, neuro, vitals
-accurate I&Os
-closely monitor vitals

77
Q

what antidote is give if IV infiltrates with osmotic diuretics?

A

hyaluronidase

78
Q

give an example of carbonic anhydrase inhibitors

A

acetazolamide

79
Q

describe the pharmacokinetics of carbonic anhydrase inhibitors

A

given IV (like never tho) and eye gtt

80
Q

describe the action of carbonic anhydrase inhibitors

A

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

81
Q

describe the use of carbonic anhydrase inhibitors

A

-open angle glaucoma
-secondary glaucoma

82
Q

what are some adverse effects of carbonic anhydrase inhibitors

A

-metabolic acidosis
-stephen johnson syndrome
-flaccid paralysis
-blood dyscrasias

83
Q

what are some contraindications of carbonic anhydrase inhibitors

A

-chronic non-congestive agle-closure glaucoma
-renal/hepatic disease
-addisons disease
-electrolyte imbalance

84
Q

what are some nursing implications r/t carbonic anhydrase inhibitors

A

-baseline vision exam
-eye gtt administration

85
Q

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

A) I should not eat foods high is potassium while taking this med
B) I should use salt substitutes instead of regular salt
C) I should call the nurse practitioner if I have any adverse effects from my med
D) I should not take potassium supplements

A

B) I should use salt substitutes instead of regular salt

most salt substitutes use potassium chloride as it tastes like salt. food high in potassium be avoided with spironolactone which is a potassium sparing diuretic

Pharm 1 (29 decks)

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