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NURS 301 > Drugs That Affect Diuresis > Flashcards

Drugs That Affect Diuresis Flashcards

1
Q

What is Diuresis?

A

The process of ridding the body of fluids through the increased production of urine and the excretion of water and electrolytes

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2
Q

What do diuretics do?

A
  • Drugs that are diuretics are used to decrease fluid volume in pathologic conditions in which the body cannot self-regulate fluid volume effectively
  • Diuretics decrease renal reabsorption of sodium and promote its excretion in water
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3
Q

What does hypervolemia result from?

A

Excessive sodium and water retention

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4
Q

What does peripheral edema do to cardiac workload and tissue perfusion?

A

Increases cardiac workload

Decreases tissue perfusion

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5
Q

What pathological conditions do diuretics help to treat?

A

CHF
Pulmonary Edema
Hypertension
Kidney Disorders

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6
Q

Parts of the nephron

A

Glomerulus
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule

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7
Q

Three functions of the nephron

A

Filtration of the blood
Reabsorption
Active tubular secretion

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8
Q

What diuretic works in the proximal convoluted tubule?

A

Mannitol (65% NaCl reabsorption)

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9
Q

What diuretic works in the Loop of Henle?

A

Furosemide (Lasix) (20% NaCl reabsorption)

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10
Q

What diuretic works in the early distal convoluted tubule?

A

Hydrochlorothiazide (HCTZ) (10% NaCl reabsorption)

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11
Q

What diuretic works in the late distal convoluted tubule?

A

Spirolactone and Triamterene (1-5% Na and K –> spares potassium!)

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12
Q

Thiazide Diuretics

A

The thiazides comprise the largest group of diuretics

They are related structurally to the antibacterial sulfonamides (Sulfa drugs that treat infections)

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13
Q

Examples of Thiazide Diuretics

A

Thiazide diuretics include hydrochlorothiazide (HydroDIURIL), benzthiazide (Exna), chlorothiazide (Diuril), chlorthalidone (Hygrotin), and metolazone (Zaroxolyn)

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14
Q

Hydrochlorothiazide (HCTZ)

A
  • Manages HTN alone or with other drugs
  • Also used in treating edema resulting from CHF, hepatic cirrhosis, renal disease, and long-term steroid or estrogen therapy
  • Acts in the distal tubule and possibly in the diluting segment of the ascending loop of Henle
  • Increases the excretion of sodium and chloride in the distal convoluted tubule by slightly inhibiting the ion pumps that work in sodium and chloride reabsorption
  • A weak diuretic effect (of the three potent, potassium-wasting diuretics), because most of the sodium is reabsorbed before the distal tubule
  • Prototype thiazide diuretic
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15
Q

When taking HCTZ, the patient is at risk for…

A

Hypokalemia, acid/base imbalance, hypomagnesemia, and hypercalcemia

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16
Q

HCTZ _______ excretion of potassium, bicarbonate, and magnesium; and _______ excretion of calcium.

A

Increases; decreases

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17
Q

HCTZ may ________ glomerular filtration and ______ BUN.

A

Decrease; increase

18
Q

Contraindications of HCTZ

A

severe renal impairment, hepatic coma (will not be able to metabolize the drug), and hypersensitivity to the drug or to sulfonamide antibiotics

19
Q

Adverse Effects

A

Mostly due to effects of fluid loss or imbalance

Many drug interactions

20
Q

Before giving HCTZ, determine:

A

allergy to sulfa (safety!), renal status (severe impairment of the kidney – this drug will be of no benefit), hepatic status, blood glucose levels (can increase; contraindication for diabetics), lipid, and uric acid levels (can increase; contradiction for patients with gout)

21
Q

Loop Diuretics

A
  • Work in the Loop of Henle to inhibit the reabsorption of sodium and chloride
  • Exert a powerful effect of fluid and electrolyte balance
  • Called high-ceiling diuretics
22
Q

Examples of Loop Diuretics

A

furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), and torsemide (Demadex)

23
Q

Furosemide (Lasix)

A
  • A potent diuretic that is effective in reducing peripheral edema from CHF and hepatic and renal diseases, including nephrotic disease
  • It is highly effective in the treatment of pulmonary edema → Drug of choice, IV route
  • It also is effective in the treatment of HTN and is the first choice over thiazides in patients with pre-existing renal disease, because, unlike thiazides, it does not decrease glomerular filtration rate
  • Furosemide inhibits the reabsorption of sodium, chloride, and water in the ascending loop of Henle
  • It also has some effect in the proximal and distal tubules
24
Q

Furosemide ________ excretion of sodium, potassium, chloride, magnesium, calcium, and water

A

Increases

25
Q

What is the difference between HCTZ and Lasix?

A

Patient is at risk for hypocalcemia because calcium is excreted

26
Q

What lab values can be increased when taking Furosemide?

A

blood glucose, low-density lipoprotein, total cholesterol, uric acid and triglyceride levels

27
Q

Effects with IV administration of Furosemide occur within ___ minutes

A

10 –> cardiac arrest has been reported to occur

28
Q

What kind of toxicity may occur with rapid IV push administration of Furosemide?

A

Ototoxicity

29
Q

What is the recommended method for IV push administration of Furosemide?

A

20-40 mg of IV should be given over at least 1 to 2 minutes to decrease risk of ototoxicity (SLOW IV PUSH)

30
Q

Potassium Sparing Diuretics

A
  • Promote sodium and water excretion in the distal tubule; at the same time, potassium is not excreted; rather, it is reabsorbed
  • Produce weak diuresis and antihypertensive effects when used alone – is usually used with another diuretic
  • More frequently used in combination with loop and thiazide diuretics to minimize potassium loss because they work synergistically with other diuretics
31
Q

When taking a potassium sparing diuretic, the patient is at risk for…

A

Hyperkalemia

32
Q

Examples of Potassium Sparing Diuretics

A

triamterene (Dyrenium), amiloride (Midamor), and spironolactone (Aldactone)

33
Q

Triamterene (Dyrenium)

A
  • Nonaldosterone Antagonist
  • Used to manage edema and hypertension; typically used with other diuretics because it allows potassium to be reabsorbed and sodium to be excreted
  • Inhibits transport of sodium in the distal tubules independent of aldosterone; this causes increased loss of sodium, chloride, water, bicarbonate, and calcium; the drug promotes the retention of potassium and magnesium (patient could develop hyperkalemia and hypermagnesium)
  • Increases serum uric acid levels
  • Adverse effects related to electrolyte imbalance, particularly hyperkalemia, which may be fatal
  • Limit the patient’s intake of potassium
34
Q

Spironolactone (Aldactone)

A
  • Aldosterone Antagonist
  • Works in the distal tubule to increase sodium and water loss and to retain potassium
  • Interferes with testosterone synthesis, which leads to altered estrogenic and androgenic activity; a major use is in diagnosing and treating primary hyperaldosteronism (endocrine disorder)
  • Adverse effects: impotence, menstrual irregularities, and gynecomastia
  • Interacts with the salicylates (cannot take this drug with aspirin)
35
Q

Osmotic Diuretics

A
  • Increase osmotic pressure and pull fluid into the vascular space from the interstitum; are not reabsorbed by the tubules and so prevent water reabsorption; also prevent the reabsorption of sodium and chloride
36
Q

Examples of Osmotic Diuretics

A

mannitol (Osmitrol), glycerin, isosorbide, and urea

37
Q

Mannitol (Osmitrol)

A
  • Major uses include:
  • Preventing and treating ARF
  • Reducing intracranial pressure in cerebral edema
  • Reducing intraocular pressure when other drugs have not worked
  • Promoting excretion of toxic substances in urine
  • Prototype
38
Q

Glycerin (Glycerol)

A
  • An osmotic agent given orally to reduce intraocular pressure before ophthalmic surgery and during acute glaucoma attacks
39
Q

Isosorbide (Ismotic)

A
  • Used to provide short-term reduction of intraocular pressure before and after intraocular surgery, and to interrupt acute attacks of glaucoma
40
Q

Urea (Ureaphil)

A
  • Administered by IV infusion

- Used to decrease intracranial pressure and to reduce intraocular pressure

41
Q

Carbonic Anhydrase Inhibitors

A
  • Used to treat chronic open-angle glaucoma; also used in acute closed-angle glaucoma when delay of surgery is desired to reduce intraocular pressure; as an adjunct in treating edema resulting from CHF or use of drugs; as an adjunct in treating epilepsy; and in preventing and treating acute motion sickness
42
Q

Examples of Carbonic Anhydrase Inhibitors

A

acetazolamide (Diamox), methazolamide (Neptazane), and dichlorphenamide (Daranide)

NURS 301 (5 decks)

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