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Pharm 2 > Exam 2- Renal > Flashcards

Exam 2- Renal Flashcards

1
Q

Where do Carbonic anhydrase inhibitors act

A

Proximal convoluted tubule

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2
Q

Where do Osmotic diuretics act

A

Loop of henle

and anywhere that is water permeable

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3
Q

Where do Loop diuretics act

A

Ascending loop of henle

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4
Q

Where do Thiazide diuretics act

A

Distal convoluted tubule

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5
Q

Where do Potassium sparing diuretics act

A

Collecting duct

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6
Q

Nursing Implications: Diuretics (6)

A
  1. Monitor intake and output
  2. Monitor electrolytes
  3. Complete health history
  4. Monitor vitals frequently
  5. Administer early in the day, allow access to bathroom
  6. Safety precautions (esp. elderly)
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7
Q

Nursing Implication specifically for Lasix

A

Will usually be administered with a K+ supplement (PO KCL normally)

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8
Q

Furosemide (Lasix) class

A

Loop diuretic (most effective diuretic)

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9
Q

Furosemide (Lasix) MOA/Onset

A

Acts on ascending loop of Henle to block reabsorption of sodium, chloride, and water. Excretion of potassium is increased
- Rapid onset (PO 60 min, IV 5 min)

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10
Q

Furosemide (Lasix) Indications (3)

A
  • Anytime you need rapid diuresis (e.g. Pulmonary edema)
  • Edematous states
  • Hypertension
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11
Q

Furosemide (Lasix) Adverse effects (7)

A
  • Hypokalemia
  • Hyponatremia
  • Hypochloremia
  • Dehydration
  • Hypotension
  • Hyperuricemia
  • Ototoxicity
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12
Q

Lasix + Digoxin, corticosteroids, amphotericin B =

A

Danger of hypokalemia

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13
Q

Lasix + lithium =

A

Increased excretion of lithium

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14
Q

Lasix + sulonylureas and insulin =

A

Diminished hypoglycemic effect

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15
Q

Lasix + NSAID’s =

A

diminished diuretic effect

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16
Q

Lasix + antihypertensives

A

increased risk of hypotension

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17
Q

Hydrochlorothiazide (Microzide) class

A

Thiazide

- Most commonly prescribed

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18
Q

Hydrochlorothiazide (Microzide) MOA

A

Block sodium reabsorption at the distal tubule

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19
Q

Hydrochlorothiazide (Microzide) Indications (3)

A
  • Hypertension (first choice med!!)
  • Diabetes Insipidus
  • Edema
20
Q

Hydrochlorothiazide (Microzide) Side Effects (6)

A

(almost same as Lasix)

  • Hypokalemia
  • Hyponatremia
  • Hypochloremia
  • Dehydration
  • Hypotension
  • Hyperuricemia
21
Q

Hydrochlorothiazide (Microzide) Contraindications

A

Don’t use if creatinine clearance is less than 30-50 mL/min

22
Q

Mannitol (Osmitrol) class

A

Osmotic diuretic

23
Q

Mannitol (Osmitrol) MOA

A

Cause diuresis by increasing the osmolality (number of solutes) of the filtrate.
This causes water to shift compartments due to osmotic pressure.
In addition to increasing renal osmolality they also cause changes in osmolality throughout the body.
(pulling of fluid out of spaces is the main use of the drug)

24
Q

Mannitol (Osmitrol) Indications (3)

A

Traumatic head injury, glaucoma, high intraocular pressure

25
Q

Mannitol (Osmitrol) Adverse Effects

A

Electrolyte imbalance
- Can cause either HYPO or HYPER kalemia and natremia.
(HypER when pulling solute into intravascular space, HypO when increasing excretion of Na+ and K+ in urine)

Fluid volume instability

  • Fluid overload when in vascular space
  • Dehydration when excreted
  • Dangerous in CHF due to fluid pulling
26
Q

Spironolactone (Aldactone) class

A

potassium sparing

27
Q

Spironolactone (Aldactone) MOA

A

Spironolactone acts by inhibiting the actions of aldosterone in the distal tubule and collecting ducts of the nephron.
When the actions of aldosterone are blocked by spironolactone, sodium, chloride, and water excretion are increased and the body retains potassium.

28
Q

Spironolactone (Aldactone) Indications (4)

A
  • Mild HTN
  • Useful in patients who need diuresis and are at high risk for hypokalemia
  • sodium retention associated with HF
  • edema or ascites in patients with hepatic cirrhosis, because it counteracts the large amount of aldosterone secreted by these patients.
29
Q

Spironolactone (Aldactone) Side Effects

A
  • Hyperkalemia- can lead to life-threatening cardiac dysrhythmias.
  • Hormonal changes: In men, spironolactone can cause gynecomastia, impotence, and diminished libido.
  • Women may experience menstrual irregularities, hirsutism, and breast tenderness. Fertility may decrease during therapy.
30
Q

Spironolactone (Aldactone) Black box warning

A

Spironolactone produces tumors in laboratory animals; unnecessary use of the drug should be avoided.

31
Q

Spironolactone (Aldactone) CI/Cautions (5)

A
  • Using potassium supplements or adding potassium-rich foods to the diet when taking these medications may lead to life- threatening hyperkalemia.
  • Anuria
  • severe renal impairment
  • Pregnancy
  • Caution in older patients and those with renal insufficiency or diabetes mellitus (high risk for hyperkalemia)
32
Q

Spironolactone (Aldactone) Drug Interactions (3)

A
  • When combined with ammonium chloride, acidosis may occur.
  • Aspirin and other salicylates may decrease the diuretic effect of the medication.
  • Concurrent use with digoxin may decrease the effects of digoxin.
33
Q

Sodium Chloride (NaCl) indication

A
  • treatment or prevention of sodium depletion when dietary measures are inadequate
34
Q

Sodium Chloride (NaCl) side effects

A
  • HYPER natremia (too much sodium)

- Pulmonary edema in more concentrated solutions

35
Q

Signs of hypernatremia

A

lethargy, confusion, hypotension, restlessness, rigidity

36
Q

Potassium Chloride (KCl) indications

A
  • treatment of potassium depletion when dietary means are not sufficient
  • Stop irregular heartbeats
  • Management of tachydysrhythmias that can occur after cardiac surgery
37
Q

KCl parenteral infusion implications

A
  • IV potassium must not be given at a rate faster than 10 mEq/hr to patients who are not on cardiac monitors.
  • For critically ill patients on cardiac monitors, rates of 20 mEq/hr or more may be used
  • NEVER give as an IV bolus or undiluted
38
Q

Magnesium Sulfate (MgSO4) Indications (3)

A
  • Severe hypomagnesemia
  • Catharsis of colon (milk of magnesia)
  • Anticonvulsant in patients with preeclampsia or eclampsia
39
Q

MgSO4 side effects (6)

A
  • Flushing of the skin
  • Diarrhea
  • Sedation/Confusion
  • Muscle weakness –> Neuromuscular blockade
  • Respiratory paralysis
  • Heart block, Circulatory collapse
40
Q

MgSO4 nursing implications (6)

A
  • Assess vital signs every 10 to 15 minutes when the drug is given IV
  • Monitor serum magnesium levels
  • Assess for early indicators of magnesium toxicity
  • Notify if respiratory rate falls below 12 breaths/minute
  • Test the patellar reflex before each repeated parenteral dose
  • Assess baseline and periodic urinary output; discontinue therapy if output less than 100 mL in preceding 4 hours
41
Q

MgSO4 Toxicity/Antidote

A
  • BP decreased, Urine output decreased, Respiratory rate <12, patella reflex absent
  • Calcium gluconate
42
Q

Sodium Bicarbonate Indications (3)

A
  • Correct metabolic acidosis
  • Alkalinize urine to speed the excretion of acidic medications
  • Neutralizes the metabolic acidosis that occurs in chronic renal failure
43
Q

Sodium Bicarbonate MOA

A

Bicarbonate ion buffers excess acid (H) to raise the pH of body fluids

44
Q

Sodium Bicarbonate side effects (5)

A
  • Metabolic alkalosis
  • Confusion
  • Irritability
  • Slow respiration rate
  • Vomiting
45
Q

Sodium Bicarbonate CI/cautions

A
  • Vomiting, Severe diarrhea or Continuous GI suctioning (all are losing acid and at risk for metabolic alkalosis)
  • Poor ventilation
    Precautions:
  • Cardiac disease
  • Renal impairment

Pharm 2 (5 decks)

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