Failure/Diuretics Flashcards

1
Q

Therapy for people with renal failure

A

Altering diet to reduce protein content, sodium, potassium, phosphorus and magnesium
Possible fluid restriction
Discontinue nephrotoxic medications
Dialysis in end stages

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2
Q

Pharm tx of renal failure

A

Treat the primary cause of the problem, often with cardiovascular drugs
Diuretics, if kidney has some function, are used as well to increase urinary output

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3
Q

Renal failure diet

A

Low protein
Limit salt intake to less than 1 tsp

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4
Q

phosphate and CKD

A

Phosphorus is a mineral that keeps your bones strong and healthy, but too much of it can cause itchy skin or painful joints. When kidneys start to fail, the phosphate levels in blood will increase. At that point they may need to limit foods that contain phosphorus, especially those that have phosphates added to them to lengthen shelf life or enhance flavor.

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5
Q

Diuretic indications

A

Hypertension, Heart failure
Renal failure
Liver failure or cirrhosis
Pulmonary edema

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6
Q

Adverse effects of adverse effects

A

Electrolyte imbalances
Dehydration, hypotension

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7
Q

Types of diuretics

A

Loop or high-ceiling
Thiazides
Potassium-sparing
Osmotic
Carbonic anhydrase inhibitors
Common to combine two or more drugs

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8
Q

Thiazide and Thiazide-Like Diuretics

A

Block Na+ reabsorption at distal tubule, reducing reabsorption of water
Available only PO except for chlorothiazide
Indications
Hypertension
Edema
Adverse effects similar to loop diuretics, but thiazides do not promote ototoxicity

Less diuresis than lasix

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8
Q

Loop (High-Ceiling) Diuretics

A

Reduces Na+, K+, Cl- reabsorption at loop of Henle increasing diuresis
Available in oral or parenteral formulations
Indications
Edema
Hypertension
HF
Adverse effects
Hypotension, hypokalemia, ototoxicity

IV or IM

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9
Q

HydroChlorothiazide (HCTZ, UROzide) (1 of 2)

A

Therapeutic effects and uses
Hypertension
Fluid retention secondary to heart failure, liver disease, corticosteroid and estrogen therapy
Mechanism of action
Acts on the kidney tubules to prevent the reabsorption of Sodium
99% of sodium is reabsorbed into the body when HCTZ blocks more is excreted into the urine.

Adverse effects
Electrolyte imbalances
High blood glucose
Alcohol potentiates effects

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10
Q

Potassium-Sparing Diuretics

A

Loop diuretics and thiazide diuretics both promote hypokalemia
Potassium-sparing diuretics increase urine output but promote retention of K+
Mechanism of action
Aldosterone antagonists – aldosterone promotes reabsorption of Na+ and secretion of K+; blocking aldosterone receptors prevents reabsorption of water by preventing reabsorption of Na+, retaining K+

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11
Q

Spironolactone (Aldactone)

A

Used for mild HTN
K+ is etaned
Inhibits action of aldosterone in distal tubule and collecting ducts of nephron

Adverse effect is Hyperkalemia

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12
Q

Osmotic Diuretics (1 of 2)

A

Raise osmolality of plasma thereby drawing fluid from ICF and interstitium

Osmotic diuretics are freely filtered by kidney but not reabsorbed; water follows the diuretic, and is not reabsorbed; Na+ is not reabsorbed

Indications
Increased intracranial pressure
High intraocular pressure
Acute renal failure

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13
Q

Indications for osmotic diuretics

A

Increased intracranial pressure
High intraocular pressure
Acute renal failure`

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14
Q

Mannitol

A

Administered IV
Action and Uses
Mannitolincreases the concentration of filtrates in the kidney and decreases reabsorption of water and sodium increasing diuresis. Mannitol alsodraws out fluid from extravascular spaces (cells) into blood vessels, which lowers the intra cranial pressure and improves cerebral oxygen delivery.

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15
Q

Adverse effects of osmotic diuretics

A

Overdose will result in a shift of fluid to the vascular compartment leading to heart failure or pulmonary edema.
Electrolyte imbalances
Hypovolemia, dehydration, tachycardia
Fatigue, dizziness
Nausea, vomiting
Convulsions

16
Q

Assessments during diuretictherapy

A

Wt
electolytes
BP

17
Q

Intercentions and nurse considerations for diurtetic use

A

Monitor hearing as some diuretics are ototoxic ( loop diuretics)
Monitor vision as thiazide diuretics interact with digitalis, causing visual disturbances
Monitor for signs of photosensitivity