Failure/Diuretics Flashcards
Therapy for people with renal failure
Altering diet to reduce protein content, sodium, potassium, phosphorus and magnesium
Possible fluid restriction
Discontinue nephrotoxic medications
Dialysis in end stages
Pharm tx of renal failure
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
Renal failure diet
Low protein
Limit salt intake to less than 1 tsp
phosphate and CKD
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.
Diuretic indications
Hypertension, Heart failure
Renal failure
Liver failure or cirrhosis
Pulmonary edema
Adverse effects of adverse effects
Electrolyte imbalances
Dehydration, hypotension
Types of diuretics
Loop or high-ceiling
Thiazides
Potassium-sparing
Osmotic
Carbonic anhydrase inhibitors
Common to combine two or more drugs
Thiazide and Thiazide-Like Diuretics
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
2-3hr ONSET
Loop (High-Ceiling) Diuretics
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
Lasix
30-60 min PO
IV in 5 min
HydroChlorothiazide (HCTZ, UROzide) (1 of 2)
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
PO ther effect can take weeks
IV results can happen in 15 to 30 minutes
Potassium-Sparing Diuretics
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+
Spironolactone (Aldactone)
Used for mild HTN
K+ is etaned
Inhibits action of aldosterone in distal tubule and collecting ducts of nephron
Adverse effect is Hyperkalemia
Extremely slow onset
Osmotic Diuretics (1 of 2)
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
Indications for osmotic diuretics
Increased intracranial pressure
High intraocular pressure
Acute renal failure`
Mannitol
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.
Results can occur in as quickly as 15 minutes or 1-3 hr
Adverse effects of osmotic diuretics
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
Assessments during diuretictherapy
Wt
electolytes
BP
Intercentions and nurse considerations for diurtetic use
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
