Fluid & Electrolytes and Diuretic Drugs

Question 1

Diuretics accelerate the formation of ______

Answer 1

urine

Question 2

Mechanisms of diuretic drugs include

Answer 2

-arteriolar dilation
-ECF reduction
-plasma reduction
-reduce cardiac output

Question 3

The _______ tubule returns sodium and water back into the bloodstream

Answer 3

proximal

Question 4

Loop diuretics MOA, and what’s special about them

Answer 4

-block K+, chloride and hence sodium reabsorption in LOH
-reduce resistance via blood vessel dilation
-they can act rapidly, for a long time, even w/ poorly functioning kidneys

Question 5

Loop diuretic adverse effects

Answer 5

-fluid loss, BP reduced too much
-hypokalemia, nausea, vomiting, dizziness, headaches, BS and electrolyte loss

Question 6

_______ _______ are used to manage edema associated w/ heart failure/hepatic disease/renal disease and pts w/ hypercalcemia

Answer 6

Loop diuretics

Question 7

Furosemide MOA, class, adverse effects (+pregnancy category), uses

Answer 7

-loop diuretic (K+ wasting)
-BLACK BOX: fluid/electrolyte loss
-pregnancy category C
-used for heart failure, edema (pulmonary)

Question 8

Osmotic diuretic (mannitol) MOA

Answer 8

increases osmotic pressure in filtrate, and pulls water into proximal tubule (slight loss of electrolytes)
-vasodilation

Question 9

Osmotic diuretic (mannitol) use, adverse effects

Answer 9

-Acute renal failure, brain swelling–critical care situations
-convulsions, thrombophlebitis, pulmonary congestion

Question 10

Potassium sparing diuretics MOA (+ site of action)

Answer 10

-blocks sodium/water reabsorption
-in collecting duct and distal tubule
-competitively bind to aldosterone binding sites

Question 11

Potassium sparing diuretics (spironolactone, amiloride) use, adverse effects, pregnancy category

Answer 11

-use: hypertension, HF
-SFX: hyperkalemia, amenorrhea, postmenopausal bleeding, gynecomastia in XY, lithium toxicity
-pregnancy category C (decreases fetal testosterone)

Question 12

Potassium sparing drugs interact w/:

Answer 12

-ACE inhibitors + other K sparing drugs
-NSAIDS

Question 13

Thiazides MOA, use

Answer 13

-inhibit reabsorption of electrolytes in distal tubule–> diuresis
-dilates arterioles
Use: hypertension treatment, heart failure, edema

Question 14

Thiazides adverse effects, considerations (K wasting or sparing?)

Answer 14

Electrolyte imbalance -K wasting (hypokalemia/hyponatrimia)
-dizziness, vertigo, headache, decreased libido
-Consider: dizziness/urination–so don’t give at night

Question 15

Patients w/ liver or renal disfunction should not take:

Answer 15

CAIs

Question 16

Labs to assess before giving diuretics

Answer 16

-vitals + fluid volume status (BP)
-BUN, creatinine, LDH, AST, ALP
-serum electrolytes
-CAIs: Na and K

Question 17

Torsemide, a _______ type diuretic, can affect what?

Answer 17

loop, WBC and platelet count

Question 18

Give an example of an osmotic diuretic and name considerations

Answer 18

-Mannitol
-carefully monitor
-IV filter (crystalization)

Question 19

Normal sodium level:

Answer 19

136-145

Question 20

Hypertonic crystalloids would be given if:

Answer 20

the patient has severe, prolonged hyponatremia (very low sodium)

Question 21

HypERtonic solution examples, MOA, considerations

Answer 21

-3-5% normal saline, D10W
-cells shrink (water leaves cell)
-HIGH ALERT! double check, administer slowly (don’t want brain swelling, osmotic demyelination)

Question 22

What fluids would you give to patient with high sodium levels (hypernatremia)?

Answer 22

HypOtonic fluids
-“half normal saline”, AKA 0.45% NaCl

Question 23

Isotonic solutions like ___% sodium chloride, D5W, and ________ _________ are given when?

Answer 23

-0.9% sodium chloride
-lactated ringers
Given when a pt just needs fluids/electrolytes and is not hyper- or hypotonic
AKA “maintenance fluids”

Question 24

Which diuretics are K sparing? Which are K wasting?

Answer 24

Sparing:
-spironolactone
-amiloride
Wasting:
-loop (ex: furosemide)
-osmotics (ex: mannitol)
-thiazides and thiazide-like (ex: hydrochlorothiazide)

Question 25

Main difference btwn spironolactone and amiloride:

Answer 25

spiro = long term, amiloride = shorter term

Question 26

What diuretic should be avoided if a patient has a sulfa allergy?

Answer 26

Loop diuretics

Question 27

In a hypOtonic solution, cells will _____

Answer 27

swell