Fluid & Electrolytes and Diuretic Drugs Flashcards
Diuretics accelerate the formation of ______
urine
Mechanisms of diuretic drugs include
-arteriolar dilation
-ECF reduction
-plasma reduction
-reduce cardiac output
The _______ tubule returns sodium and water back into the bloodstream
proximal
Loop diuretics MOA, and what’s special about them
-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
Loop diuretic adverse effects
-fluid loss, BP reduced too much
-hypokalemia, nausea, vomiting, dizziness, headaches, BS and electrolyte loss
_______ _______ are used to manage edema associated w/ heart failure/hepatic disease/renal disease and pts w/ hypercalcemia
Loop diuretics
Furosemide MOA, class, adverse effects (+pregnancy category), uses
-loop diuretic (K+ wasting)
-BLACK BOX: fluid/electrolyte loss
-pregnancy category C
-used for heart failure, edema (pulmonary)
Osmotic diuretic (mannitol) MOA
increases osmotic pressure in filtrate, and pulls water into proximal tubule (slight loss of electrolytes)
-vasodilation
Osmotic diuretic (mannitol) use, adverse effects
-Acute renal failure, brain swelling–critical care situations
-convulsions, thrombophlebitis, pulmonary congestion
Potassium sparing diuretics MOA (+ site of action)
-blocks sodium/water reabsorption
-in collecting duct and distal tubule
-competitively bind to aldosterone binding sites
Potassium sparing diuretics (spironolactone, amiloride) use, adverse effects, pregnancy category
-use: hypertension, HF
-SFX: hyperkalemia, amenorrhea, postmenopausal bleeding, gynecomastia in XY, lithium toxicity
-pregnancy category C (decreases fetal testosterone)
Potassium sparing drugs interact w/:
-ACE inhibitors + other K sparing drugs
-NSAIDS
Thiazides MOA, use
-inhibit reabsorption of electrolytes in distal tubule–> diuresis
-dilates arterioles
Use: hypertension treatment, heart failure, edema
Thiazides adverse effects, considerations (K wasting or sparing?)
Electrolyte imbalance -K wasting (hypokalemia/hyponatrimia)
-dizziness, vertigo, headache, decreased libido
-Consider: dizziness/urination–so don’t give at night
Patients w/ liver or renal disfunction should not take:
CAIs
Labs to assess before giving diuretics
-vitals + fluid volume status (BP)
-BUN, creatinine, LDH, AST, ALP
-serum electrolytes
-CAIs: Na and K
Torsemide, a _______ type diuretic, can affect what?
loop, WBC and platelet count
Give an example of an osmotic diuretic and name considerations
-Mannitol
-carefully monitor
-IV filter (crystalization)
Normal sodium level:
136-145
Hypertonic crystalloids would be given if:
the patient has severe, prolonged hyponatremia (very low sodium)
HypERtonic solution examples, MOA, considerations
-3-5% normal saline, D10W
-cells shrink (water leaves cell)
-HIGH ALERT! double check, administer slowly (don’t want brain swelling, osmotic demyelination)
What fluids would you give to patient with high sodium levels (hypernatremia)?
HypOtonic fluids
-“half normal saline”, AKA 0.45% NaCl
Isotonic solutions like ___% sodium chloride, D5W, and ________ _________ are given when?
-0.9% sodium chloride
-lactated ringers
Given when a pt just needs fluids/electrolytes and is not hyper- or hypotonic
AKA “maintenance fluids”
Which diuretics are K sparing? Which are K wasting?
Sparing:
-spironolactone
-amiloride
Wasting:
-loop (ex: furosemide)
-osmotics (ex: mannitol)
-thiazides and thiazide-like (ex: hydrochlorothiazide)
