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Therapeutics I > Fluid Status/Diuretics > Flashcards

Fluid Status/Diuretics Flashcards

1
Q

When people say fluid what are they talking about?

A

Blood, plasma, water

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2
Q

How does fluid enter the body?

A

PG, NG Tube, IV, drinking, absorption

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3
Q

How does fluid leave the body?

A

Urine, Sweat, breathing (insensible loss), bleeding, vomiting, defecation

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4
Q

Describe how fluid is distributed in the body?

A

40% solid, 60% Fluid
2/3 ICF, 1/3 ECF (20% plasma, 80% Interstitial fluid)

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5
Q

What are the standards we must consider when looking at TBW?

A

1L of water = 1 kg
Values are based on the 70 kg man

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6
Q

What is tonicity?

A

Concentration of a solution compared to another solution

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7
Q

What is osmole?

A

Number of osmotically active particles in a solution

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8
Q

What is osmolality?

A

Osmoses/kg of water

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9
Q

What is osmolarity?

A

Osmoles/Liter of solution

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10
Q

What components are not included in the TBW and osmolarity of body fluids?

A

WBC, RBC, platelets

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11
Q

What are extracellular electrolytes?

A

Cations: Na+, Ca2+
Anions: Cl-, HCO3-

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12
Q

What are the intracellular electrolytes?

A

Cations: K+, Mg2+
Anions: PO4^3-, proteins

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13
Q

What is the physiological osmolarity?

A

280 mOsm/L

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14
Q

What is the difference between filtration and reabsorption?

A

F: Fluid exits the arterial capillary due to capillary hydrostatic pressure
R: Fluid moves in the venous capillary driven by colloid osmotic pressure

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15
Q

How do we maintain fluid status?

A
  1. ADH
  2. RAAS (retain Na+ and water)
  3. Natriuretic peptides (lose Na+ and water)
  4. Osmoreceptors in the hypothalamus
  5. Proteins

Water follows the highest concentration of solute

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16
Q

What are the types of fluid balance states?

A
  1. Hypervolemia
  2. Euvolemia
  3. Hypovolemia
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17
Q

What are the daily fluid requirements?

A

1st 10 kg/ → 100mL/kg
2nd 10 kg → 50 mL/kg
Weight over 20 kg → 20 mL/kg

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18
Q

What are the hourly fluid requirements?

A

1st 10 kg/ → 4 mL/kg
2nd 10 kg → 2 mL/kg
Weight over 20 kg → 1 mL/kg

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19
Q

What is the clinically utilized fluid requirement?

A

25-30 mL/kg

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20
Q

What is progressions of hypovolemia?

A

Euvolemic → GI and intraabdominal → lack of intake → skin → kidneys → insensible losses → dehydration

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21
Q

What are the signs and symptoms of hypovolemia?

A
  1. Fatigue
  2. Thirst
  3. Dry mucous membraneis
  4. Low UO
  5. Muscle cramps
  6. Lightheadedness
  7. DZ
  8. Hypotension
  9. Poor skin turgor
  10. Sunken eyes
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22
Q

What are the lab findings of hypovolemia?

A

≥295 mOsm/kg
BUN/sCr >10:1
Low urine Na+ concentration
High urine osmolality

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23
Q

What can hypervolemia lead to?

A
  1. Edema (peripheral)
  2. Effusion (pleural)
  3. Ascites (peritoneal)
24
Q

What are the causes of edema?

A
  1. Increased capillary hydrostatic pressure
  2. Increased capillary permeability
  3. Decrease colloid osmotic pressure
  4. Obstruction of the lymphatic systems
  5. Excess in water and Na+
25
Q

What is the increase in volume in a person with edemas?

A

Increase of at least 2.5 -3 L

26
Q

What is the treatment for hypovolemia?

A
  1. Volume resuscitation
  2. Treatment of underlying cause
27
Q

What are the types of IV fluids and what is the difference between the two?

A

Crystalloids: electrolytes
Colloids: water-pulling and don’t cross membrane as easily

28
Q

What are the hypotonic solutions? What is the cells response?

A

Quarter NS
Half NS
Half DW

Cells swell

29
Q

What are the isotonic solutions? Which are balanced colloids? What is the cells response?

A

NS
LR (BC)
Plasma-lyte (BC)
Normosol (BC)
D5W → becomes hypertonic in the body

No change

30
Q

What are the hypertonic solutions? What is the cells response?

A

Hyper-sol (3%)
D10W, D20W, D50W

Cell shrinks

31
Q

Why are colloids important?

A

Given to hypotensive patient to increase BP by increased vascular fluid retention and CO

Considered hypertonic and doesnt move freely

32
Q

What are the types of colloids?

A

Albumin 5%, 25%
Hetastarch
Pentastarch
Dextran-40, -70

33
Q

What are the treatments for hypervolemia?

A
  1. Fluid removal
  2. Sodium restriction
  3. Fluid restriction
  4. Treatment of underlying cause
34
Q

What is the efficacy of diuretic in a patient dependent on especially with edemas?

A
  1. Amount of filtered Na+ normally reabsorbed at the site of action
  2. Amount of Na+ reabsorbed distal to its site of action
  3. Adequate medication delivery to site of action
  4. Amount of Na+ reaching the site of action
35
Q

What are carbonic anhydrase inhibitors used for?

A
  1. Acid/base disorders
  2. GLacoma
  3. Diuretic resistance
  4. Edema: acetazolamide 250 mg IV/PO QD
36
Q

Dosage forms of CAIs?

A

IV, PO, opthalmic

37
Q

What is the MOA of osmotic?

A

Mannitol (hypertonic) to reduce ICP and IOP by pulling H2O from vasculature to urine

38
Q

What are the PK characteristics of Loops?

A
  1. Most potent
  2. High ceiling
  3. Rapid acting and short DOA (except torsemide)
39
Q

What are the clinical uses of loops

A
  1. Edema (associated with excess salt, HF, poor renal function)
  2. Acute renal failure (improve urine output and limit kidney damage)
  3. Hypercalecemia
  4. Hyperkalemia
40
Q

What are the ratios of loops?

A

Furosemide IV:PO (1:2)
Lasix: Bumex: Demadex IV (40: 1: 20)

41
Q

What are the clinical uses of thiazide?

A

HTN, mild edema, kidney stones

Ceiling doses but longer half-life and less diuretic effect than loops

42
Q

What are the daily dose of thiazides used for?

A

HTN

43
Q

What are the sequential nephron blockade doses of thiazides used for?

A

Edema

44
Q

What are the types of thiazesd? Strongest?

A
  1. Chlorothiazide
  2. Chlorthaliidone (strongest)
  3. HCTZ
  4. Indapamide
  5. Metolazone
45
Q

What are the types of K+ sparing diuretics?

A

Direct inhibit: triamterene and amiloride
Aldosterone antagonists: Spiranolactone and eplerenone

46
Q

What are K+ sparing clinical uses?

A

HTN, CHF in combo with loop and thiazides

Weaker than loops and thiazides (gradually fluid loss)

47
Q

What do you evaluate in fluids?

A
  1. Volume status
  2. Perfusion
  3. ADRs
48
Q

What is third spacing?

A

Water flowing into tissue spaces caused by blood pooling and decrease CO

49
Q

Who qualifies for diuretic dose adjustments?

A

Pediatric, HF, renal impairment (increased dosing), geriatric, liver

50
Q

When would you do a dosage adjustment?

A
  1. Taking too much fluid → decrease diuretics
  2. Taking too little fluid → increase diuretic
51
Q

Why do we do dosage adjustment?

A

To reduce ADRs, morbidity, and mortality

52
Q

What do we do when there decreased efficacy of a diuretic?

A
  1. Increase dose or frequency
  2. Add another diuretic
  3. Sodium restriction
53
Q

What ADRs are we looking for in diuretics?

A
  1. Hypovolemia
  2. Electrolyte imbalnaces
  3. AKI
54
Q

What disease states require dosage adjustment? Dosage forms?

A
  1. CKD
  2. GI edema and delayed gastric emptying
  3. Cirrhosis

IV → PO

55
Q

What are loop ADRs?

A

Hypokalemia, Hypernatriemia, hypocalcemia

56
Q

What are the thiazide ADRs?

A

hypokalemia, hypercalcemia, hyponatremia

57
Q

What are ADRs of K+ sparing?

A

Mild metabolic acidosis, hyperkalemia

Carospir: reversible gynecomastia

Therapeutics I (32 decks)

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