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Pharmacology 101 > Lecture 13 Nursing 100 > Flashcards

Lecture 13 Nursing 100 Flashcards

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1
Q

Diuretics Purpose

A

to decrease body fluids
Water follows sodium
Na reabsorption blocked so less H20 reabsorbed
Inc. glomerular filtration rate (GFR)
Increase Na excretion rate = inc. H20 excretion

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2
Q

Thiazide diuretics

A

Hydrochlorothiazide (HCTZ) or Chlorothiazide (Diuril)
Sulfonamide derivatives (antibiotic)
Act at Early Distal convoluted Tubule
Increase Na excretion by inhibiting Na reabsorption
Cause inc. K excretion
Lowers BP

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3
Q

Thiazide diuretics- chem

A 
K wasting decrease BP
mild
first step in controlling high BP and HTN
Early DCT loses about 10% Na here
K is lost
electrolyte imbalances can occur
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4
Q

Thiazide therapeutic use

A 
First step agent to control HTN
Edema assoc. w/ CHF
Cirrhosis in liver disease
Renal dysfunction
Steroid or Estrogen therapy
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5
Q

Thiazide Adverse Reactions

A 
Blood volume depletion
Orthostatic hypotension
Hypokalemia
Glucose intolerance
Inc. Ca, Dec. Phos.
Allergic reaction (r/t sulfonamides)
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6
Q

Thiazide drug interactions

A 
Resulting From altered fluid volume, low BP & electrolyte shifts
Oral hypoglycemics (high BG)
Corticosteroids
Some Antibiotics
Increased effect with antihypertensives
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7
Q

Thiazide Nursing Implications

A 
Do not use if sensitive to sulfonamides
Caution in Diabetics (hi BG), Gout,
Give in early AM
Daily Weight, BP
Monitor I&O, electrolytes (esp. low K), may need supp.
Assess BUN, Cr, Glu, CBC
May cause photosensitivity
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8
Q

Thiazide Loop Diuretics

A 
Lasix (furosemide) & bumex (Bumetanide)
Derivative of Sulfonamides
Highly protein-bound (99%)
Works at Loop of Henle
Inhibits Na & Cl reabsorption
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9
Q

Thiazide therapeutic use

A

Edema assoc. w/ CHF, Hepatic or Renal Disease

Management of HTN

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10
Q

Thiazide drug interaction

A 
Aminoglycosides
Oral Anticoagulants
Corticosteroids
r/t altered renal function, fluid & elect. imblance
Affects a variety of RX
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11
Q

Thiazide Adverse Reactions

A 
Severe fluid & electrolyte imbalances
Hypovolemia & Dehydration
Hyponatremia, Hypokalemia
Postural hypotension
Ototoxicity
Hyperglycemia
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12
Q

Thiazide Nursing Implications

A 
Assess for allergies
Not if pregnant
Assess I& O, Daily wt., electrolytes  (Na, K, BUN, Cr, Uric acid)
Check skin turgor
Monitor Digoxin toxicity
Monitor for inc. effect of anticoagulants
Sx hearing loss, gout
Encourage K rich foods or K supplement
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13
Q

gout

A

increased uric acid

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14
Q

Potassium Sparing Diuretics

A

Aldactone (spiroaldactone) & Diazide (triamterene)
Weaker diuretic
Weaker Anti HTN effect
conserves K in body

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15
Q

Aldactone actions

A

blocks aldosterone receptors in late distal tubule

Na, Cl & H20 excreted, K retained

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16
Q

Triamterene actions

A

enhances Na excretion w/ direct action on late distal tubules
Less K excreted

17
Q

Potassium Sparing Therapeutic Uses

A 
Dec. edema (CHF, cirrhosis)
Reduce BP
Nephrotic Syndrome
Combined with K wasting diuretics
Spiroaldactone + HCTZ = Aldactazide
Triamterene + HCTZ = Dyazide or Maxzide
18
Q

K-Sparing Drug Interactions

A

K wasting diuretics
Potassium supplements
High Potassium foods

19
Q

K-Sparing Adverse reactions

A

Fluid & elec. Imbalances
Low Na & Hi K = confusion, muscle weakness,
dysrhythmmias, paralysis, diarrhea,
Fatigue, HA
Spiroladactone = enlarged breast in men & masculine effects in women

20
Q

K-Sparing Nursing Implications

A 
Monitor for electrolyte imbal (^K)
renal, hepatic insufficiency
Signs of hi K =confusion, muscle weakness, paralysis dysrhthmia, diarrhea
Monitor I & 0, edema, Daily Wt
Monitor blood count, BUN, Cr, K
Warn pt of orthostatic hypotension
Avoid K rich foods
21
Q

Carbonic Anhydrase Inhibitors (Diamox)

A

Sulfonamide derivative
Action- inhibits action of carbonic anhydrase at proximal tubule
prevents formation of carbonic acid (source of H+)
Absence of H+ inhibits reabsorption of Na
In eye prevents formation of aqueous humor
Uses- glaucoma, reducing edema in:
cardiac disorders

22
Q

Diamox Adverse Reactions

A

Fluid & elec. imbalances
Lowers K levels & bicarb levels
Allergic reactions to sulfonamides

23
Q

Diamox Nursing Implications

A

Not to pt with allergies to sulfonamides
Not if hepatic insufficiency, pregnant
Caution in DM (^BG), low K, low Na
Caution if hi Ca or gout, taking Digoxin
Observe for sx of low K, give supplements
I & O, Daily Wt, Electrolyte levels, Blood count
Give early am, with food (dec. GI upset)

24
Q

Osmotic diuretics- Mannitol Action

A

Action- increases osmolarity of plasma (thickens)
^GFR , decreases reabsorption of fluid & elec.
Pulls fluids from 3rd space

25
Q

Mannitol use

A

Use - reduce intracranial pressure & cerebral edema
prevents acute renal failure
decreases pulmonary edema & intraocular pressure
aids excretion of toxic drugs

26
Q

Mannitol Adverse reactions

A 
Transient expansion of plasma volume
Circulatory overload, cellular volume depletion
Tachycardia, electrolyte imbalances
HA, N/V
Rebound of ^ ICP p Dcd
27
Q

Mannitol Nursing Implications

A

Not if in acute renal failure, cardiac dysfunction, CHF
Not if cranial hemorrhage, severe dehydration
Monitor I & O q1h, Daily Wt, Report UO <30 ml/hr
Monitor electrolytes Na, K, Cl
VS q1h, Check IV site, Mouth Care
Monitor signs of electrolyte imbalance-thirst,
muscle cramps, weakness, paralysis
Monitor for sx CHF (^P, JVD, crackles)

28
Q

Osmotic diurectics chem

A

60% Na lost in PCT
increase BP b/c extra fluid
taper off drug

29
Q

Potassium

A

Body can not store K
Need to ingest daily po or IV
Needed for all nerve & muscle function & impulses
Used in K depletion
Available in several salts
KCl, K bicarb, K gluconate, K phos
No significant Rx interactions
Caution with K sparing diuretics
Adverse Reactions Hi K -listless, confusion
weakness, paralysis, EKG changes, heart block
GI irritation po, IV pain at site
MUST dilute for IV infusion
Check K levels, do not give in Renal failure

30
Q

Calcium

A

99% in body stored in bones
If not sufficient intake will take Ca from bones
Action crucial for heart, nerve & bone function
Used in Vitamin D deficiencies, strengthens cardiac tissue
Ca poor diets, prevention of osteoporosis
pregnancy or lactation
Interacts with Digitalis =dysrhythmias, Ca Channel blockers
Adverse reactions- Hi Ca (drowsiness, muscle weakness, HA
EKG changes, kidney stones)
Nursing Implications-Inc. Vit D foods to ^ absorption (fruits, veg)
Warm IV solutions, run slow to prevent dysrhymias & arrest

31
Q

Oxygenation/Circulation

A 
Respiratory Functions
Oxygenate tissues
Remove CO2
Regulate acid-base
Provide defense against infection
32
Q

Methylxanthine Agents

A

relax constricted airway & reduce bronchospasm

33
Q

Methylxanthines

A 
Theophylline, Aminophylline, Theodur
Originally from plants- tea, coffee, cola, chocolate
elevate mood, dec. fatigue
Pharmacokinetics depend on route & dose
need loading dose for therapeutic level
34
Q

Methylxanthines M of A

A 
CNS stimulant
decreases fatigue
stimulates respiratory center (^ sensitivity to CO2)
cardiovascular stimulation (^P)
smooth muscle relaxation
dilate coronary & pulmonary vessels
35
Q

Methylxanthines Therapeutic uses

A 
Asthma
chronic bronchitis
Emphysema
Neonate apnea
Relief of bronchospasm
36
Q

Methylxanthines drug interactions

A 
Cause toxic levels in other Rx & foods
May decrease therapeutic level of other Rx
Toxic
Therapeutic
Ineffective
37
Q

Methylxanthines Adverse reactions

A 
Transient
GI irritation, N/V, HA, restless, insomnia
More serious Sx of toxicity
Tachycardia, palpitations,
drops in BP
peripheral dilation
38
Q

Methylxanthines Nursing Implications

A 
Individualize dose by serum levels
Caution in pt with seizures, migraine HA
Caution in cardiac disease, MI
Teach pt to report side effects
Avoid other stimulants- caffeine

Pharmacology 101 (15 decks)

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