Lecture 13 Nursing 100 Flashcards by Rebecca Buchanan

Diuretics Purpose

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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Thiazide diuretics

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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Thiazide diuretics- chem

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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Thiazide therapeutic use

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

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Thiazide Adverse Reactions

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

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Thiazide drug interactions

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

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Thiazide Nursing Implications

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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Thiazide Loop Diuretics

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

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Thiazide therapeutic use

Edema assoc. w/ CHF, Hepatic or Renal Disease

Management of HTN

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Thiazide drug interaction

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

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Thiazide Adverse Reactions

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

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Thiazide Nursing Implications

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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gout

increased uric acid

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Potassium Sparing Diuretics

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

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Aldactone actions

blocks aldosterone receptors in late distal tubule

Na, Cl & H20 excreted, K retained

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Triamterene actions

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

Potassium Sparing Therapeutic Uses

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

K-Sparing Drug Interactions

K wasting diuretics
Potassium supplements
High Potassium foods

K-Sparing Adverse reactions

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

K-Sparing Nursing Implications

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

Carbonic Anhydrase Inhibitors (Diamox)

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

Diamox Adverse Reactions

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

Diamox Nursing Implications

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)

Osmotic diuretics- Mannitol Action

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

Mannitol use

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

Mannitol Adverse reactions

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

Mannitol Nursing Implications

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)

Osmotic diurectics chem

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

Potassium

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

Calcium

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

Oxygenation/Circulation

``` Respiratory Functions Oxygenate tissues Remove CO2 Regulate acid-base Provide defense against infection ```

Methylxanthine Agents

relax constricted airway & reduce bronchospasm

Methylxanthines

``` 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 ```

Methylxanthines M of A

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

Methylxanthines Therapeutic uses

``` Asthma chronic bronchitis Emphysema Neonate apnea Relief of bronchospasm ```

Methylxanthines drug interactions

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

Methylxanthines Adverse reactions

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

Methylxanthines Nursing Implications

``` 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 ```