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Pharmacology > Medications Affecting Urinary Output > Flashcards

Medications Affecting Urinary Output Flashcards

1
Q

What is the mechanism of action for loop-diuretics?

A

Block the reabsoprtion of sodium, chloride, potassium in the ascending loop of henle to prevent reabsorption of water

This decreases intravascular volume by increasing urine output

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2
Q

How would you give a loop diuretic IV push? Why?

A

10-20mg per minute (slowly)

It is ototoxic if administered too fast (can cause permanent hearing loss)

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3
Q

How can loop diuretics be administered?

A

IV and orally, sometimes IM

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4
Q

Are loop diuretics used for chronic management?

A

NO, they are for more acute situations because of the higher chance for adverse affects

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5
Q

What are some adverse effects of loop diuretics?

A

Dehydration/hyponatremia/hypochloremia

hypotension (orthostatic)

hypokalemia

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6
Q

What are some nursing considerations for loop diuretics?

A

Look for low urine output (patient can excrete so much that there could be none left to excrete)

Tell patient to get up slowly, monitor BP, if they get dizzy when they get up check for orthostatic hypotension

Monitor cardiac status

monitor electrolyte levels (especially potassium)

look for signs of hypokalemia (nausea, vomiting, weakness)

LOOK AT POTASSIUM LEVELS BEFORE ADMINISTERING LOOP DIURETIC

dailys weight, i/o

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7
Q

How would you administer IV potassium?

A

Dont give it any faster than 10 mEq/hr or you can kill the patient

NEVER GIVE IV PUSH

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8
Q

What are some other adverse affects of loop diuretics?

A

hyperglycemia - monitor especially with DM

Digoxin toxicity - due to hypokalemia, monitor cardiac and potassium levels, also digoxin lvls

Lithium toxicity - due to hyponatremia - monitor lithium levels

ototoxicity - monitor for tinnitus (ringing in ears) give slowly IV

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9
Q

What are some patient teaching points for loop diuretics?

A

avoid in pregnancy (cat C)

Teach about adverse effects and measure to avoid them
        hypokalemia (nausea, vomiting, weakness)
        orthostatic hypotension (get up slowly)

Eat foods high in potassium
dried fruits, bananas, nuts, spinach, avocados, citrus fruits, potatoes

monitor BG levels/ BP/ daily weights

Follow up and dont stop until consulting with physician

Take in the morning or when your day starts so you arent peeing all night

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10
Q

What pregnancy category are loop diuretics in?

A

Category C

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11
Q

What is the mechanism of action for thiazide diuretics?

A

blocks reabsorption of sodium, chloride, potassium, and water at the early distal convoluted tubule.

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12
Q

What is the huge difference between thiazide and loop diuretics?

A

thiazide are usually the first choice because they arent as potent so there is less risk for adverse effects.

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13
Q

How are thiazide diuretics usually administered?

A

PO

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14
Q

What are the adverse effects of thiazide diuretics?

A

Same as diuretics except:

Not ototoxic

Limited concern for digoxin and lithium toxicity - LESS POTENT

Less risk for hypotension

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15
Q

What are some patient teaching points for thiazide diuretics?

A

Same as loop diuretics

UNCLEAR ON BLOOD SUGAR EFFECTS ON PPT, LOOK UP THOSE FOR LOOP AND THIAZIDE!!!

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16
Q

What is the mechanism of action for potassium-sparing diuretics?

A

Blocks the action of aldosterone causing potassium retention and the secretion of sodium and water

GIVEN PO

17
Q

Do potassium-sparing diuretics reach therapeutic levels quickly?

A

NO it takes a longer time

the least potent of the diuretics

used for more chronic maintenance

18
Q

What patients should you not administer potassium sparing diuretics to?

A

severe kidney failure and anuria (potassium retention is already present)

19
Q

What are some adverse effects of potassium-sparing diuretics?

A

hyperkalemia

endocrine dysfunctions - impotence, irregularities in menstrual cycles

20
Q

What are some nursing considerations for potassium-sparing diuretics?

A

monitor for symptoms of hyperkalemia (numbness, tingling, weakness, fatigue, irregular cardiac activity

NEVER GIVE SUPPLEMENTAL POTASSIUM

closely monitor cardiac status when given with ACE inhibitors, ARBS, or direct renin inhibitors (all cause the retention of potassium)

MONITOR POTASSIUM LEVELS

21
Q

What are some patient teaching points for potassium-sparing diuretics?

A

avoid salt substitutes (contain potassium)

look out for signs of hyperkalemia (numbess, tingling, weakness, fatigue

22
Q

What is a weird side effect of triamterene?

A

may turn urine a bluish color

NOT A SAFETY CONCERN

23
Q

what if patients need to avoid salt, and they are also told to avoid salt substitutes?

A

Look for substitutes that dont contain potassium

24
Q

What is the mechanism of action for osmotic diuretics?

A

draws fluid back into intravascular space by raising serum osmolality, usualy to reduce ICP and IOP and to prevent kidney failure in hypovolemic shock (pulls fluid into intravascular space whihc makes the kidney want to start excreting it)

USUALLY USED FOR HEAD INJURIES AND SOMEITMES SHOCK

25
Q

What units are osmotic diuretics usually given on?

A

ICUs and EDs under close monitoring

26
Q

What patients should you be cautious about giving an osmotic diuretic to?

A

heart failure

27
Q

What are some adverse effects of osmotic diuretics?

A

nephrotoxic - can cause kidney failure if used for long term (helpful to kidneys at first if there is a low circulating volume, but after long term use the kidneys wont be able to keep up)

hypernatremia - monitor electrolytes

Fluid volume overload - asses for edema, respiratory and cardiac status

Lithium levels - can lower them because of hypernatremia

28
Q

How are osmotic diuretics usually administered?

A

IV continuous infusion through a filter needle to prevent microcrystallization

29
Q

What are some nursing considerations for osmotic diuretics?

A

Monitor I/O

monitor BP

monitor serum electrolytes

monitor kidneys

monitor lithium levels

assess for fluid overload

Pharmacology (13 decks)

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