Medications Affecting Urinary Output (ATI 19)

Question 0

High-ceiling loop diuretics

Answer 0

Natriuretic diuretic
Prototype: furosemide (Lasix)
Causes calcium loss, hypocalcemia

Slow down/turn off the Na+ pumps in the nephron tube in a place different from thiazide diuretic action.

Most powerful diuretics (therefore used for CHF) side effects are then more severe due to greater water, Na+ & K+ loss

Intended responses: urine output is increased, urine is lighter in color, blood pressure is lower

Side effects: dizziness, lightheadedness, hypokalemia, hyponatremia,

Question 1

Thiazide Diuretics

Answer 1

Natriuretic diuretic
Ideal for primary HTN
Slows down/turns off sodium pumps in the nephron tubes furthest away from capillaries. Causes sodium, potassium, & water to be excreted, which reduces blood volume & lowers BP.

Intended response: urine output increase, urine output lighter, blood pressure is lower

Side effects: decreased blood volume, hypokalemia, hyponatremia, hypochloremia, & hypomagnesemia
Hypercalcemia, hyperuremia (increased urea)

Adverse effects: passing out/falling when changing positions, muscle weakness, blurred vision

Before administration: check most recent K+ level if below 3.5 inform prescriber, ask about allergies/pregnancy status

After administration: watch electrolyte levels especially K+ watch for signs of hypokalemia (abnormal, heart rhythms, muscle cramps, constipation & changes in reflexes)

Check apical pulse for 1 full minute to determine irregular HR

Teach patients to report signs of hypokalemia to prescriber (muscle weakness, cramps, decrease in urination, irregular heartbeat)
Class B (avoid during pregnancy) can cause jaundice & low K+ levels can pass into breast milk/decrease flow
Older adults more sensitive to side effects like dizziness/lightheadedness so teach to change positions slow, use hand rails & about signs of hypokalemia

Question 2

Potassium-Sparing Diuretics

Answer 2

Natriuretic diuretic
Prototype: spironolactone (Aldactone)
Other:
triamterene (Dyrenium)
amiloride (Midamor)

Question 3

Osmotic Diuretics

Answer 3

mannitol (Osmitrol)
Only osmotic diuretic
Increases blood vow to the kidneys

Question 4

hydrochlorothiazide (Hyrdodiuril)

Answer 4

Prototype for thiazide diuretics

Question 5

chlorothiazide (Diuril)

Answer 5

Thiazide diuretic

Question 6

metolazone (Zaroxolyn)

Answer 6

Thiazide type diuretic

Question 7

Diuretics

Answer 7

‘Water pills’ that work on the kidney directly or increases blood flow to them, treats problems where the body is retaining too much water, Na, or K generally for people with HTN, HF, kidney disease, & liver disease
Before administration obtain baselines for weight, BP & HR for comparison after administration. For low BP (90/60) hold drug & contact prescriber
Give doses in the morning to avoid nocturia
Monitor for signs of orthostatic hypotension (dizziness/light-headedness) assist to change positions slowly
Instruct to sit on side of bed for 1-2 mins (dangle) before getting up & then rise slowly
Following administration of a diuretic monitor BP & HR because rapid water loss decreases blood volume & lowers BP
Obtain daily weights, keep urine output record to note increase in voiding, monitor electrolytes (Na & K)
For diuretics with 2 doses, second dose shouldn’t be administered after 6PM (1800) to avoid nocturia, if missed dose, do not double next dose
Teach patient to notify provider if HR is 100 or BP is <90/60
Teach patient to drink same amount of fluid that they urinate each day

Question 7

furosemide (Lasix)

Answer 7

High ceiling loop diuretic prototype

Question 8

ethacrynic acid (Edecrin)

Answer 8

High ceiling loop diuretic

Question 9

bumetanide (Bumex)

Answer 9

High ceiling loop diuretic

Question 10

torsemide (Demadex)

Answer 10

High ceiling loop diuretic