Monitoring Drug Therapy (not finished) Flashcards
What does Urea and Electrolyte levels indicate? (4)
- Renal function
- Hydration status
- Assess disease status
- Identify possible ADRs
Give the concentration values of Hypo- and Hyper- (in mmol/L) levels of:
Sodium
Potassium
Calcium
Sodium:
Hypo: under 133 mmol/L
Hyper: over 146 mmol/L
Potassium:
Hypo under 3.5 mmol/L
Hyper: over 5.3 mmol/L
Calcium:
Hypo: under 2.12 mmol/L
Hyper: iver 2.65 mmol/L
Give the concentration values of Hypo- and Hyper- (in mmol/L) levels of:
Phosphate
Magnesium
Phosphate
Hypo: under 0.8mmol/L
Hyper: over 1.4 mmol/L
Magnesium
Hypo: under 0.7 mmol/L
Hyper: over 1 mmol/L
a) Sodium levels are mainly regulated by what system?
b) What does abnormal sodium levels reflect?
clue, water loss/imbalance or sodium loss/gain
a) Renin-angiotensin-aldosterone system (RAAS)
b) Water loss/imbalance
How can Sodium imbalance effect blood pressure?
Too much (from diet)- hypertension Too little- Hypotension
a) What effect does the increase of Aldosterone have on the distal tubules?
b) What effect does that have on blood pressure?
BONUS: what else in the RAAS has an effect on blood pressure and in what way?
a) Increases the reabsorption of water and sodium in distal
b) Increases blood pressure
BONUS: Angiotensin 2 increases blood pressure by vasoconstriction
Causes of Hypernatraemia (Na+ >146mmol/L) (5)
- Insufficient fluid intake
- Excessive water loss
- Sodium retention (or too much sodium from diet)
- Excess adrenocorticoid hormones eg aldosterone (eg. cushing syndrome)
- Drugs eg. corticosteroids, NSAIDs, Lithium toxicity
Consequences (1) and side effects (6) of Hypernatraemia
- CNS changes from lethargy to deep coma
- Depends on level but >170mmol/L life threatening
Symptoms: tachycardia, fever, hypertension, dizziness, increased thirst, oedema
Causes of Hyponatraemia Na+
1) Sodium depletion from various disease states
2) Water retention: eg. SIADH
3) Pharmacological drugs: Diuretics, Carbamazepine, SSRI’s, ACEi
Name some disease states that cause sodium depletion (9)
some aren’t even diseases!
loss from burns severe exudative skin lesions excessive sweating Haemodilution (caused by cardiac/renal/hepatic failure) vomitting and diarrhoea infection Aspiration Carcinoma
Name 4 drugs that cause sodium depletion
Diuretics, Carbamazepine, ACEi, SSRI’s
Hyponatraemia symptoms (9)
Nausea Vomitting Headache Postural Hypotension Cramps Fatigue Circulatory failure Confusion Convulsion
Treatment of Hyponatraemia (5)
HINT: what are the types of hyponatraemia along with their treatments)
Treatment depends on cause
HYPOVOLAEMIC HYPONATRAEMIA (low bv): Replacement with IV NaCl 0.9%
EUVOLAEMIC HYPONATRAEMIA (norm bv): Treat immediate cause, if not feasible, water restriction
(symptomatic: hypotonic (3%) saline infusion)
HYPERVOLAEMIC HYPONATRAEMIA (high bv): fluid restriction , diuretics, sodium restriction
CHRONIC CONDITIONS w. Mild/Moderate sodium depletion: oral supplements
(Avoid rapid correction- osmosis)
Potassium are mainly found intracellular and the main source is dietary
What are the mains functions of potassium in our body? (4)
- Maintains muscle contractility eg. cardiac muscle
- Maintains fluid balance
- Maintains nerve impulse function
- Maintains muscle function
Hyperkalaemia (>5.3mmol/L) causes (9)
- Renal failure
- Redistribution of K+ between ICF and ECF
- Metabolic acidosis
- K+ sparing diuretics
- K+ supplements
- ACEi, Angiotensin 2 receptor blockers, NSAID’s
- Heparin
- BB’s (non-selective)
- Trimethoprim
