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Nursing N368 Pharmacology I > N368 Final Diuretics, Fluids, Electrolyte, Acid-Base Balance Drugs > Flashcards

N368 Final Diuretics, Fluids, Electrolyte, Acid-Base Balance Drugs Flashcards

1
Q

This is the excessive accumulation of fluid in body tissues

A

Edema

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2
Q

What causes Edema?

A

Inc. Capillary permeability in response to tissue injury (burns, allergic reaction, trauma, Inc. capillary hydrostatic pressure a) fluid overload b) Obstruction of venous blood flow, Decrease in plasma oncotic pressure related to decrease in plasma proteins a) plasma proteins keep fluid in bloodstream

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3
Q

Edema interferes with blood flow to ?

A

Tissues

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4
Q

What are three things that Diuretics do?

A

1) Act on kidneys to decrease reabsorption of NA and H20
2) Increase urine output
3) Indicated for edema, HTN, Heart Failure

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5
Q

This type of Diuretic is used to treat Glaucoma?

A

Carbonic Anhydrase Inhibitor

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6
Q

This diuretic is used as anti-convulsant to control certain seizures in the treatment of epilepsy

A

Carbonic Anhydrase Inhibitor

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7
Q

This is sometimes used to prevent or lessen some effects in mountain climbers who climb to high altitudes

A

Carbonic Anhydrase Inhibitor

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8
Q

This is a Carbonic Anhydrase Inhibitor is used to treat Glaucoma and aid in altitude sickness/ prevention? edema and CHF (IV)

A

Acetazolamide

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9
Q

These are major SEs of what diuretic?

Dehydration, pancytopenia

A

Carbonic Anhydrase Inhibitor

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10
Q

This diuretic is used in the long term management of HF and HTN?

A

Thiazide Diuretics

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11
Q

This diuretic act on the early distal tubule to block the reabsorption of sodium and water.

A

Thiazide diuretics

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12
Q

This diuretic is weak, it will be ineffective against decreased renal function and ineffective when immediate diuresis is needed. Only effective when urine flow is accurate

A

Thiazide diuretics

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13
Q

This diuretic is not recommended for pregnant women nor pt with an allergy to sulfonamides.

A

Thiazide Diuretics

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14
Q

Name the prototype thiazides?

A

Chlorothiazide (Diuril)

Hydrochlorothiazide (Microzide)

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15
Q

This diuretic takes 2 hrs to activate, 4 to 6 hrs to peak, and last 6-24 hrs.

A

Thiazide Diuretics

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16
Q

Electrolyte disturbance (reduced K, Elevated CA, lipids, glucose, uric acid), GI disturbances, Skin Rash, Photosensitivity, Dizziness, HA, IMPOTENCE are all s/e of ?

A

Thiazides

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17
Q

This is a potent diuretic. This diuretic is used when rapid diuresis is required. It will also work with diminished renal function.

A

Loop Diuretics

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18
Q

This diuretic acts primarily along the loop of henle.

A

Loop Diuretics

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19
Q

A sodium restricted diet is required to achieve optimum therapeutic benefits.

A

Loop Diuretics

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20
Q

This diuretic is used in the treatment of edema associated with CHF, Cirrhosis, and renal disease.

A

Loop Diuretics

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21
Q

What are two types of loop diuretics?

A

1) Furosemide - most common

2) Bumetanide - more potent than furosemide, but similar effect

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22
Q

What is another name for Furosemide?

A

Lasix

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23
Q

What is another name for Bumetanide?

A

Bumex

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24
Q

How long does it take for PO lasix to work, peak, last?

A

occurs 30-60 min, peaks 1-2 hrs, and lasts for 6-8 hrs

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25
Q

Loop diuretics are used as a single dose or maintenance?

A

Both

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26
Q

Excessive Diuresis, Fluid and electrolyte imbalance, Hypokalemia, hyponatremia, paresthesia, hyperglycemia, muscle cramps, orthostatic hypotension, Ototoxicity (inner ear damage, Tinnitus, dizziness, and vertigo are associated with admin IV to fast, are S/E of what Diuretic?

A

Loop Diuretics

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27
Q

What diuretic is used to treat Cerebral edema, renal failure, promote excretion of toxic substances, and reduce increased intracranial pressure?

A

Osmotic diuretics

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28
Q

What diuretic increases osmotic pressure of the glomerular Filtrate causing H20 to be pulled into the bloodstream, increasing blood volume, and decreasing reabsorption of H20 and electrolytes in renal tubules? This also produces Rapid Diuresis.

A

Osmotic Diuretics

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29
Q

What IV Osmotic Diuretic infusion adjusts flow rates to maintain urine output of 30-50 mL/hr?

A

Mannitol (Osmitrol)

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30
Q

What are three examples of Potassium Sparing Diuretics?

A

Spironolactone
Amiloride
Triameterene

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31
Q

Name the potassium-sparing diuretic prototypes

A

Spironolactone (Aldactone) Amiloride (Midamor)

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32
Q

What is another name for Amiloride?

A

Midamore

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33
Q

Decreases Na reabsorption and decreases potassium excretion.

A

Potassium Sparing diuretic called Triameterene (Dyrenium)

34
Q

This is a weak diuretic when used alone?

A

Potassium Sparing Diuretic

35
Q

What is the major adverse effect of a potassium-sparing Diuretic?

A

Hyperkalemia

36
Q

If taking a PSD, the pt should ?

A

1) not receive any potassium supplements
2) not be encouraged to eat foods high in K
3) not be allowed to use salt substitutes (Contains KCL rather than NaCL)

37
Q

PSD is contraindicated in pt using?

A

1) salt substitues and KCL supplements

2) Pt w/renal impairment b/c high risk of hyperkalemia

38
Q

This is a major diuretic that is used to prevent potassium imbalances?

A

PSD + Thiazide Diuretics

39
Q

What are three examples of PSD + thiazide diuretics?

A

1) Spiro/HCTZ (Aldactazide) give 25/25 mg or 50/50mg
2) Amiloride/HCTZ (Moduretic) 5/50 mg
3) Tram/HCTZ (Dyazide or Maxzide) 37.5/35 mg or 75/50 mg

40
Q

What are some drug interactions of potassium-sparing diuretics?

A

ACE inhibitors together put at risk for hyperkalemia

41
Q

If a patient is Hypokalemia, what should the nurse do?

A

1) supplemental K: KCL 20-60 mEq qd
2) Potassium sparing diuretic w/potassium losing drug
3) Increasing foods with potassium

42
Q

If your patient is on a diuretic, what major electrolyte should be monitored?

43
Q

Cardiac Dysrhythmias, Skeletal muscle weakness, hypotension, and weak, shallow respirations are all S & S of what?

A

Hypokalemia

44
Q

What are some fruits that are high in K?

A

Bananas, citrus fruits, raisins

45
Q

What are some vegetables that are high in K?

A

Sweet and white potatoes, spinach, whole grains, milk, yogurt, ice cream, pudding

46
Q

What are some precautions that should be taken with the elderly and Diuretic therapy?

A

1) obtain baseline measurements (wt. lab)
2) Take early in the day
3) limited assistance: utilize home health nurses
4) Dehydration, electrolyte loss dizziness
5) Change positions slowly
6) Look out for hypotension, electrolyte imbalance, and fluid volume depletion

47
Q

What diuretic is not recommended for children

48
Q

This diuretic crosses the placenta and is secreted in breast milk?

49
Q

This diuretic is for adults only?

A

Carbonic Anhydrase Inhibitors

50
Q

This diuretic is mostly used in children?

A

Loop diuretic / lasix

51
Q

What are some things that a nurse should assess when administering diuretics?

A

fluid volume status

electrolyte levels, weight, vital signs, skin turgor, creatinine level, ABG, BLood pH, Diet

52
Q

What safety precaution should pt be advised to use when taking a diuretic?

A

Rise slowly- get assistance if weak or dizzy/unsteady, do to orthostatic hypotension

53
Q

When administering Lasix, what should the nurse always make sure to do?

A

push lasix slowly to prevent ototoxicity

54
Q

What therapeutic effects would the nurse see to know that the diuretic is working?

A

1) Decreased Edema
2) increased urine output
3) decreased BP
4) Daily weight best indicator of fluid loss or gain

55
Q

Potassium losing diuretics adverse affects?

A

Hypokalemia, dehydration, Hyperglycemia, Hyperuricemia, pulmonary edema (osmotic diuretics), Ototoxicity (lasix)

56
Q

Potassium sparing diuretics adverse affects?

A

Hyperkalemia (serum K >5.0)

57
Q

What drug interactions: digoxin

A

Digoxin toxicity increased due to diuretic induced hypokalemia, particularly with Lasix (furosemide)

58
Q

The 3 primary functions of the kidneys?

A

Filtration, Reabsorption, Secretion

59
Q

The major complications of kidney failure?

A

Osteoporosis
Metabolic Acidosis
Fluid Retention
Hypocalcemia

60
Q

The following actions by the nurse is most important when caring for a patient with renal disease?

A

Identify drugs with potential for nephrotoxicity

61
Q

The patient admitted for congestive heart failure (CHF) is receiving digoxin (Lanoxin) and furosemide (Lasix). What lab value needs to be monitored closely?

62
Q

What clinical manifestations may indicate the patient is experiencing hypokalemia?

A

Heart Dysrhythmias

63
Q

What diuretic medication must be used with caution in patients with a history of CHF?

A

Contraindicated for CHF (congestive heart failure)

explanation:
Once that fluid is in the blood stream the osmotic pressure is going to equalize and what you have done is equal to giving a liter or two (depending on the pts overall avail fluid, and the manny dose) of fluid bolus.

64
Q

Many _________ are contraindicated for pregnant women because?

A

diuretics, many cross the placenta

65
Q

Potassium-Sparing Diuretics Major SEs?

A

Hyperkalemia, dehydration, dysrhythmia (hyperkalemia), gynecomastia

66
Q

These are major SEs of what diuretic? Fluid and electrolyte imbalances, thrombophlebitis

A

Osmotic Diuretics

i.e., mannitol (Osmitrol)

67
Q

These are what type of diuretic?

Chlorothiazide (Diuril)
Hydrochlorothiazide (Microzide)

68
Q

These diuretics act on the ascending limb of the loop of Henle to block the reabsorption of sodium and water.

A

loop diuretics,

i.e., furosemide (Lasix), bumetanide (Bumex)

69
Q

These diuretics act using the below mechanism.Misc. Diuretic; to produce uresis by inhibiting carbonic anhydrase, a enzyme that affects acid-base balance by its ability to form carbonic acid (H2CO3) from water and carbondioxide (CO2); this inhibition promotes the direction making more CO2 and water, which will be excreted. Used for the management of open-angle glaucoma or other forms of ocular hypertension

A

Carbonic Anhydrase Inhibitor

70
Q

These diuretics act on the late distal tubule and collecting ducts to block the reabsorption of sodium while retaining the secretion of potassium

A

Potassium-sparing diuretics

71
Q

These diuretics act by increases the osmotic pressure of the glomerular filtrate, thereby inhibiting reabsoprtion of water and electrolyte, and reduce plasma volume

A

Osmotic Diuretics

72
Q

Dehydration and pancytopenia (i.e. decrease in RBCs, WBCs, and Platelets) are side effects of what diuretic

A

Carbonic Anhydrase Inhibitor

73
Q

____Colloids: name the class and mechanism of action

A

fluid replacement agent; Provides colloidal oncotic pressure of blood, which serves to mobilize fluid from extravascular space into vascular system; expands plasma volume within minutes of administration

74
Q

____Colloids: name the major SEs

A

Hypertension, Fluid overload, cardiac failure

75
Q

____Colloids: name the prototype

A

Albumin (Albuminar, plasbumin)

76
Q

Sodium bicarbonate: name the class and mechanism of action

A

Agents to treat acidosis or bicarbonate deficiency

77
Q

Sodium bicarbonate: name the major SEs

A

Metabolic Akalosis due to too much HCO3 infusion(confusion, irritability, slow HR); Hyperkalemia; Tx for metabolic alkalosis (give KCL or NH3CL, ammonium chloride)

78
Q

Sodium bicarbonate: name the prototype

A

Sodium bicarbonate (NaHCO3)

79
Q

Ammonium chloride: name the class

A

Agents to treat alkalosis

80
Q

Ammonium chloride: name the SEs

A

Metabolic Acidosis due to too much loss of HCL

81
Q

Ammonium chloride: name the drug type

A

Ammonium chloride

Nursing N368 Pharmacology I (16 decks)

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