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

This is the excessive accumulation of fluid in body tissues

Edema

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What causes Edema?

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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Edema interferes with blood flow to ?

Tissues

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What are three things that Diuretics do?

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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This type of Diuretic is used to treat Glaucoma?

Carbonic Anhydrase Inhibitor

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

Carbonic Anhydrase Inhibitor

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

Carbonic Anhydrase Inhibitor

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

Acetazolamide

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These are major SEs of what diuretic?

Dehydration, pancytopenia

Carbonic Anhydrase Inhibitor

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

Thiazide Diuretics

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

Thiazide diuretics

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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

Thiazide diuretics

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

Thiazide Diuretics

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Name the prototype thiazides?

Chlorothiazide (Diuril)

Hydrochlorothiazide (Microzide)

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

Thiazide Diuretics

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

Thiazides

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

Loop Diuretics

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This diuretic acts primarily along the loop of henle.

Loop Diuretics

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

Loop Diuretics

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

Loop Diuretics

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What are two types of loop diuretics?

1) Furosemide - most common

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

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What is another name for Furosemide?

Lasix

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What is another name for Bumetanide?

Bumex

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

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

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Loop diuretics are used as a single dose or maintenance?

Both

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?

Loop Diuretics

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

Osmotic diuretics

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.

Osmotic Diuretics

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

Mannitol (Osmitrol)

What are three examples of Potassium Sparing Diuretics?

Spironolactone Amiloride Triameterene

Name the potassium-sparing diuretic prototypes

Spironolactone (Aldactone) Amiloride (Midamor)

What is another name for Amiloride?

Midamore

Decreases Na reabsorption and decreases potassium excretion.

Potassium Sparing diuretic called Triameterene (Dyrenium)

This is a weak diuretic when used alone?

Potassium Sparing Diuretic

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

Hyperkalemia

If taking a PSD, the pt should ?

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)

PSD is contraindicated in pt using?

1) salt substitues and KCL supplements | 2) Pt w/renal impairment b/c high risk of hyperkalemia

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

PSD + Thiazide Diuretics

What are three examples of PSD + thiazide diuretics?

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

What are some drug interactions of potassium-sparing diuretics?

ACE inhibitors together put at risk for hyperkalemia

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

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

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

Potassium

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

Hypokalemia

What are some fruits that are high in K?

Bananas, citrus fruits, raisins

What are some vegetables that are high in K?

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

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

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

What diuretic is not recommended for children

Thiazide

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

Thiazide

This diuretic is for adults only?

Carbonic Anhydrase Inhibitors

This diuretic is mostly used in children?

Loop diuretic / lasix

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

fluid volume status | electrolyte levels, weight, vital signs, skin turgor, creatinine level, ABG, BLood pH, Diet

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

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

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

push lasix slowly to prevent ototoxicity

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

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

Potassium losing diuretics adverse affects?

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

Potassium sparing diuretics adverse affects?

Hyperkalemia (serum K >5.0)

What drug interactions: digoxin

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

The 3 primary functions of the kidneys?

Filtration, Reabsorption, Secretion

The major complications of kidney failure?

Osteoporosis Metabolic Acidosis Fluid Retention Hypocalcemia

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

Identify drugs with potential for nephrotoxicity

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

potassium

What clinical manifestations may indicate the patient is experiencing hypokalemia?

Heart Dysrhythmias

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

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.

Many _________ are contraindicated for pregnant women because?

diuretics, many cross the placenta

Potassium-Sparing Diuretics Major SEs?

Hyperkalemia, dehydration, dysrhythmia (hyperkalemia), gynecomastia

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

Osmotic Diuretics i.e., mannitol (Osmitrol)

These are what type of diuretic? Chlorothiazide (Diuril) Hydrochlorothiazide (Microzide)

Thiazides

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

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

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

Carbonic Anhydrase Inhibitor

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

Potassium-sparing diuretics

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

Osmotic Diuretics

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

Carbonic Anhydrase Inhibitor

____Colloids: name the class and mechanism of action

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

____Colloids: name the major SEs

Hypertension, Fluid overload, cardiac failure

____Colloids: name the prototype

Albumin (Albuminar, plasbumin)

Sodium bicarbonate: name the class and mechanism of action

Agents to treat acidosis or bicarbonate deficiency

Sodium bicarbonate: name the major SEs

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

Sodium bicarbonate: name the prototype

Sodium bicarbonate (NaHCO3)

Ammonium chloride: name the class

Agents to treat alkalosis

Ammonium chloride: name the SEs

Metabolic Acidosis due to too much loss of HCL

Ammonium chloride: name the drug type

Ammonium chloride