Pharm - Renal

Question 1

Diuretics Types

Answer 1

● Osmotic diuretics
○ Mannitol

● Loop diuretics
○ Bumetanide
○ Furosemide
○ Torsemide

● Thiazide diuretics
○ Chlorothiazide
○ Hydrochlorothiazide

● Potassium sparing diuretics
○ Eplerenone
○ Spironolactone

Question 2

Loop Diuretics

Answer 2

Names: Bumetanide, Furosemide, Torsemide
Indication: Low urinary output, edema, CHF, blood pressure management

Action: Act on the loop of Henle to increase urine output by affecting sodium reabsorption
within the nephron. Inhibits the sodium potassium chloride cotransporter causing sodium to
be excreted in the urine, therefore increasing diuresis.

Nursing considerations:
● Adverse effects:
○ Hyponatremia, -chloremia, -kalemia** → Monitor potassium levels
■ Caution in clients also on digoxin**
○ Ototoxicity → do not combine with other ototoxic meds (aminoglycosides)
○ Dehydration → hypotension
● These are the most effective of all diuretics

Question 3

Thiazide Diuretics

Answer 3

Names: Chlorothiazide, Hydrochlorothiazide

Indications: Hypertension, edema

Action: These diuretics act on the distal convoluted tubule to inhibit the sodium-chloride
cotransporter. This decreases sodium reabsorption, causing more fluid loss in the urine.

Nursing Considerations:
● Adverse effects:
○ Hyponatremia, -chloremia, -kalemia (less severe than in loop diuretics)
○ Dehydration → hypotension
■ Monitor BP

Question 4

Potassium Sparing Diuretics

Answer 4

Names: Spironolactone, Eplerenone

Indications: Hypertension, edema, HF

Action: Inhibit sodium and potassium exchange via sodium channels in the distal parts of
the nephron. This ‘spares’ potassium!!
Nursing considerations:
● Can cause hyperkalemia
○ Monitor K levels
○ Don’t combine with other drugs that increase the K (ACE, ARB, K+ supps, or salt substitutes)
● Response develops slowly; over a few days
These medications are not as strong as other diuretics, so are often combined with a loop or
thiazide diuretic!

Question 5

RAAS Drugs

Answer 5

● Angiotensin Converting Enzyme Inhibitors (ACEs)
● Angiotensin Receptor Blockers (ARBs)

Question 6

Angiotensin-Converting Enzyme Inhibitors (ACEs)

Answer 6

Names: Enalapril, lisinopril, captopril, fosinopril, moexipril, perindopril….

Indication: Hypertension, CHF

Action: Blocks conversion of angiotensin I to angiotensin II, increases renin levels,
and decreases aldosterone leading to vasodilation

Nursing Considerations:
● Can cause a dry cough - should be discontinued if it does
● Monitor BP
● Contraindicated during pregnancy

Question 7

Angiotensin II Receptor Blockers (ARBs)

Answer 7

Names: Losartan, olmesartan, valsartan, irbesartan, azilsartan, candesartan…

Indication: hypertension, HF, DM nephropathy, MI and stroke prevention

Action: blocks angiotensin II receptors stopping the actions of angiotensin II. Leads to:
vasodilation, decreased aldosterone (less sodium and water retention), and prevention of
pathologic changes in the cardiac structure.

Nursing Considerations:
● Adverse effects: Angioedema and renal failure
○ Caution in clients with renal disease - monitor renal function
● Do not cause cough - common to switch from an ACE to an ARB if cough develops
● Contraindicated during pregnancy