pharm week 2

Question 1

know brand and

Answer 1

generic - where each falls

Question 2

Levels below 60 mL/min for 3 or more months are a
sign of chronic kidney disease. Those with GFR results
below 15 mL/min are a sign of kidney failure.

Answer 2

Levels below 60 mL/min for 3 or more months are a
sign of chronic kidney disease. Those with GFR results
below 15 mL/min are a sign of kidney failure.

Question 3

loop diuretics

Answer 3

Laboratory changes associated with loop diuretics:
 Hypokalemia, hyponatremia, hypocalcemia,
hypomagnesemia, hypochloremia
 Hyperglycemia possible in diabetic patients
 Hyperuricemia
 Elevated blood urea nitrogen and creatinine
 Elevated lipids
 Thrombocytopenia, leukopenia

Question 4

loop diuretics

Answer 4

 Risk for hypokalemia; potassium supplements
may be necessary

Question 5

Na+ subsitutes

Answer 5

so they take sodium substitutes. it’s actually potassium chloride - so make sure pts. know.

Question 6

furosemide

Answer 6

 High ceiling (loop) diuretic
 Inhibits sodium (Na) and chloride (Cl) reabsorption
through direct action in the ascending loop of Henle
 Rapid Onset**

Question 7

furosemide precautions

Answer 7

 Dehydration through excessive fluid loss
 Renal Failure
can be effective even when GFR is low
 Adverse Effects
 Hypokalemia, Hyponatremia, Hypochloremia
 Hyperglycemia, Hyperuricemia (gout)
 Reversible hearing loss (1-24 hours)

Question 8

can use___when GFR is low? (Furious I can’t use GFR)

Answer 8

furosemide

Question 9

furosemide drug interactions - (furious I can’t take NSAIDS)

Answer 9

 Interactions: NSAIDS may decrease effect *

Question 10

thiazide (Thia with sugar and milk)

Answer 10

Action
 Serum chemistry abnormalities with thiazides
 Hypokalemia
 Hypomagnesemia
 Hypercalcemia
 Hypochloremia
 Hyperuricemia
 Hyperglycemia
 Hyperlipemia

Question 11

hydrochlorothiazide (HCTZ®)

Answer 11

Action
 Thiazide diuretic
 Inhibits sodium (Na) and chloride (Cl) reabsorption in the early segment of the
distal convoluted tubule
 Peaks in 4-6 hours
 Uses
 Hypertension
 Chronic Congestive Heart Failure (CHF)
 Diabetes Insipidus (triggers negative feedback)
 Edematous states

Question 12

hydrochlorothiazide and GFR (Thia won’t work with GFR)

Answer 12

won’t work with pts who have low GFR

Question 13

hydrochlorothiazide adverse affects

Answer 13

 Adverse Effects
 Hypokalemia, Hyponatremia, Hypochloremia
 Hyperglycemia, Hyperuricemia (gout)
 Effects are minimal compared to loop diuretics
 Interactions: NSAIDS may decrease effect

Question 14

Thiazide and Thiazide-Like Diuretics may be combined with

Answer 14

potassium sparing or antihypertensive agents

Question 15

potassium sparing

Answer 15

 Amiloride (Midamor®)
 Spironolactone (Aldactone®) *
 Triamterene (Dyrenium®)

Question 16

spironolactone

Answer 16

Action
 Potassium sparing diuretic
 Blocks aldosterone in the distal convoluted tubule
 Induces urinary excretion of Na and reduces excretion of K
and H ions
 Peaks at 48 hrs
 Uses
 CHF – chronic maintainence
 Prevent diuretic induced hypokalemia
 Primary hyperaldosteonism

Question 17

spironolactone

Answer 17

 Precautions
 Renal dysfunction (anuria)
 Adverse effects
 Hyperkalemia
 Drug Interactions
 Others: Potassium Supplements incr. K
 Salt Substitutes (KCl) incr. K
 ACE – I incr. K

Question 18

osmotic diuretics - mannitol (Osmitrol®) (Man, Oz is proximal)

Answer 18

 Osmotic Diuretic
 Increases Osmotic Pressure
 Diuresis in the proximal lumen of the nephron (rapid!)
 Immediate onset
usually used IV, usually emergency situations

Question 19

osmotic diuretics - mannitol (Osmitrol®) - can do what?

Answer 19

crystalize while it’s sitting on the shelf. Look at it to make sure nothing is floating in there. Dont use that bottle.

Question 20

if there are crystals with mannitol,

Answer 20

it’s always adminstered through an IV filter.

Question 21

what to monitor for with mannitol? (man oz makes me dehydrated)

Answer 21

dehydration bc it works so quickly

Question 22

acetazolamide (Diamox®)

Answer 22

used for glacuoma.  Action: Diuretic, carbonic anhydrase inhibitor,
antiglaucoma agent
 Onset 1-1½ hr, peak 2-4 hr, duration 8-12 hr

Question 23

acetazolamide (Diamox®) side effects

Answer 23

Adverse effects: Common side effects of using this drug include
numbness and tingling in the fingers and toes, and taste alterations
(parageusia), especially for carbonated drinks. Some may also experience blurred vision but this usually
disappears shortly after stopping the medication.

Question 24

kidney stones - which med (Zola has kidney stones)

Answer 24

acetazolamide (Diamox®)

Question 25

Signs and Symptoms of Fluid and Electrolyte
Imbalances Associated with Diuretic Therapy

Answer 25

 Hypovolemia
 Hyponatremia
 Hypokalemia
 Hypocalcemia
 Hypochloremia
 Hypomagnesemia
 Hyperkalemia

Question 26

Nursing Implications : Diuretics

Answer 26

 Monitor weight
 Monitor electrolytes
 Monitor for hypotension
 Monitor intake and output
 Monitor blood glucose in diabetes
 Watch for tinnitus and hearing loss
 Pt. education: report thirst, cramping, weakness,
confusion
 Avoid nocturia by taking doses early in the day

Question 27

GFR rates will be on

Answer 27

test