pharm week 2 Flashcards
know brand and
generic - where each falls
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.
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.
loop diuretics
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
loop diuretics
Risk for hypokalemia; potassium supplements
may be necessary
Na+ subsitutes
so they take sodium substitutes. it’s actually potassium chloride - so make sure pts. know.
furosemide
High ceiling (loop) diuretic
Inhibits sodium (Na) and chloride (Cl) reabsorption
through direct action in the ascending loop of Henle
Rapid Onset**
furosemide precautions
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)
can use___when GFR is low? (Furious I can’t use GFR)
furosemide
furosemide drug interactions - (furious I can’t take NSAIDS)
Interactions: NSAIDS may decrease effect *
thiazide (Thia with sugar and milk)
Action
Serum chemistry abnormalities with thiazides
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hypochloremia
Hyperuricemia
Hyperglycemia
Hyperlipemia
hydrochlorothiazide (HCTZ®)
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
hydrochlorothiazide and GFR (Thia won’t work with GFR)
won’t work with pts who have low GFR
hydrochlorothiazide adverse affects
Adverse Effects
Hypokalemia, Hyponatremia, Hypochloremia
Hyperglycemia, Hyperuricemia (gout)
Effects are minimal compared to loop diuretics
Interactions: NSAIDS may decrease effect
Thiazide and Thiazide-Like Diuretics may be combined with
potassium sparing or antihypertensive agents
potassium sparing
Amiloride (Midamor®)
Spironolactone (Aldactone®) *
Triamterene (Dyrenium®)
spironolactone
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
spironolactone
Precautions
Renal dysfunction (anuria)
Adverse effects
Hyperkalemia
Drug Interactions
Others: Potassium Supplements incr. K
Salt Substitutes (KCl) incr. K
ACE – I incr. K
osmotic diuretics - mannitol (Osmitrol®) (Man, Oz is proximal)
Osmotic Diuretic
Increases Osmotic Pressure
Diuresis in the proximal lumen of the nephron (rapid!)
Immediate onset
usually used IV, usually emergency situations
osmotic diuretics - mannitol (Osmitrol®) - can do what?
crystalize while it’s sitting on the shelf. Look at it to make sure nothing is floating in there. Dont use that bottle.
if there are crystals with mannitol,
it’s always adminstered through an IV filter.
what to monitor for with mannitol? (man oz makes me dehydrated)
dehydration bc it works so quickly
acetazolamide (Diamox®)
used for glacuoma. Action: Diuretic, carbonic anhydrase inhibitor,
antiglaucoma agent
Onset 1-1½ hr, peak 2-4 hr, duration 8-12 hr
acetazolamide (Diamox®) side effects
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.
kidney stones - which med (Zola has kidney stones)
acetazolamide (Diamox®)
Signs and Symptoms of Fluid and Electrolyte
Imbalances Associated with Diuretic Therapy
Hypovolemia
Hyponatremia
Hypokalemia
Hypocalcemia
Hypochloremia
Hypomagnesemia
Hyperkalemia
Nursing Implications : Diuretics
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
GFR rates will be on
test
