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PHARM EXAM 3 > Renal > Flashcards

Renal Flashcards

1
Q

define anasrca.

A

generalized severe edema

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2
Q

define anuria

A

no urine output

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3
Q

define ascites

A

fluid volume overload and build-up, concentrated in the abdomen

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4
Q

where does edema typically form?

A

the lowest part of the body

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5
Q

define extracellular/intracellular fluid

A

fluid outside of the cell, inside the cell

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6
Q

what are the parts of the renal system?

A

kidney, ureters, bladder, urethra

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7
Q

list the primary functions of the kidneys

A

regulate volume: through urine production
composition of urine: electrolytes concentration
regulation of pH: through hydrogen ions
eliminating waste: meds, diet, muscle metabolism
BP regulation: RAAS, increase blood and oxygen flow
RBC production: stimulates erythropoietin
vitamin d conversion

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8
Q

how much of the body’s CO goes to the kidneys

A

25%

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9
Q

what is the general anatomy of the renal capsule

A

outer cortex: nephrons
inner medulla: the loop of Henle and collecting ducts
renal pelvis: transfers urine to bladder
afferent and efferent arteriole

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10
Q
A
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11
Q

What does the glomerulus do?

A

Filter. (Fluid and blood)
IN: sodium,potassium, and maybe protein
OUT: extra electrolytes, meds, etc

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12
Q

What are the three nephron functions

A

Glomerulus filtration, tubular secretions, tubular reabsorption

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13
Q

The glomerulus is under high pressure, 70mg, what is a healthy GFR

A

125 ml/min, if it is lower it shows damage

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14
Q

What is the passage of nephron

A

Glomerulus
Bowman’s
Tubules
Loop of henle/medulla
Renal pelvis

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15
Q

Where is the loop of henle found

A

The nephron

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16
Q

What conditions require diuretics

A

Cardiovascular (HTN and HF)
Renal — GFR effects
Hepatic
Burns
Trauma
Allergies
Inflammatory reaction
Fluid overload— increased hydrostatic pressure
Low plasma: decreased ontonic pressure

17
Q

What is dependent, pulmonary and anasarca edema?

A

D: sets in lowest point
P: fluid overload in lungs
A: massive, generalized

18
Q

True or false, edema occurs only when the heart no longer functions efficiently?

A

False

19
Q

What is the main function of diuretics

A

Increases secretion of water, sodium, and other electrolytes

20
Q

What are the main drug classes of diuretics

A

Loop diuretics - furosemide
Thiazide - HCTZ/metolazone
Potassium sparing- spironolactone
Osmotic - mannitol
Carbonic anhydrase inhibitor: acetazolamide

21
Q

What diuretic does not work in renal tubules

A

Osmotics

22
Q

What is used when a rapid diuretic is needed? Hint: it is also used for renal impairment

A

Loop diuretics

23
Q

What is the main loop diuretics, how it is given, its MOA and when it is used?

A

Furosemide (bumetanide, toresemide)
Given: PO, IV, IM
MOA: inhibits Na and Cl reabsorption in ascending LOH
USE: pulmonary edema, CHF, hepatic, renal, HTN, critically ill, and for chronic conditions

24
Q

What are the adverse reaction, contraindications and drug interactions for loop diuretics?

A

A: fluid/electrolyte imbalance, hyponatremia, hypokalemia, fluid deficit, ototoxicity (low plasma, hearing loss is main symptom)
C: Anuria, allergy to sulfonamides
D: Aminoglycosides, cephalosporins,(increased effect) corticosteroids, digoxin (hypokalemia)

25
Q

What are the nursing implications and patient teaching for loop diuretics

A

N: slow IV push (20mg/min), checking labs, daily weight and I&O, vital monitoring (hypotension), give PO in AM
P: low sodium diet, high k diet, daily weight, orthostatic, take in AM

26
Q

What is the main thiazide and thiazide like diuretic, how it is given, MOA and use?

A

Hydrochlorothiazide HCTZ) and metolazone (like)
Given: PO
MOA: decreases reabsorption of Na, H2O, Cl and HCO3 in distal convoluted tubule
Use: first line for HTN, edema for CHF, nephrotic syndrome, renal impairment

27
Q

What are the adverse effects and contraindications for thiazide and thiazide like diuretics?

A

A: hypotension, weakness, dizziness, diarrhea/constipation, hypokalemia, hyperglycemia
C: allergy to sulfonamides, renal failure/anuria

28
Q

What are the nursing implications and patient teaching for thiazide and thiazide like diuretics

A

N: check labs, weight and I&O, vitals, give in AM, monitor dizziness
P: low sodium, high k diet, daily weight, orthostatic, take in AM

29
Q

What is hypokalemia, and the prevention and management of it?

A

K lower than 3.5
Signs: conduction, weakness, palpitations, GI upset

low dose diuretics — combo with potassium sparing/wasting
Supplements
Increase foods in potassium
Restrict sodium

30
Q

What assessment finding in a patient with heart failure recovering furosemide would indicate an improvement in fluid volume status?

A

Absence of crackles in lungs

31
Q

What is the main potassium sparing diuretic, how it works, MOA, and use

A

Spironolactone
-slow onset and peak (24-48 hrs)
-6 weeks for full effects
MOA: blocks aldosterone (RAAS)
Use: HF, ascites, hypokalemia, HTN, hyperaldosteronism

32
Q

What are the adverse effects, contraindications, and drug interactions for potassium sparing diuretics

A

A: dizziness, diarrhea, androgen like (breast growth, irregular periods), increased GI bleed, BB: tumorigenic with chronic toxicity
C: renal insufficiency and hyperkalemia
D: ACE, ARB, K containing drugs (hyperkalemia)

33
Q

What are the nursing implications and patient teaching for potassium sparing diuretics?

A

N: check labs, weight and I&O, dizziness
P: avoid salt subs, low k diet (no oranges, banana, spinach), weight, acites, orthostatic, take in morning WITH food

34
Q

What is hyperkalemia and the prevention and management of it?

A

K greater than 5
Signs: muscle cramps, EKG changes, hypotension, arrhythmias, death
-potassium sparing and wasting meds
-no supplements
-no salt substitutes
-maintain urine output

35
Q

What is the main osmotic diuretic, how it is given, MOA and use?

A

Mannitol
Given: IV (glass) in critical care
MOA: increases pressure of glomerular filtrate, pulls from extra vascular into blood (goes to kidneys), decreases reabsorption of H2O and electrolytes
USE: intracranial pressure, intraocular pressure, decreased renal circulation and GFR
(Not used in the loop)

36
Q

What are the adverse effects, contraindications, and nursing implications of osmotic diuretics?

A

A: hyperosmolar non ketotic coma, confusion, headache, syncope, dysrhythmias, dehydration
C: dehydration, abdomen pain, appendicitis, pulmonary edema, cardiac decompensation (HF), older adults
N: physical and neuro exam, I&Os, vitals
INFILTRATION=hyaluronidase

37
Q

What is the main carbonic anhydrase inhibitor, how its given, MOA, use and adverse effects?

A

Acetazolmide
GIVEN: IV or eye drops
MOA: inhibits CA to reduce formation of aqueous humor and lower IOP
USE: open angle glaucoma and secondary glaucoma
A: metabolic acidosis
IV ONLY: Steven Johnson’s, flaccid paralysis, blood dycrasias

38
Q

What are the contraindications and nursing implications of carbonic anhydrase inhibitors?

A

C: renal/hepatic, Addisons disease, electrolyte imbalance, chronic non congestive angle closure glaucoma
N: vision exam, teach to give eye drops

39
Q

Should a patient taking spironolactone use salt substitutes?

A

No, it will increase K levels

PHARM EXAM 3 (6 decks)

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