Unit 3: Ch 44, 47, &51 Flashcards by Taya Schreiter

What are diuretics used for?

reduce fluid volume
increase urine output

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What do diuretics help treat?

HTN
edema
renal failure prevention

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What is the diuretic mnemonic?

“LOST”
Loop Diuretic
Osmotic Diuretic
Spironolactone
Thiazide

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What med class is Furosemide apart of?

High-Ceiling (loop) Diuretics

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What is the mechanism of action for Furosemide?

Acts at ascending loop of Henle to block reabsorption

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Is Furosemide effective even with a low GFR?

Yes!

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What are the therapeutic uses of Furosemide?

Pulmonary edema
Edematous states
HTN

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What are the adverse effects of Furosemide?

Electrolyte imbalance
Dehydration
Hypotension
Ototoxicity
Hyperglycemia

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What are the drug interactions of Furosemide?

Digoxin
Ototoxic drugs
Potassium-sparing diuretics
Lithium
Antihypertensive agents
NSAIDs

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What is the mechanism of action for Thiazides?

acts at early segment distal convoluted tubule to block reabsorption

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Are Thiazides effective even with low GFR?

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What med class is Hydrochlorothiazide apart of?

Thiazides

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What are the therapeutic effects of Hydrochlorothiazide?

Essential HTN
Edema

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What are the adverse effects of Hydrochlorothiazide?

Electrolyte imbalance
Hyperglycemia
Impact on lipids
Photosensitivity

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What are the drug interactions of Hydrochlorothiazide?

Digoxin
HTN medications
NSAIDs

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What are the therapeutic uses of Potassium-Sparing Diuretics?

small increase in urine production
substantial decrease in potassium excretion

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What med class is Spironolactone apart of?

Potassium-sparing diuretics, Aldosterone antagonist

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What is the mechanism of action for Spironolactone?

blocks aldosterone in distal nephron
retention of potassium
increased excretion of sodium

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What are the therapeutic uses of Spironolactone?

HTN
Edematous states
HF
Primary hyperaldosteronism

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What are the adverse effects of Spironolactone?

Hyperkalemia
Benign and malignant tumors
Endocrine effects

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What are the drug interactions of Spironolactone?

Thiazide and loop diuretics
Agents that raise potassium levels
Meds that need stable K+ levels

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What med class is Mannitol apart of?

Osmotic Diuretic

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What are the mechanisms of action for Mannitol?

creates osmotic force that draws fluid from brain into blood- decreases ICP

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What are the therapeutic uses of Mannitol?

Prevention of renal failure
Reduction of ICP
Reduction of IOP

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What are the adverse effects of Mannitol?

Edema Headache N/V Fluid and electrolyte imbalance

What foods should pts have when taking thiazide diuretics?

K+ rich foods

A patient is prescribed spironolactone for treatment of HTN. Which foods should the pt be taught to avoid? A. Baked Fish B. Low-fat milk C. Salt Substitutes D. Green Beans

C (contains potassium chloride)

The nurse should monitor for which adverse effect after administering hydrochlorothiazide and digoxin to a pt? A. Digoxin toxicity B. Decreased diuretic effect C. Dehydration D. Heart Failure

A (check pts plasma levels when on Digoxin, normal level is 0.8-2)

What do Renin-Angiotension Aldosterone System (RAAS) drugs do?

Regulate BP Regulate blood volume Regulate electrolyte balance

What are the actions of angiotensin II?

Vasoconstriction: increase BP, acts primarily in arterioles, some in veins Release of Aldosterone: Na+ retention, K+ loss, increased volume. Alteration of cardiac and vascular structure (Cardiac remodeling)

How does RAAS help regulate BP?

constricts renal b.v. acts on kidney to promote retention of sodium and water and excretion of potassium

What are the RAAS drugs?

ACE inhibitors Angiotensin receptor blockers (ARBs) Direct Renin Inhibitor (DRI) Aldosterone Antagonists

What med class is Captopril apart of?

ACE inhibitors

What is the mechanism of action for Captopril?

inhibits the ACE needed to change the inactive angiotensin I to the active form of angiotensin II (reduces amount of blood heart needs to pump)

What are the therapeutic uses of Captopril?

HTN Heart failure (Cardiac remodeling) MI (cardiac remodeling) Diabetic and nondiabetic nephropathy

What are the adverse effects of ACE inhibitors?

First-dose hypotension Fetal injury Cough Angioedema Hyperkalemia Renal failure

What are the drug interactions of ACE inhibitors?

diuretics antihypertensive agents drugs that raise K+ levels Lithium NSAIDs

What are the mechanisms of action for Losartan?

blocks receptor access to angiotensin II cause dilation of arterioles and veins Prevent angiotensin II from inducing pathologic changes in cardiac structure decrease release of aldosterone increase excretion of Na+ and water

What are the therapeutic uses of ARBs?

HTN HF Diabetic nephropathy MI Stroke prevention

What are the adverse effects of ARBs?

Angioedema Fetal harm renal failure

What pt would the nurse be most concerned about developing hyperkalemia? A. A pt who is prescribed enalapril and spironolactone B. a pt who is prescribed losartan C. a pt who is prescribed an ARB D. A pt who has type II diabetes mellitus w/HTN

The nurse is caring for a pt with BPD treated with Lithium. The pt has a new prescription for captopril for HTN. The combination of these 2 drugs makes which assessment particularly important? A. K+ levels B. Lithium levels C. Creatinine levels D. BP

What are the drug therapies for HF?

Diuretics ACE inhibitors ARBs Beta blockers Dopamine Dobutamine Vasodilators

What are the diuretics used to treat HF?

Thiazide diuretics High-ceiling (loop) diuretics Potassium-sparing diuretics

Which diuretic is the drug of choice for treating HF?

High-ceiling (loop) diuretics

What are the RAAS inhibitor drugs used to treat HF?

ACE inhibitors ARBs Aldosterone antagonists

Which med class is Lisinopril apart of?

ACE inhibitor

What are the therapeutic effects of Lisinopril?

Hemodynamic benefits (arteriolar & venous dilation, and suppression of aldosterone release) Alter cardiac remodeling Decrease pulmonary congestion and peripheral edema (dilate veins)

What are the adverse effects of Lisinopril?

Hypotension Hyperkalemia Intractable cough angioedema renal failure fetal injury

What med class are ARBs apart of?

RAAS inhibitors

What are the therapeutic effects of ARBs?

Improve LV ejection fraction Reduce HF symptoms Increase exercise tolerance

What med class is Spironolactone apart of?

Aldosterone antagonists (RAAS inhibitors)

What med class is Metoprolol apart of?

Beta Blockers

What are the therapeutic effects for beta blockers?

protect from excessive sympathetic stimulation protect against dysrhythmias

What are the adverse effects for beta blockers?

fluid retention or worsening of HF Fatigue Hypotension Bradycardia or heart block

What med class is Isosorbide dinitrate apart of?

Vasodilators

What are the therapeutic effects of Isosorbide dinitrate?

selectively dilates veins

What are the adverse effects of Isosorbide dinitrate?

Reflex Tachycardia Orthostatic hypotension

What is the mechanism of action for Inotropic Agents?

Increase myocardial contractile force Alter electrical activity of heart

What med class is Dopamine apart of?

Sympathomimetic of Inotropic Agents

What is the mechanism of action for Dopamine?

Synthesis Catecholamine Activates beta 1-adrenergic receptors in the heart, kidney, and b.v.

What are the therapeutic effects of Dopamine?

Increases HR Dilates renal b.v. Activates alpha 1 receptors

What med class is Dobutamine apart of?

Sympathomimetic, Inotropic Agents

What are the mechanisms of action for Dobutamine?

Synthetic catecholamine Selective activation of beta 1-adrenergic receptors

What are the therapeutic effects of Dobutamine?

Improves myocardial contractility and improves cardiac performance

Which drug is preferred for treatment of HF: Dopamine or Dobutamine?

Dobutamine

What are the therapeutic uses of Phosphodiesterase inhibitors?

Inodilator- increases myocardial contractility and promotes vasodilation Used if HF- reserved for pts w/severe reduction in cardiac output resulting in decreased organ perfusion Arrythmias, myocardial ischemia

What med class is Digoxin apart of?

Cardiac Glycoside

What are the mechanisms of action for Digoxin?

Profound effects on mechanical and electrical properties of the heart Increase myocardial contractility Increase C.O. Suppress SA node

What are the therapeutic effects of Digoxin?

Hemodynamic benefits: decreased sympathetic tone increased urine production decreased renin release

What is the relationship of K+ to inotropic action in Digoxin?

An increase in K+ can impair therapeutic responses, whereas a decrease in K+ can cause toxicity

What are the adverse effects of Digoxin?

Cardiac dysrhythmias Anorexia N/V fatigue visual disturbance muscle weakness

What are the interactions of Digoxin?

Diuretics ACE inhibitors and ARBs Verapamil

A pt is prescribed digoxin and furosemide. It is most important for the nurse to assess which value before administration of these meds? A. Serum sodium B. Blood urea nitrogen C. Serum potassium Plasma B-natriuretic peptide

A nurse instructs a pt about signs and symptoms of digoxin toxicity. The nurse determines that teaching is successful if the patient makes which statement? A. "If my heart is racing, the dose may be too high." B. "I should report any muscle weakness or nausea." C. "My doctor should be notified if diarrhea occurs." D. "The dose will be reduced if I develop memory loss."

B (shows symptoms of digoxin toxicity)

The nurse cares for a pt receiving digoxin. What indicates to the nurse that treatment with this medication is effective? A. Improved cardiac output B. Reduced exercise tolerance C. Increased body weight D. Decreased cardiac contractility

The nurse cares for a pt w/a digoxin level of 1.9 ng/mL. Which action would be most appropriate for the nurse to take initially? A. Start continuous heart monitoring B. Check the pts serum creatinine C. Administer digoxin as prescribed D. Give Fab antibody fragments (Digibind)

A (close to toxic level (2ng/mL) and digoxin has a low therapeutic index)