Urinary Meds

Question 1

Loop diruetics

Answer 1

ex - Furosemide

potent

blocks Na resorption (where slat goes, water follows)

activates renal prostaglandins -> vasodilation -> increased blood flow to kidney and lungs

Question 2

thiazide diuretics

Answer 2

ex - Hydrochlorothiazide (HCT)

inhibits K+ and Na+ resorption (where salt goes, water follows)

directly relaxes arterioles, reduces PV resistance, preload and afterload

Question 3

due to an increased loss of K+ due to these drugs (loop and thiazide diuretics), what should we monitor for?

Answer 3

hypotension

Question 4

Potassium sparing diuretics

Answer 4

ex - Spironolactone

competitively binds to aldosterone receptors and blocks resorption of Na+ and water

Question 5

Osmotic diuretics

Answer 5

ex - Mannitol

increases osmotic pressure in glomerular filtration -> pulls fluids from tissues into tubules -> diuresis

note - need functioning kidney

Question 6

which two diuretic types have less K+/electrolyte loss?

Answer 6

potassium sparing diuretics, osmotic diuretics

Question 7

5 electrolytes

Answer 7

sodium (Na+), potassium (K+), chloride (Cl-), calcium (Ca+), magnesium (Mg-)

Question 8

3 intracellular electrolytes

Answer 8

potassium, magnesium, and clacium

Question 9

Potassium K+

Answer 9

used for muscle contraction, transmission of nerve impulse, regulating HR (pacemaker)

essential for maintaining acid-base balance, isotonicity, and electrodynamic characteristics of the cells

essential component in gastric secretion, renal function, tissue synthesis, and carbohydrate metabolism

Question 10

magnesium MG+

Answer 10

essential for energy metabolism

required for muscle contractions and nerve function

Question 11

Calcium Ca++

Answer 11

most abundant mineral element in the human body

highest concentration in our bones and teeth

catalyst for coagulant pathways, essential for clotting

needed for nerve impulses, cardiac contraction, smooth and skeletal muscle contractions, renal function, and respirations

Question 12

extracellular electrolytes

Answer 12

Sodium Na+ and chloride Cl-

Question 13

Sodium Na+

Answer 13

maintained by thirst, secretion of ASH, and renal mechanism

counterpart to K+

involved in the control of water distribution, F+E balance, and osmotic pressure

along with chloride and bicarb, helps regulate acid-base balance

Question 14

3 “sedating” electrolytes

Answer 14

Potassium, calcium, and magnesium

Question 15

symptoms of sedating electrolytes

Answer 15

bradycardia, hypo tension, skeletal muscle depression, flaccid, decreases peristalsis, and muscle weakness

Question 16

2 “Irritable/excitable” electrolytes

Answer 16

sodium and phosphorus (Po4)

Question 17

symptoms of Irritable/excitable electrolytes

Answer 17

agitation/restlessness, confusion, hallucinations, seizures, muscle twitching, rigidity, increased DTR, hypocalcemia (Trousseau’s Sign and Chvostek’s)

Question 18

electrolyte replacement therapy - potassium

Answer 18

ex - potassium chloride, potassium phosphate, and potassium acetate

Safety considerations - NEVER bolus potassium (rapid infusion causes CV arrest, max rate of 10 mEq hr)), irrigating to veins (larger amounts (20 mEq) often require central access devices, caution while using in conjunction with ACE inhibitors

Question 19

electrolyte replacement therapy - sodium

Answer 19

ex - sodium chloride, hypertonic saline (3% saline)

3% saline is considered high risk -> can not be given too rapidly or too high of a dose, can cause central pontine myelinolysis or osmotic demyelination syndrome (irreversible brain stem damage)

other tx method - fluid restriction

Question 20

electrolyte replacement therapy - magnesium

Answer 20

ex - magnesium oxide, magnesium sulfate

indications - preeclampsia, eclampsia, deficiency, cardiac dysrythmias

MOA - known co factor for other agents, produces an anti-consultant effect by inhibiting neuromuscular transmission in selected convulsive states

SE - diarrhea