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Chap. - 15


most commonly used drug, influencing function of urinary tract, increasing urine excretion diuretics
thiazides, loop, potassium-sparing, & osmotic agents are four classes of diuretics
type of diuretic used is determined by condition being treated
diuretics used to lower intraocular pressure carbonic anhydrase inhibitors
most commonly used type of diuretic; increases excretion of water, sodium, chloride, & potassium thiazides
thiazides are used in the treatment of __ from causes such as heart failure & cirrhosis edema
thiazides are used in treatment of __ __, either alone or in combination w/drugs from other classes; functions to reduce peripheral vascular resistance as well as by decreasing fluid retention uncomplicated hypertension
thiazides are used as __ for calculus formation in patient w/hypercalciuria prophylaxis
thiazides are used to treat __ __ from renal dysfunction electrolyte imbalance
diuretic of choice to treat electrolyte imbalance from renal dysfunction metolazone
stone calculus
excess calcium in the urine hypercalciuria
side effect to thiazides that may lead to cardiac arrhythmias hypokalemia
hypokalemia is __ deficiency potassium
side effect to thiazides that may lead to alkalosis hypochloremia
hypochloremia is __ deficiency chloride
thiazide side effects include __ hypotension, vertigo, & headache postural
side effect of thiazides can include __ & increased uric acid hyperglycemia
contraindications/caution: thiazides may cause hyperglycemia & glycosuria for patient who have diabetes
contraindications/caution: thiazides may cause increased uric acid level in patient with history of gout
contraindications/caution: thiazides may cause severe __ disease renal
contraindications/caution: thiazides may cause impaired __ function liver
contraindications/caution: thiazides if patient will be using for prolonged periods periodic __ __ checks are indicated serum electrolyte
contraindications/caution: thiazides if patient will be using for prolonged periods __ __ are recommended to prevent hypokalemia potassium supplements
contraindications/caution: thiazides if older patient will be using may cause __ __, due to greater sensitivity of patient low sodium
contraindications/caution: thiazides if patient is hypersensitive to sulfonamide
patients prescribed thiazides should be instructed to include __ __ in their diet potassium-rich foods
if thiazides are prescribed for hypertension, a __ __ may be prescribed by physician low-sodium diet
thiazides should be administered with __ to reduce gastric irritation food
thiazides should be administered in __ to prevent sleep-cycle disruption morning
patients on thiazides should rise slowly from reclining position to counter act postural hypotension
thiazides may interact w/NSAIDs; there is a risk of renal insufficiency
thiazides taken w/corticosteroids may increase potassium loss
thiazides is taken with lithium may interact by causing lithium intoxication
thiazides interact w/hypotensive agent which potentiate blood pressure decrease
thiazides taken w/digitalis will increase potential for digitalis toxicity
thiazides may be taken with Probenecid (Benemid) in order to block uric acid retention
thiazides taken with antidiabetic agents can lead to loss of diabetic control
act directly on a specific portion of the kidneys to inhibit sodium & chloride reabsorption loop diuretics
furosemide (Lasix), bumetanide (Bumex), & torsemide (Demadex) a potent diuretics that act in a similar way to __, to increase excretion of water, sodium, chloride, & potassium thiazides
the action of loop diuretics is more __ & __ than thiazides with greater diuresis rapid; effective
furosemide (Lasix), bumetanide (Bumex), & torsemide (Demadex) are __ diuretics loop
loop diuretics are used in the treatment of edema associated w/impaired renal function or __ disease hepatic
loop diuretics are used in the treatment of congestive heart failure
loop diuretics are used in the treatment of __ edema pulmonary
loop diuretics are used in the treatment of __ caused by malignancy or cirrhosis ascites
loop diuretics are used in the treatment of __; if thiazides are ineffective, loops are sometimes combined w/ other ___ hypertension; antihypertensives
side effects of loop diuretics include fluid/electrolyte imbalance w/dehydration, __ __, & chest pain circulatory collapse
side effects of loop diuretics includes ___ w/weakness & vertigo hypokalemia
potassium supplements are recommended for cardiac patients taking loop diuretic in order to prevent arrhythmias
side effects of loop diuretics includes __, close BP checks required hypotension
side effects of loop diuretics includes hyperglycemia & increased uric acid
side effects of loop diuretics includes allergic reactions to furosemide & bumetanide in those allergic to sulfa
contraindications/caution: careful morning monitoring required for patients taking loop diuretics by those with cirrhosis or other liver disease
contraindications/caution: loop diuretics may cause __ impairment kidney
contraindications/caution: loop diuretics may cause __ & dehydration alkalosis
contraindications/caution: loop diuretics may cause cardiac arrhythmias if potassium not supplemented for ___ patients digitalized
contraindications/caution: loop diuretics for __ __ __, regarding Bumex & Demadex children under 18
in patients w/cirrhosis of liver, torsemide (Demadex) must be given with a potassium-sparing agent to prevent hypokalemia & __ __ metabolic acidosis
interactions of loop diuretics are __ __ those of thiazides similar to
loop diuretics interact w/corticosteroids by potentiating potassium loss
loop diuretics interact w/digitalis w/increased potential for __ __ & arrhythmias digitalis toxicity
loop diuretics interact w/aminoglycosides, increasing the chance for deafness
loop diuretics interact w/indomethacin decreasing diuretic effect
loop diuretics interact w/salicylates, specifically __, by increasing chance of salicylate toxicity furosemide
loop diuretics interact w/anticonvulsants, specifically __, by reducing the diuretic effect of furosemide phenytoin
patients taking loop diuretics should take with __ prior to 6pm food
patients taking loop diuretics should report any changes in urinary output, especially a __ decrease
patients taking loop diuretics should report abrupt or severe weight loss
patients taking furosemide should limit exposure to __, due to __ sunlight; photosensitivity
administered under conditions in which potassium depletion can be dangerous potassium-sparing diuretics
potassium-sparing diuretics such as spironolactone (Aldactone) & triamterene (Dyrenium) counteract increased glucose & uric acid levels associated with thiazide diuretic therapy
diuretic of choice for patients w/cirrhosis spironolactone
spironolactone has been shown very effective in patient with severe heart failure
potassium-sparing diuretics are __ used alone seldom
potassium-sparing diuretics are usually combined w/thiazide diuretics to __ diuretic & hypotensive effects increase
potassium-sparing diuretics are usually combined w/thiazide diuretics to __ danger of hyperkalemia reduce
when combination products, such as Aldactazide or Dyazide, are given __ __ is usually not indicated; varies w/individual & other medications taken concomitantly supplemental potassium
periodic __ __ __ are indicated for patients taking potassium-sparing diuretics serum electrolyte checks
side of effects of potassium-sparing diuretics can lead to hyperkalemia, especially with __ __, which may lead to cardiac arrhythmias potassium supplements
side of effects of potassium-sparing diuretics can lead to fatigue, lethargy, & __ weight loss profound
side of effects of __ diuretics can lead to hypotension potassium-sparing
side of effects of potassium-sparing diuretics can lead to __ with spironolactone gynecomastia
potassium-sparing diuretics is indicated w/patient who have renal insufficiency, cirrhosis & other liver disease, & pregnant/lactating caution
patients taking potassium-sparing diuretics may experience the interaction of ___ when taken w/potassium supplements, ACE inhibitors, ARBs, salicylates, & NSAIDs hyperkalemia
when patients taking potassium-sparing diuretics also take lithium there is a possible interaction of ___ ___ & cause lithium toxicity reduce clearance
patients taking potassium-sparing diuretics should be instructed to __ potassium rich foods & salt substitutes in their diet avoid
patients taking potassium-sparing diuretics should be instructed to report signs of __ __, such as dry mouth, drowsiness, lethargy & fever excessive dehydration
patients taking potassium-sparing diuretics should be instructed to report __ __, such as nausea, vomiting, & diarrhea GI symptoms
patients taking potassium-sparing diuretics should be instructed to report __ headache & mental confusion persistent
patients taking potassium-sparing diuretics should be instructed to report __ heartbeat irregular
patients taking potassium-sparing diuretics should be instructed to take medication __ meals after
frequently use to reduce intracranial/intraocular pressure, prevent/treat acute renal failure, & during certain cardiovascular surgery osmotic agents
thiazide & related diuretics; trade name for indapamide Lozol
thiazide & related diuretics; trade name for hydrochlorothiazide Esidrix, HydroDIURIL
thiazide & related diuretics; trade name for metolazone Zaroxolyn
loop diuretic; trade name for furosemide Lasix
loop diuretic; trade name for bumetanide Bumex
loop diuretic; trade name for torsemide Demadex
potassium-sparing diuretic; trade name for spironolactone Aldactone
potassium-sparing diuretic; trade name for triamterene Dyrenium
combination potassium-sparing/thiazide diuretic; trade name for spironolactone/hydrochlorothiazide Aldactazide
combination potassium-sparing/thiazide diuretic; trade name for triamterene/hydrochlorothiazide Dyazide, Maxzide
osmotic agents; parenteral administration only; trade name for mannitol Osmitrol
osmotic agents; parenteral administration only; trade name for urea Ureaphil
form of arthritis in which uric acid crystals are deposited in & around joints, causing inflammation & pain gout
gout usually begin in the __ or __, but affected joints in any location knee; foot
medications to treat gout include uricosuric agents & allopurinol, which lower uric acid levels
act on the kidney by clocking reabsorption & promoting urinary excretion of uric acid uricosuric agents
uricosuric agent; trade name for probenecid Benemid
uricosuric agents are used in treatment of __ cases of gout & frequent __ attacks of gouty arthritis chronic; disabling
uricosuric agents have no __ or __ activity analgesic; anti-inflammatory
uricosuric agents are __ __ in treatment of acute gout not effective
during acute attacks of gout the probenecid dosage is supplemented with __, which has anti-inflammatory action colchicine
in a gonococcal infection probenecid is sometimes given w/penicillin to __ levels of antibiotic in the blood potentiate
probenecid can also be given with cefoxitin to treat acute pelvic inflammatory disease
if probenecid is not taken with large volumes of fluid, consistently, the side effect can include kidney stones & renal colic
hypersensitivity reactions, rash, hypotension, & anaphylaxis are rare side effects from probenecid administration
patients w/uric acid kidney stone & peptic ulcer history, or renal impairment, or blood dyscrasias are __ for administration of probenecid contraindicated
the action of penicillins/cephalosporins when taken with probenecid can cause potentiation of therapeutic effects
the interaction of oral hypoglycemics & probenecid can cause ___ through potentiation hypoglycemia
salicylates __ uricosuric action antagonize
probenecid decreases __ __ when taken w/NSAIDs renal clearance
uricosuric agents should taken __ food with
acts by decreasing serum & urine levels of uric acid; trade name Zyloprim & Lorpurin allopurinol
blocking sympathetic nerve impulses anticholinergic
anticholinergic in action, used to reduce strength & frequency of contractions of urinary bladder antispasmodics
antispasmodic; used to increase bladder capacity in patients w/neurogenic bladder resulting in incontinence propantheline (Pro-Banthine)
anticholinergic, used as antispasmodic, with adverse effects in older adults hyoscyamine (Cystospaz, Levsin)
chemically similar drugs that exert spasmolytic effects on smooth muscle; used for relief of symptoms such as urgency, frequency, nocturia, & incontinence; adverse effects in older adults tolterodine (Detrol) & oxybutynin (Ditropan)
fewer anticholinergic adverse effects than, and are less than/equally effective to oxybutynin IR oxybutynin XL, or Oxytrol patch
side effects of antispasmodics are anticholinergic in action
includes: drying of all secretions (esp. eyes & mouth); drowsiness/dizziness, urinary retention & constipation; blurred vision; mental confusion (esp. older adults); tachycardia, palpations; nausea, vomiting; rash, urticaria, allergic reactions side effects of antispasmodics
patients w/hepatic/renal disease, obstructive uropathy; bladder/GI obstructions/ulcerative colitis; cardiovascular disease; prostatic hypertrophy; pregnant/nursing; narrow angle glaucoma are advised to use antispasmodics with caution
antispasmodics are contraindicated for children under 5
cholinergic drug that stimulates parasympathetic nerves to bring about contraction of urinary bladder in cases of nonobstructive urinary retention, usually post-op or postpartum bethanechol (Urecholine)
Urecholine is called the "pharmacological catheterization"
side effects of bethanechol are cholinergic in action and usually __ related dose
GI cramping, diarrhea, nausea, vomiting; sweating & salivation; headache & bronchial constriction; slow heartbeat/reflex tachycardia & orthostatic hypotension; urinary urgency are all side effects of cholinergics
obstruction of GI/urinary tract, hyperthyroidism, peptic ulcer, IBS, asthma, cardiovascular disease/bradycardia, Parkinson, seizure disorder, pregnancy & lactation are all contraindications of cholinergics
when bethanechol has known interactions w/other cholinergic or anticholinesterase agents which can potentiate effects, increasing possibility of toxicity
quinidine/procainamide can __ the cholinergic effects of bethanechol when taken concomitantly antagonize
in cases of cholinergic toxicity __ can be used as an antidote, since it antagonizes the cholinergic effect Atropine
used to relieve burning, pain, & discomfort in urinary tract mucosa urinary analgesics
urinary analgesic or local anesthetic for relief of burning, pain, discomfort, & urgency associated w/urinary tract mucosa for cystitis, cytoscopy/surgery, or trauma phenazopyridine (Pyridium)
phenazopyridine (Pyridium) should not be taken for more than (2) days when used with antibacterial agents
phenazopyridine (Pyridium) is only used for __ __ & not substitute for treatment of causative conditions symptomatic relief
include headache/vertigo, mild GI disturbances, & orange-red urine which may stain fabric & contact lenses side effects of phenazopyridine (Pyridium)
oral urinary antispasmodic medication exhibiting weak anesthetic & analgesic properties for symptomatic relief flavoxate (Urispas)
urinary analgesics are not a __ for antibiotic treatment of UTIs substitute
impaired kidney function (esp. older adults) & severe hepatitis are __ of urinary analgesics contraindications
phenazopyridine (Pyridium) may __ with various urine, kidney function, or liver function tests interfere
used to reduce size & associated urinary obstruction & manifestations (urgency, nocturia, & urinary hesitancy) in patients w/BPH; antiandrogens finasteride (Proscar) & dutasteride (Avodart)
age-associated enlargement of prostate from proliferation of glandular/stromal elements; generally begins in 5th decade of life; interferes with the normal passage of urine from the bladder benign prostatic hypertrophy (BPH)
Proscar 5mg or Avodart 0.5mg daily for minimum of 6-12 months is the treatment for BPH
treatment for BPH appears to be __ rather than __ suppressive; curative
if patient stops BPH treatment __ is likely to to return hypertrophy
includes: impotence, decreased libido/ejaculation, & gynecomastia (incl. breast tenderness/enlargement) side effects from antiandrogens
enlargement of one or both breasts in a male, usually seen in adolescents or elderly men due to excessive estrogen activity; occasionally there is even excretion of milk gynecomastia
patients being administered antiandrogens should be screened first for cancer, infection, or other urinary dysfunctions
antiandrogens may cause __ for patients w/liver function abnormalities exacerbations
crushed tablets & soft gelatin capsules, of antiandrogens, should not be handled by pregnant women because they can cause fetal damage
blocks alpha-1 receptors in smooth muscle in the bladder neck & prostate, causing them to relax tamsulosin (Flomax)
tamsulosin (Flomax) is able to decreased symptoms of BPH because the __ __ rate improves urine flow
alpha-clockers used in treatment of hypertension, as well as for BPH doxazosin (Cardura) & terazosin (Hytrin)
include: dizziness, headache, nasal congestion; orthostatic hypertension; palpitations (not Flomax); ejaculation dysfunction, decreased libido, impotence side effects from alpha-blockers
combination therapy recently shown to significantly reduce overall clinical progression of BPH & may reduce need for invasive therapy compared to either agent alone Proscar & Cardura
uricosuric agent; trade name for probenecid w/colchicine ColBenemid
antispasmodic; trade name for propantheline ProBanthine
antispasmodic; trade name for tolterodine Detrol, Detrol LA
antispasmodic; trade name for oxybutynin Ditropan, Ditropan XL, Oxytrol patch
antispasmodic; trade name for hyoscyamine Cystospaz, Levsin
antispasmodic; trade name for flavoxate Urispas
antispasmodic; trade name for phenazopyridine Azo Standard
antiandrogen; trade name for finasteride Proscar
antiandrogen; trade name for dutasteride Avodart
alpha-blocker; trade name for doxazosin Cardura
alpha-blocker; trade name for tamsulosin Flomax
alpha-blocker; trade name for terazosin Hytrin