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diuretics
pharm final
| Question | Answer |
|---|---|
| physiology regulatory factors of BP | fluid balance; acid-base balance; electrolyte regulation; osmotic pressure |
| secretory factors of BP | renin production; erythropoeitin production; prostaglandin production |
| excretory factors of BP | metabolic waste removal |
| How do diuretics help control BP | increase urinary salt excretion and water follows |
| Goal of diuretics | increase excretion of solutes (NaCl) and water |
| What does the excretion of solutes do to fluid volume | reduce extracellular fluid volume and rid the body of interstitial fluid |
| diuretics are used to treat what? | high blood pressure; congestive heart failure; edema; glaucoma |
| What type of diuretic are Thiazides? | diluting segment diuretics |
| Thiazide (diluting segment diuretic) prototype | chlorothiazide (Diuril); hydrochlorothiazide (Hydrodiuril) |
| thiazide (diluting segment diuretics) dynamics | decrease reabsorption of sodium/chloride/potassium/bicarbonate in distal tubules |
| effect of thiazides (diluting segment diuretics) on blood vessels | widen blood vessels |
| Thiazide (diluting segment diuretics) therapeutic use | edema; hypertension; heart failure; hypercalciuria |
| site of action of thiazides | early part of distal tubule; inhibit sodium/chloride symporter |
| contraindication for thiazides | gout = secretion of medication in proximal tubules inhibit secretion of uric acid |
| Increased tubular flow rate as seen in thiazides (diluting segment diuretics) causes the increase of what electrolyte excretion? | potassium |
| GI side effects of thiazides (diluting segment diuretics) | nausea/vomiting, diarrhea |
| CNS side effects of thiazides (diluting segment diuretics) | drowsiness, confusion, headache |
| Hematopoietic side effects of thiazides (diluting segment diuretics) | agranulocytosis, anemia |
| What is another name for loop diuretics? | high ceiling |
| loop diuretics (high ceiling) prototypes | furosemide (Lasix); torsemide (Demadex); bumetanide (Bumex) |
| chlorothiazide (Diuril) | thiazide (diluting segment diuretic) |
| hydrochlorothiazide (hydrodiuril) | thiazide (diluting segment diuretic) |
| furosemide (Lasix) | loop diuretics (high ceiling) |
| torsemide (Demadex) | loop diuretics (high ceiling) |
| bumetanide (Bumex) | loop diuretics (high ceiling) |
| dynamics of loop diuretics (high ceiling) | block sodium/potassium/chloride transporter, inhibits reabsorption of sodium, calcium, potassium, magnesium in thick ascending loop of henle |
| Therapeutic uses of loop diuretics (high ceiling) | edema (CHF), hypertension, pulmonary edema, ascites |
| Kinetics of loop diuretics (high ceiling) | oral(acts 40 minutes to 1 hour( IV (5-10 minutes) |
| Adverse effects of loop diuretics (high ceiling) | hypovolemia = decreased blood pressure, weakness |
| Side effects of loop diuretics (high ceiling) | rapid fluid and electrolyte depletion; GI upset; ototoxicity |
| Caution to take with loop diuretics (high ceiling) | very powerful, close monitoring especially digitalis |
| electrolyte side effects of loop diuretics (high ceiling) | hypokalemia, hyponatremia, hypercalcemia; hypovolemia; photosensitivity |
| Drug interactions with loop diuretics (high ceiling) | digoxin, beta-blockers |
| What agents act on the distal tubule | potassium-spapering diuretics |
| potassium-sparing diuretic prototype | spironolactone (Aldactone) |
| spironolcatone (Aldactone) | potassium-sparing diuretic prototype |
| potassium-sparing diuretic dynamics | antagonized aldosterone; inhibits potassium/sodium exchange in disal tubules |
| What type of diuretic are potassium-sparing diuretics | weak diuretics |
| Potassium-sparing diuretic uses | edema, hypertension, cirrhosis of liver |
| potassium-sparing diuretic kinetics | oral peak 2-3 days; duration = 24 hours |
| Adverse effects of potassium-sparing diuretics | hyperkalemia; GI upset; headache; confusion |
| Sexual changes with potassium-sparing diuretics | decreased libido, impotence |
| what diuretics work on the proximal tubule | osmotic diuretics |
| osmotic diuretic prototype | mannitol |
| mannitol | osmotic diuretics (proximal tubule) |
| Kinetics of mannitol (osmotic diuretic) | IV; acts in 10 minutes and oral |
| dynamics of mannitol (osmotic diuretic) | increased water excretion |
| therapeutic uses of mannitol (osmotic diuretic) | prevent acute renal failure during surgery or trauma; prevent/decrease cerebral, intraocular pressure |
| side effects of mannitol (osmotic diuretic) | increases plasma osmolality |
| adverse effects of mannitol (osmotic diuretic) | nausea/vomiting, headache, electrolyte imbalance |
| contraindicaitons for mannitol (osmotic diuretic) | congestive heart failure, renal failure |
| Where do CAH inhibitors act | proximal tubules |
| CAH | carbonic anhydrase |
| CAH inhibitor prototype | acetazolamide (Diamox) |
| acetazolamide (Diamox) | CAH ihnibitor |
| CAH inhibitor dynamics | inhibit action of CAH enzyme |
| Therapeutic uses for CAH inhibitors | claucoma; increased CNS pressure; altitude sickness; edema (CHF) |
| What do CAH inhibitors do to urine | makes it alkaline |
| what does alkaline urine (from CAH inhibitors) do? | decreases excretion of some drugs; increases excretion of salycylates |
| What drugs are not as excreted as much when urine is alkaline from CAH inhibitors | procainamide |
| What drugs are excreted more when urine is alkaline from CAH inhibitors | salycylates |
| Kinetics of CAH inhibitors | oral; IM; IV |
| distribution of CAH inhibitors throughout body | widely distributed throughout body |
| Frequency of dosage of CAH inhibitors | daily dosage or alternate day dosage |
| What drugs can produce diuresis as a side effect | digitalis; Xanthines (Theophylline, caffine) |
| How do Xanthines cause diuresis | increases heart rate and blood flow |
| why does diuresis occur when kidney function is impaired due to hypovolemia | increase pressure in glomerulus and restores function |
| nursing assessment with diuretics | baseline weight, CBC, chemistry, presence of edema (abdominal-ascites), note allergies |
| What allergies should you be aware of with diuretics | sulfa |
| Nursing interventions with diuretics | monitor fluid and electrolyte balance |
| Signs of hypovolemia | hypotension, weak pulse, tachycardia, clammy skin, reduced urinary output |
| define hyponatremia | low sodium levels (135-145) |
| symptoms of hyponatremia | lethargy, disorientation |
| define hypokalemia | low potassium levels (3.5-3) |
| symptoms of hypokalemia | weakness, abnormal EKG |
| What diruetics may cause hyperkalemia | potassium-sparing diuretics |
| define hypocalcemia | low calcium levels (8.4-10.2) |
| symptoms of hypocalcemia | irritability, twitching, nausea, vomiting, tetany |
| what to monitor when on diuretics | diet (sodium/potassium); intake and output, daily weight |
| what teaching needs to be done with diuretics | "take it easy on salt"; constipation and orthostatic hyptension may be a problem |
| treatment for orthostatic hypotension | elevating feet, using compression hose |
| Diet modifications when on diuretics | high potassium diet or potassium supplement |
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