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Pharm exam 2
B&S
| Question | Answer |
|---|---|
| What type of diuretic? Furosemide (Lasix) | LOOPS |
| What type of diuretic? Bumetanide (Bumex) | LOOPS |
| What type of diuretic? Ethacrynic Acid (Edecrin) | LOOPS |
| What type of diuretic? Hydrochlorothiazide (Hydrodiuril) | THIAZIDES |
| What type of diuretic? Chlorothiazide (Diuril) | THIAZIDES |
| What type of diuretic? Spironolactone (Aldactone) | POTASSIUM SPARER |
| What conditions do you use diuretics? | Heart failure, Cirrhosis/liver disease , Renal disease/failure , Hypertension , Pulmonary edema. |
| Goal of Diuretics | Reduction of fluid volume: Benefits. Reduced workload of the heart. Increased cardiac output. Decreased peripheral edema. Decreased pulmonary congestion. |
| Important Assessments when using diuretics | Daily Weight I&O Urine output Response of Blood Pressure Electrolytes Take Pulses |
| Conditions with bad response to diuretics | Ischemic Episodes (TIA) Complications: the 4C's - Coronary Artery Disease , Chronic Renal Failure , Congestive Heart Failure , A Cerebral Vascular accident. |
| Potassium range - | 3.5-5-0 mEq/L |
| Sodium range- | 135-145 mEq/L |
| cloride range | 96 - 106 mEq/L |
| Calcium range | 9.0-10.5 mEq/L |
| Magnesium range | 1.3-2.1 mEq/L |
| Phosphorus range | 3.0-4.5 mg/dL |
| Minimum urine output per hour (adult) | 30 mL/hour |
| Serum creatinine: | 0.5-1.2 |
| BUN | 10 - 20 mg/dL |
| what diuretic: Work in distal convoluted tubule to Prevent reabsorption of water & Promote diuresis when renal function is not impaired | THIAZIDES |
| what diuretic: Watch Out! Prenancy Category B, use with caution in view of impaired renal function as it just may not work! | THIAZIDES |
| THIAZIDES Adverse Reactions: | Hypotension electrolyte imbalance Hyperglycemia Photosensitivity of skin Gl Upset |
| THIAZIDES DDI: | Digoxin, antihypertensives, Lithium, NSAIDs |
| Thiazide Diuretics are often a medication of first choice for | essential hypertension. |
| Thiazide diuretics are recommended as drugs of choice for initial treatment of | mild to moderate HTN. The thiazides have been PROVEN to effectively contorl HTN AND reduce HTN-related morbidity and mortality. |
| Purpose: Block reabsorption of sodium and chloride in the ascending loop of Henle to | High ceiling” Loop Diuretics |
| Prevent reabsorption of water & Cause extensive diuresis | High ceiling” Loop Diuretics |
| these increase renal blood flow, they are useful in renally compromised patients. | High ceiling” Loop Diuretics |
| You often see the ______ used for edema in Med-Surg applications. | High ceiling” Loop Diuretics |
| They are “choice” for renal compromised patients because they tend to increase renal blood flow. | High ceiling” Loop Diuretics |
| What drug ? Watch Out! Pregnancy Category C Use with caution in view of diabetes (it increases blood sugar) Use with caution in view of gout (may result in hyperuricemia) | High ceiling” Loop Diuretics |
| High ceiling” Loop Diuretics Adverse Reactions: | Common: Hypotension Common: electrolyte imbalance Hypokalemia Hyponatremia Hypochloremia Hypocalcemia Hypomagnesemia Common: Hyperglycemia Ototoxicity (transient deafness = rare) |
| High ceiling” Loop Diuretics DDI: | Digoxin, antihypertensives, Lithium, NSAIDs |
| High ceiling” Loop Diuretics sulfa alery | Lasix & Bumex |
| High ceiling” Loop Diuretics What to monitor: | dehydration = I&O, daily weights.Monitor BP.E-Lytes and signs and symptoms. POTASSIUM especially important: report levels of 3.0 or less Monitor blood sugar esp DM |
| potassium foods | avocado, strawberry, bananas, potatoes |
| High ceiling” Loop Diuretics, Teaching points: | Monitor your weight – report significant weight loss (>2 pounds/week). Weight loss of 2.5 pound = 1 Liter fluid. Avoid getting up suddenly – report dizzyness Eat potassium foods. Keep sodium intake to < 4000 mg/day |
| What drug? Purpose: Block the action of aldosterone. Keeps potassium & gets rid of sodium and water | Potassium Sparing Diuretics |
| What type of diuretic? Traimterene (Dyrenium) | Potassium Sparing Diuretics |
| What type of diuretic? Amiloride (Midamor) | Potassium Sparing Diuretics |
| Do not administer if K+ is >5.0 mEq/L what drug? | Potassium Sparing Diuretics |
| Potassium Sparing Diuretics: Adverse Reactions | Common: Hyperkalemia Common: Endocrine effects (gynecomastia/impotence/irregular menstural cycles) Triamterene may turn urine “blue” |
| Potassium Sparing Diuretics DDI | : ACE inhibitors (may K+ levels); Concurrent use of potassium supplements (may K+ levels); Lithium |
| Potassium Sparing Diuretics: What to monitor | Monitor for dehydration = I&O, daily weights. Monitor BP – be alert for orthostatic hypotension Monitor E-Lytes and signs and symptoms of E-Lyte disturbance POTASSIUM especially important: report levels of 5.0 or more |
| Teaching points: | Monitor your weight – report (>2 pounds/week). Avoid getting up suddenly – report dizzyness AVOID potassium foods: avocado, strawberry, bananas, potatoes, salt substitutes Can be taken with food to avoid GI upset Keep sodium intake to < 4000 mg/da |
| What type of diuretic? Mannitol (Osmitrol) | Osmotic Diuretics |
| What type of diuretic? Purpose: Increase blood osmolality to create diuresis. Attracts fluids from other compartments (third-spaced, cerebral, intraocular) | Osmotic Diuretics |
| What type of diuretic? Urea (Ureaphil) | Osmotic Diuretics |
| What type of diuretic? Glycerin (Osmoglyn) | Osmotic Diuretics |
| What type of diuretic? Isosorbide (Ismotic) | Osmotic Diuretics |
| What type of diuretic? Watch Out! Extreme caution needed when administering to cardiac patients (mannitol may edema & cardiac workload) . Do not use in patient with total renal failure. | Osmotic Diuretics -mannitol |
| Osmotic Diuretics Adverse Reactions: | headache, nausea, vomiting, dizziness, rash, blurred vision, thrombophlebitis, fluid/electrolyte disorders, dehydration, thirst, urticaria, hypotension |
| Osmotic Diuretics DDI: | lithium, MAOIs, organic nitrates |
| Osmotic Diuretics What to monitor: | Monitor for dehydration = I&O, daily weights. Monitor serum osmolality Monitor urine osmolality |
| What class? Aluminum Hydroxide Gel (Amphojel | Phosphate Binders |
| What class? Aluminum Carbonate gel (Basaljel) | Phosphate Binders |
| What class? Sevelamer Hydrochloride (Renagel) | Phosphate Binders |
| What class? Calcium Carbonate (Tums) | Phosphate Binders |
| Phosphate Binders Contraindications | Patients with any type of GI motility disorders where slowing down the movement through the GI would be deleterious. Patients with vitamin deficiencies Pregnant women/breast-feeding women |
| What class of drugs? Watch Out! May interfere with absorption of MANY other medications. (assume it does unless proven otherwise). | Phosphate Binders |
| Phosphate Binders Adverse Reactions: | Constipation (which is why we do NOT use these when slowing down peristalsis would be a problem!) Interference with absorption of other medications. |
| Why do we worry about hyperkalemia? | Most dangerous of the electrolyte disorders Commonly accompanies metabolic acidosis Several common underlying mechanisms can result in too much K+ Best clinical indicators: serum potassium levels electrocardiogram tracings |
| Serum potassium levels exceeding 7 mEq/L can cause | possible serious cardiac arrhythmias/heart block leading to cardiac arrest. |
| What drug? Purpose: To promote potassium excretion | Sodium polystyrene sulfonate (Kayexalate) |
| This medication is used to treat hyperkalemia (potassium >5 mEq/L). | Sodium polystyrene sulfonate (Kayexalate) |
| What drug? Watch Out! Use with caution in patients who cannot tolerate shifts in sodium & patients who receive digoxin or K+ sparing diuretics | Sodium polystyrene sulfonate (Kayexalate) |
| Sodium polystyrene sulfonate (Kayexalate) Adverse Reactions: | Adverse Reactions: Common: Electrolyte imbalance: you can send the K+ too low. Sodium excess possible |
| Sodium polystyrene sulfonate (Kayexalate) DDI: | DDI: Calcium or magnesium antacids or laxatives may reduce drug effect (oral form). Patients on digoxin and potassium-sparing diuretics require frequent K+ monitoring |
| Which drug may be useful to treat hyperkalemia effects on the heart when acute potassium imbalance exists. At the same time sodium bicarbonate may be used to correct any metabolic acidosis that happens with hyperkalemia. | Calcium gluconate |
| What drug type? Potassium gluconate | Potassium Supplements |
| What drug type? potassium phosphate | Potassium Supplements |
| What drug type? potassium bicarbonate | Potassium Supplements |
| What drug type? Potassium Chloride (K-Dur) | Potassium Supplements |
| Potassium Supplements Administration: | IV: rapid IV infusion can result in fatal hyperkalemia. No more than 40 mEq per Liter IV solution No more than 10 mEq/hour rate Really tears up veins – watch for phlebitis Oral (powder to mix in water common) In at least 4 ounces liquid |
| Type of patients where excessive potassium loss might be a problem: | GI fistulas Intestinal drainage Strenuous muscular activity Laxative abuse (think bingers-purgers) Excessive or prolonger vomiting/diarrhea (disease related or bulemics) |
| What does hypokalemia look like clinically: | muscle weakness, anorexia, lethargy. |
| What drug? Watch Out! Do NOT use with K+ sparing diuretics. Do NOT use when there is severe renal disease or hypoaldosteronism | Potassium Supplements |
| Potassium Supplements Adverse Reactions: | Common: GI distress, GI ulceration, hyperkalemia |
| Potassium Supplements DDI: | DDI: Spironolactone (and other potassium sparers), ACE inhibitors due to risk for hyperkalemia |
| URINE OUTPUT should be greater that __ ml with Potassium Supplements | MONITOR URINE OUTPUT!!! Be sure it stays at least 30 mL/hour. |
| Magenesium Levels HYPO signs & Tx | HYPO Muscle Twitch Tremor Treatment Oral supplements are used to prevent hypo IV supplements are used to treat severe hypo |
| Magenesium Levels HYPer signs & Tx | HYPER Depressed deep tendon reflex Treatment Calcium gluconate |
| What class? Magnesium Sulfate | Magnesium Supplements |
| What class? Magnesium hydroxide | Magnesium Supplements |
| What class? Magnesium gluconate | Magnesium Supplements |
| What class? Purpose: Replacement or prevention of hypmagnesemia | Magnesium Supplements |
| The primary clinical findings of HYPOmagnesemia | are neuromuscular irritability, CNS hyperexcitability, and cardiac arrhythmias |
| Which class? Watch Out! Pregnancy Risk “B”; cautious used in view of renal/cardiac disease (a “no no” if AV block is present); cautious use in view of rectal bleeding, nausea/vomiting, abdominal pain. | Magnesium Supplements |
| Adverse Reactions: Magnesium Supplements | Adverse Reactions: Common: Hypermagnesemia: monitor deep tendon reflexes. |
| Magnesium Supplements DDI: | DDI: Decreased absorption of tetracyclines. |
| Magnesium Supplements Monitoring: | Serum Mag levels should be 1.3 – 2.1 mEq/L Also monitor calcium and phosphorus levels. Monitor vital signs when giving by IV route as nuromuscular blockade and respiratory depression may occur. Depressed deep tendon reflex indicates hypermagnesemia. |
| Drug used for hypermagnesemia toxicity | Have INJECTABLE calcium gluconate on hand in case of toxicity as this is the therapy. |
| Dietary sources of magnesium | Dietary sources of magnesium – whole grain cereal, nuts/legumes, green leafy veggies, bananas |
| What drug? Purpose: An alkalinizer to correct metabolic acidosis (acidosis = ph <7.35) | Sodium bicarbonate (aka “bicarb”) |
| This drug is NOT a suitable antacid for peptic ulcer disease because it is short-acting, high in sodium, and can cause metabolic alkalosis. | Sodium bicarbonate (aka “bicarb”) |
| Which drug? Uses: Acidosis due to diabetes, cardiac arrest, vascular collapse Antacid Raise urinary pH in light of salicylate overdose | Sodium bicarbonate (aka “bicarb”) |
| Signs of Alkalosis: | Signs of Alkalosis: tachycardia, irritability, muscle twitching |
| What drug? Watch Out! Hypertension, heart failure, kidney disease | Sodium bicarbonate (aka “bicarb”) |
| Sodium bicarbonate (aka “bicarb”) Adverse Reactions: | Adverse Reactions: Sodium overload Renal calculi Metabolic alkalosis |
| Sodium bicarbonate (aka “bicarb”)DDI: | DDI: corticosteroids (can result in K+ Na+; Increases effect of pseudoephedrine and quinidine; decreases effect of Lithium, salicylates (aspirin), and benzos. |
| Sodium bicarbonate (aka “bicarb”)Monitoring: | Monitoring must include: Fluid balance – I & O, daily weights (remember, weight increases with fluid load increase such as would happen with too much sodium) Electrolytes, blood chemistries, ABGs |
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