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NURS202 Exam III Pt4
Antihypertensive Drugs- Diuretics
| Question | Answer |
|---|---|
| What are diuretic drugs and what are the results? | drugs that accelerate the rate of urine formation RESULT: removal of Na+ and H2O, decrease the plasma and extracellular fluid vol- decreased preload, CO, total peripheral resistance overall effect: decreased workload of the heart and BP |
| Name the types of diuretic drugs. | thiazide and thiazide-like, carbonic anhydrse inhibitors, loop diuretics, osmotic diuretics, potassium sparing diuretics |
| What is the first line choice of drugs when treating hypertension? | thiazide and thiazide-like diuretics |
| What is a possible nursing dx for a patient taking diuretics? | risk for fluid volume- deficit, excess or imbalance |
| What is the mechanism of action of thiazides? | inhibit tubular reabsorption of Na+, Cl-, and K+ ions, distal convoluted tubule, dilate the arterioles by direct relaxation, |
| What is the result of thiazides? | H2O, Na+, Cl- are excreted and some K+, lower preripheral vascular resistance |
| When should thiazides not be used? | if creatinine clearance is <30 to 35ml/min (normal is 125) metolazone can be used to 10ml/min |
| What are indications for thiazides? | edema, idiopathic hypercalciuria, diabetes insipidous, HF due to diastolic dysfunction, adjunct drugs in treatment of edema related to HF, hepatic cirrhosis, corticosteroid or estrogen therapy, HTN |
| what are adverse effects of thiazides? | photosensitivity, paresthesias, decreased libido, impotence, blurred vision, dizziness, headache, anorexia, nausea, vomiting, diarrhea, urticaria, hypokalemia, glycosuria, hyperglycemia, hyperuricemia |
| What is the mechanism of action of carbonic anhydrase inhibitors (CAI's)? | block carbonic anhydrase preventing exchange of H+ with Na+, H2O in proximal tubule, blocking of carbonic anhydrase reduces H+ ion concentration in tubules->increased excretion of HCO3(bicarb),Na+,H2O,K+, decreased absorption of H2O,increased urine output |
| What are indications for CAI's? | open-angle glaucoma, with miotics to lower intraocular pressure pre-sx, edema, epilepsy, high-alt sickness acetazolamide: edema secondary to HF when other diuretics ineffective less potent than loop or thiazides |
| What are adverse effects of CAI's? | metabolic acidosis, photosensitivity, melena, hematuria, anorexia, hypokalemia, paresthesias, urticaria, drowsiness |
| What is the mechanism of action of loop diuretics? | act directly on the ascending limb of the loop of Henle to inhibit Cl- and Na+ reabsorption, increase renal prostaglandins, resulting in dilation of blood vessels and reduced peripheral vascular resistance |
| What is the result of loop diuretics? | decreased fluid volume causes reduced: BP, pulmonary vascular resistance, systemic vascular resistance, central venous pressure, L ventricular end-diastolic pressure, K+ and Na+ depletion |
| What are the indications for loop diuretics? | edema associated with HF or hepatic or renal disease, increase renal excretion in patients with hypercalcemia, HF resulting from diastolic dysfunction, HTN |
| What are adverse effects of loop diuretics? | tinnitus, agranulocytosis, neutropenia, thromocytopenia, hypokalemia, hyperglycemia, hyperuricemia, blurred vision, dizziness, headache, nausea, vomiting, diarrhea, |
| What is the mechanism of action for osmotic diuretics? | work mostly in proximal tubule, nonabsorbable, producing osmotic effect, pull H2O into the renal tubules from the surrounding tissue, inhibits tubular resorption of H2O and solutes, producing rapid diuresis |
| What are the results of osmotic diuretics? | increases glomerular filtration and renal plasma flow- helps prevent kidney damage during acute renal failure, reduces excessive intraocular pressure |
| What are indications for osmotic diuretics? | early oliguric phase of acute renal failure (ARF), promote excretion of toxic substances, reduction of intracranial pressure, treatment of cerebral edema, NOT indicated for peripheral edema |
| What are adverse effects of osmotic diuretics? | convulsions, thrombophlebitis, pulmonary congestion, headaches, chest pains, tachycardia, blurred vision, chills, fever |
| What is the mechanism of action of potassium sparing diuretics? | work in collecting ducts and distal convoluted tubules, interfere with Na+/K+ exchange, competitively bind to aldosterone receptors, block reabsorption of Na+ and H2O usually induced by aldosterone |
| What are the results of potassium sparing diuretics? | prevent K+ from being pumped into the tubule thus preventing secretion, competitively block the aldosterone receptors and inhibit its action, promote excretion of Na+ and H2O |
| What are indications for potassium sparing diuretics? | spironolactone and triamterene: hyperaldosteronism, reversing the potassium loss caused by potassium-losing drugs, HF, HTN amiloride: HF ascites |
| What are adverse effects of potassium sparing diuretics? | urinary freq, weakness, cramps, dizziness, headache, nausea, vomiting, diarrhea, hyperkalemia spironolactone: gynecomastia, amenorrhea, irregular menses, postmenopausal bleeding |
| What are nursing implications associated with patients taking diuretics? | patient hx and physical exam-drug allergies, baseline fluid volume, I/O, serum electrolytes, weight, VS, postural BP's, skin turgor, lung sounds, labs (BUN), disorders that contraindicate cautious use of these drugs |
| What education needs to be given to a patient taking diuretics? | take in AM to avoid interference with sleep, maintain proper nutritional and fluid volume status, eat more K+ rich foods: bananas, dates, oranges, raisins, plums, fresh veggies, potatoes, meat, fish, apricots, whole grain cereals, legumes |
| Patients taking diuretics should notify the physician immediately if they experience: | rapid heart rates or syncope (hypotension or fluid loss which could be K+ imbalance), a weight gain of >2 lbs a day or >5 lbs a week |
| S/s of hypokalemia include: | muscle weakness, constipation, irregular pulse rate, overall feeling of lethargy |
| Patients taking thiazides should avoid excessive consumption of: | black licorice |
| Patients taking diuretics should be monitored for these adverse effects: | metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alertness, hyperkalemia with potassium sparing diuretics |
| Patients taking diuretics should be monitored for these therapeutic effects: | reduced edema, fluid volume overload, HF reduced hypertension return to normal intraocular pressures dypsnea & pulse ox should improve weight loss |
| Patients taking diuretics should be evaluated for the following: | SBP <120 and DBP <80 and controlled F/E balance WNL lungs clear to auscultation no evidence of weight gain |
Created by:
kgrabo99
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