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NURS 572 Ch 40
Pharm Ch 40 diuretics
| Question | Answer |
|---|---|
| general MOA of diuretics | generally blockade of Na and Cl reabsorption |
| Three classes of diuretics | *loop diuretics - high ceiling *thiazides *K sparing (aldosterone blockers, non-aldosterone blockers) *osmotic |
| what are the most effective diuretic, with highest ceiling, that doesn't plateau with dose | Loop diuretics are all of this |
| SOA of loop diuretics | ascending Loop of Henle |
| MOA of loop diuretics | blocks Na/Cl reabsorption in ascending Loop of Henle. medulla less hypertonic, more water in urine. |
| Loop diuretics are indicated for these pts | *pulmonary edema, edematous states *HTN, especially renal impaired |
| Which class of diuretics is safe for renal impaired HTN | Loop diuretics - furosemide, bumetanide, torsemide |
| how are loop diuretics administered | They have rapid onset where IV admin > po admin |
| What drug class has interactions with digoxin and lithium | Loop Diuretics have these interactions |
| What drug class has interactions with NSAIDs, K+ sparing antidiuretics and antihypertensives | Loop diuretics have these interactions |
| Watch first dose effect of othorthostatic hypoTN - name 3 drugs in this class | watch this SE for furosemide, bumetanide, torsemide |
| what drug class has the 'hypo---' ADRS | Loop diuretic ADRs ---hypo - vol/natremia/kalemia/chloremia/Mg/Ca and alkalosis |
| what drug class has the 'hyper---' ADRs in addition to otototoxicity | Loop diuretics have mild/ST HYPER---glycemia/lipidemia/uricemia |
| are Loop diuretics often given in combination | yes, often given in combination |
| furosemide class | loop diuretic |
| bumetanide class | loop diuretic |
| torsemide class | loop diuretic |
| What class of drug peaks in 4-6 hours | Thiaziade drug class |
| MOA of thiazides | block reabsorption of Na/Cl in DCT & asecending LofH? |
| Thiazides indicated for which pts | Indicated for HTN, edema *less effective than loop diuretics in renal impairment |
| ADRs of thiazides | less pronounced first dose hypoTN effect, overall ADRs the same but less pronounced due to lower maximum effect. no ototoxicity |
| Let's review lesser effect of thiazide ADRs | dehydration, all the 'hypos' and 'hypers'. but no ototoxicity |
| Do thiazides have same interactions, but to a lesser effect, as loop diuretics? | Yes, lesser but present interactions for digoxin, lithium, NSAIDs, K sparing and antihypertensive drugs |
| name 4 thiazide drugs | *hydrochlorothiazide *chlorothiazide *chorothalidone *metolazone |
| hydrochlorothiazide class | thiazide - most widely used |
| chlorothiazide class | thiazide - oral, IV |
| chlorothalidone class | thiazide - longer acting |
| metolazone class | thiazide class |
| Two sub-classes of K-sparing diuretics | Aldosterone blockers, non-aldosterone blockers |
| what class of drug is it unusual to be on alone due to SE of weakeness | aldosterone blockers least likely to be admin solely |
| What class of drug is most often combined with another diuretic | K+ sparing diuretics most often combined when pt needs to conserve K |
| K sparing diuretics indicated for | Indicated for severe HF, some HTN, hyperaldosteronism |
| MOA of K sparing diuretics | both subclasses prevent the exchange of Na reabsorption/K secretion in COLLECTING DUCT. non-aldosterone blockers do this DIRECTLY while aldosterone blockers do this INDIRECTLY |
| which drug class has delayed effects due to 2nd messenger mechanism | K sparing adlosterone blockers have this delayed effect |
| what drug class has a MAJOR concern for hyperkalemia, especially for RF pts | K sparing diuretics have this concern - both aldosterone/non-aldosterone blockers |
| name 2 aldosterone antagonists | *spironolactone, eplerenone |
| what drug has estrogen effects bwo its chemical structure | spironolactone has this effect |
| spironolactone class | K sparing aldosterone blocker |
| eplerenone class | K sparing aldosterone blocker |
| which subclass of K sparing diuretic has QUICKEST onset | non-aldosterone blocker doesn't use 2nd messenger, otherwise same MOA |
| class of triamterene | K sparing non-aldosterone blocker |
| class of amiloride | K sparing non-aldosterone blocker |
| MOA of osmotic diuretic | drug IS filtered through glomerulus but NOT reabsorbed --> stays in filtrate --> exerts osmotic effect to draw water into lumen of nephron |
| osmotic diuretics indicated for | *Renal failure - prevention/tx *Increased ICP *Increased intraocular pressure |
| mannitol is an osmotic diuretic that has an ADR of edema. How can this be | because it is filtered out at every capillary bed EXCEPT those in the brain. When filtered out of peripheral capillaries it pulls fluid into third space --> edema |
Created by:
lorrelaws
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