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NURS 572 Ch 40

Pharm Ch 40 diuretics

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