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