Pharmacology, Nursing, diuretics
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| Diuretics | Increase urine output
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| How do diuretics work? | By increasing glomerular filtration rate and decreasing tubule reabsorption
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| What are the classes of diuretics? | Thiazides, High Ceiling (loop), Osmotics, Carbonic Anhydrase Inhibitors, Potassium Sparing
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| How do thiazides work? | By decreasing the reabsorption of Mg, Na, Cl, water, carbonic acid, and K. Also, it increases the reabsorption of glucose, Ca and lipids.
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| What is the prototype for thiazides? | HCTZ hydroclorothiazide
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| What are some clinical uses for diuretics? | to treat hypertension and edema. To decrease interocular pressure and to soften the eye for surgery.
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| HCTZ | hydrochlorozide. The prototype for thiazides.
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| What is the prototype for high ceiling diuretics? | Lasix/furosemide
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| How do high ceiling/loop diuretics work? | By decreasing reabsorption of Ca, Na and Cl.
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| What are they key features of thiazides? | They are not a strong diuretic, they take 2 hours to start working, they can be used to treat hypercalcemia in the urine, they are a poor choice to use on diabetics and risk of allergy in people who are allergic to sulfonamides.
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| What are common adverse effects of diuretics? | hypotension, fluid deficit, hypokalemia, hyponatrimia, hyperglycemia
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| What are some causes of edema? | heart failure, renal failure, poor circulation
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| Polyurea | large urine output
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| Oligurea | small urine output
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| Anurea | no urine output
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| Edema | excessive fluid in the tissues
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| Hypokalemia | low levels of serum potassium
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| How is mannitol/Osmitrol administered? | By IV only
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| mannitol/Osmitrol | osmotic diuretic
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| Why would you need to monitor hr and rhythm when using potassium sparing diuretics? | abnormal potassium affects the conduction of cardiac nerve impulses and myocardial contraction
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| How do potassium sparing diurectics work? | Promotes the loss of sodium and retains potassium
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| What is a risk with using an osmotic diuretic? | hypervolemia then hypovalemia
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| What are the key features of high ceiling diuretics? | stronger/faster onset of action, sodium restriction is often needed, treats hypercalcemia, is ototoxic
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| Which diuretic would you use to treat anuria, increased IOP, and/or edema? | Osmotic diuretics
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| spironolactone/Aldactone | potassium sparing diuretic
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| Explain how osmotic diuretics affect the blood volume | fluid is drawn from the tissues into the blood, as the blood filters through the kidneys, water is excreted. If too much water is excreted then hypovalemia can occur.
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| How do carbonic anhydrase inhibitors work? | by inhibiting bicarbonate reabsorption and by inhibiting production of aqueous humor and cerebrospinal fluid
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| What is the prototype for the osmotic diuretic? | mannitol/Osmitrol
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| What are clinical uses for osmotic diurectics? | Used to treat anuria, increased IOP, and edema
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| How do osmotic diuretics work? | By increasing osmotic pressure in blood and in the glomerular filtrate.
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| What are the key features of potassium sparing diuretics? | There is the potential for hyperkalemia, potassium supplements are not needed, monitor hr and rhythm.
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| What is the potassium sparing diuretic? | spironolactone/Aldactone
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| Why is a sodium restriction needed in conjunction with use of a high ceiling diuretic? | post-diuretic rebound effect
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| furosemide/Lasix | high ceiling (loop) diuretic
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| why are thiazides a poor choice as a diuretic for pts w/diabetes? | b/c it increases serum gluose and lipids
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| Why are thiazides useful in treating elevated urine calcium? | B/c it increases reabsorption of Ca. (meaning less Ca in the urine!)
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| Carbonic anhydrase inhibitor prototype? | acetazolamide/Diamox
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| What are the key points of carbonic anhydrase inhibitors? | Reduces IOP and ICP (intercranial pressure)also decreases blood pH.
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| When your pt is on diuretics what do you need to monitor? | I&O, weight, edema, serum electrolytes, neuromuscular status, serum glucose and mental status.
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| When your pt is on a diuretic, what should you see on thier I&O? | output should be higher than input
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| What is the best method for detecting fluid loss or gain? | daily weight
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| Where is edema most prevalent? | ankles, on the back (when pt is on bed rest). And auscultation of the lungs may reveal pulmonary edema.
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| Serum glucose is most likely to be affected by which type of diuretic? | Thiazides
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| assessment of reflexes and muscle tone may be indicative of ____. This is important b/c _____. | electrolyte imbalance; impulse conduction and muscle activity depend on specific concentrations of electrolytes.
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| cerebral edema causes ______. | confusion or decreased alertness.
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| What are signs of hypovolemia? | hypotension, tachycardia, dry mucous membranes and concentrated urine.
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| What are signs of hypokalemia? | irregular pulse, hypotension, weak respirations, muscle weakness, and abdominal distention.
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| What do you need to know about administering potassium? | always dilute and give slowly
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| In a pt w/hyponatremia, what would you assess for? | Hypotension, tachycardia, oliguria, confusion, and abdominal cramps.
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| In a pt w/hypocalcemia what would you assess for? | neuromuscular irritability
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| In a pt w/hypercalcemia what would you assess for? | depressed neuromuscular function
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| What do you need to do to treat hypocalcemia? | provide Ca as ordered
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| How do you treat hypercalcemia? | encourage fluids to prevent urinary stones, administer a high ceiling diuretic as ordered
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| What should you include in pt teaching about diuretics? | take diuretics in the morning, report muscle weakness, palpations, muscle cramps, confusion, reduce sodium intake (as ordered), salt subtitutes contain potassium
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| acetazolamide/Diamox | Carbonic anhydrase inhibitor
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| Which group of pts are at higher risk for sodium depletion? | the elderly
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