diuretics

Question 1

diuresis

Answer 1

increased water loss

Question 2

what do diuretic drugs do?

Answer 2

• increase urine output
• remove excess fluid

Question 3

what are they used for?

Answer 3

• hypertension
• heart failure
• edematous states

Question 4

what are diuretics

Answer 4

drugs that accelerate rate of urine formation (excretion of sodium and water)

Question 5

can water move out of the nephron on its own?

Answer 5

no; where sodium goes water follows (osmosis)

Question 6

what parts of the nephron do drugs work

Answer 6

• not proximal tubule
• loop of henle (20-25% reabsorbtion)
• distal convoluted tubule (7% reabsorption)
• collecting ducts (1-2%

Question 7

negatives of diuretics

Answer 7

• excessive fluid loss (dehydration)
• electrolyte imbalance
• acid-base imbalance

Question 8

types of diuretics

Answer 8

• loop diuretics
• thiazide (and related) diuretics
• k sparing

Question 9

loop diuretic example

Answer 9

furosemide

Question 10

furosemide mechanism of action

Answer 10

• in ascending loop of henle
• inhibit Na transporter

Question 11

is furosemide high or low ceiling

Answer 11

high ceiling diuretic: significant diuresis and quickly

Question 12

furosemide indications

Answer 12

• heart failure
• hypertension: reduced venous return and CO (secondary choice)
• hypercalcemia

Question 13

furosemide adverse effects

Answer 13

• excessive fluid loss (dehydrated and easier to have thrombosis/embolism, low Na/Cl and electrolyte imbalance)
• hypokalemia
• hypoglycemia (diabetes mellitus pt)

Question 14

hypokalemia symptoms
- decrease in potassium (<3.5mmol/L)

Answer 14

• irregular heartbeat (fatal dysrhythmias)
• muscle weakness/lethargy
• leg cramps
• GI disturbances (constipation)

Question 15

furosemide interactions

Answer 15

• digoxin (heart failure drug) more toxic with hypokalemia
• can have increased hypokalemia with other diuretics - glucocorticoids
• ototoxicity (ear) with aminoglycosides
• decrease hypoglycemic effect of diabetic drugs

Question 16

thiazide diuretic example

Answer 16

hydrochlorothiazide (po)

Question 17

thiazide mechanism of action

Answer 17

• distal convoluted tubule
• inhibit sodium and chloride reabsorption
• affect protein transporter

Question 18

why are thiazide diuretics low ceiling

Answer 18

less Na reabsorption in this area so drugs have less effect

Question 19

thiazide indications

Answer 19

• hypertension (first choice drug)
• edema

-indirect: HF, liver cirrhosis

Question 20

thiazide adverse effects

Answer 20

• hypokalemia
• hyperglycemia (diabetes pt - inhibit insulin secretion)
• genitourinary system (impotence - no penile erection)

Question 21

thiazide interactions

Answer 21

• digoxin more toxic with hypokalemia
• antidiabetic drugs don’t work at well, lead to hyperglycemia

Question 22

k sparing diuretic example

Answer 22

spironolactone (aldactone)

Question 23

spironolactone mechanism of action

Answer 23

• act on collecting ducts
• aldosterone receptor blocker
• affect hormonal control of sodium reabsorption
• block reabsorption of sodium and water usually induced by aldosterone
• reduce sodium-potassium exchange

Question 24

spironolactone indications

Answer 24

• edema from HF
• hypertension
• reverse potassium loss from other diuretics (combo therapy)
• hyperaldosteronism

Question 25

does spironolactone work slow or fast and why

Answer 25

- not immediate effect - onset: 1-2 days - peak: 2-3 days - bc drug stop ald from making new proteins but doesn't effect the existing ones

Question 26

spironolactone contraindications

Answer 26

- hyperkalemia (>5mmol/L)

Question 27

spironolactone adverse effects

Answer 27

- hyperkalemia - sex hormone-like effects: amenorrhea, irregular menses, postmenopausal bleeding, gynecomastia

Question 28

spironolactone interactions

Answer 28

- other drugs that increase K+ levels (RAAS drugs like ACE inhibitors) - potassium supplements (do not give)

Question 29

nursing implications

Answer 29

- diuretics in morning (pee lots, effect sleep) - monitor K+ levels - thiazide and loop eat potassium (bananas, oranges, raisins, plums, veg, legumes, potatoes) - watch for digoxin toxicity - watch for hyperglycemia on diabetes pt - change position slowly: orthostatic hypertension - tell physician if: rapid HR, weight loss - monitor therapeutic effect (reduce edema, hypertension)

Question 30

digoxin toxicity

Answer 30

- fatigue - GI problems - changes in HR and rhythm - loss of appetite (anorexia) - visual disturbances