Pharm Final -- Diuretics
Nursing 1 with Covelli at University of Central Florida
About this deck
By: caitlin blue
Created: 2010-12-02
Size: 28 flashcards
Views: 47
Created: 2010-12-02
Size: 28 flashcards
Views: 47
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Diuretics (overview)
- block Na+ and Cl- reabsorption (decrease in blood serum levels) to create osmotic pressure within nephron to PREVENT passive reabsorption of water to then be excreted
--> increases urine flow directly related to amount of Na+ and Cl- blocked
--> increases urine flow directly related to amount of Na+ and Cl- blocked
Diuretics - Adverse Impact of Extracellular fluid
- can cause hypovolemia
- acid-base imbalance
- disturbance of electrolyte levels
- acid-base imbalance
- disturbance of electrolyte levels
Classifications of Diuretics
- High ceiling Loop diuretics (lasix)
- Thiazide diuretics (hydochlorothiazide)
- Osmotic diuretic
- Potassium sparing (spironolactone)
- Nonaldoantagonist
- Carbonic anhydrase inhibitors--drugs to lower intraocular pressure
- Thiazide diuretics (hydochlorothiazide)
- Osmotic diuretic
- Potassium sparing (spironolactone)
- Nonaldoantagonist
- Carbonic anhydrase inhibitors--drugs to lower intraocular pressure
Nursing Care for all diuretics
- ASSESS:
VS, I and Os, effectiveness, electrolytes, respiratory status, edema, and change position slowly
VS, I and Os, effectiveness, electrolytes, respiratory status, edema, and change position slowly
Loop Diuretics (Lasix)
** most effective
** prevents reabsorption of Na+ and Cl-
- Uses: HTN, pul. edema (renal, cardiac, hepatic), HF,
** (other LD) Ethacrynic acid (Edecrin) – may cause permanent ototoxicity!!
** prevents reabsorption of Na+ and Cl-
- Uses: HTN, pul. edema (renal, cardiac, hepatic), HF,
** (other LD) Ethacrynic acid (Edecrin) – may cause permanent ototoxicity!!
Lasix (furosemide) -- Interactions and duration
- digoxin toxicity with hypokalemia
- potassium sparing diuretics may limit K+ loss
oral--diuresis in 60 min lasts 8 hours
IV --diuresis in 5 min --lasts 2 hours
- potassium sparing diuretics may limit K+ loss
oral--diuresis in 60 min lasts 8 hours
IV --diuresis in 5 min --lasts 2 hours
Lasix -- Adverse Effects
- dehydration
- hypotension
- electrolyte imbalance (*** decrease K+ levels)
- hypokalemia ** check serum levels and EKG -- peaked T waves, weak pulse, dysrhythmias
- ototoxicity-- lasix (reversible) and ethacrymic acid ***may be irreversible!
**photosensitivy
- hypotension
- electrolyte imbalance (*** decrease K+ levels)
- hypokalemia ** check serum levels and EKG -- peaked T waves, weak pulse, dysrhythmias
- ototoxicity-- lasix (reversible) and ethacrymic acid ***may be irreversible!
**photosensitivy
Hydochlorothiazide (good kidneys????)
- distal convoluted tubule
- ** dependent on adequacy of kidney function
****do not use in renal impairment***
USE: HTN, edema , heart failure, hepatic failure, Diabetes insipidus
- ** dependent on adequacy of kidney function
****do not use in renal impairment***
USE: HTN, edema , heart failure, hepatic failure, Diabetes insipidus
Thiazide Diuretics
- increases excretion of Na, Cl, K and H2O (hypovolemia, hypokalemic)
***May elevate plasma glucose and uric acid***** (diabetics and gout)
***less effective than loop diuretics
DO NOT use if breastfeeding
***May elevate plasma glucose and uric acid***** (diabetics and gout)
***less effective than loop diuretics
DO NOT use if breastfeeding
Thiazides -- Adverse Effects
- Electrolyte disorders:
Hyponatremia
Hypochloremia
Hypokalemia
Dehydration
*******Hyperglycemia
*****Hyperuricemia
Cholesterol abnormalities
Hyponatremia
Hypochloremia
Hypokalemia
Dehydration
*******Hyperglycemia
*****Hyperuricemia
Cholesterol abnormalities
Thiazides -- Pharmacokinetics
- Onset 2 hours after administration
- Peak 4 to 6 hours
- Duration 12 hours
- Excreted unchanged in urine
- Peak 4 to 6 hours
- Duration 12 hours
- Excreted unchanged in urine
Potassium Sparing Diuretics
- blocks the action of Aldosterone (which reabsorbs sodium)
- retains K+ and excretes Na+--->H2O
- modest increase in urine production
- retains K+ and excretes Na+--->H2O
- modest increase in urine production
Potassium Sparing Diuretics -- Therapeutic effects
- Hypertension
- Edema
- Congestive heart failure
- Primary hyperaldosteronism
- Acne in young women
- Edema
- Congestive heart failure
- Primary hyperaldosteronism
- Acne in young women
K+ Sparing Diuretics --> Agents
- Spironolactone (Aldactone)
--> Aldosterone antagonist
- Triamterene (Dyrenium) ***** may cause BLUE URINE
--> Aldosterone antagonist
- Triamterene (Dyrenium) ***** may cause BLUE URINE
Adverse Effects of Aldosterone (K+ sparing diuretics)
- Hyperkalemia***** monitor*
--> Must use with care if combined with other K+ retaining meds
such as ACE inhibitors
--> Must use with care if combined with other K+ retaining meds
such as ACE inhibitors
Adverse Effects of Aldosterone (K+ sparing diuretics) --> endocrine effects
- Gynecomastia
- Menstrual irregularities
- Impotence
- Hirsutism
- Deepening of voice
- Menstrual irregularities
- Impotence
- Hirsutism
- Deepening of voice
Mannitol --> Osmotic Diuretic
- Causes water to be drawn into the blood stream from ECF compartment.
- The increased blood volume --> excretion of water and lytes by kidney
- The increased blood volume --> excretion of water and lytes by kidney
Mannitol Uses
** Maintain urine output and prevent RF
- reduction of ICP and intraocular pressure
- maintain urine flow in dehydration, shock.
****must be give IV
***does not diffuse GI epithelium
- IV--diuresis--30-60 minutes --lasts 6-8 hours
- reduction of ICP and intraocular pressure
- maintain urine flow in dehydration, shock.
****must be give IV
***does not diffuse GI epithelium
- IV--diuresis--30-60 minutes --lasts 6-8 hours
Mannitol Adverse Effects
- Edema
** the increased blood volume can precipitate HF and Pulmonary edema
** with ICP will need lasix or bumex
- Headache
- N&V
- F&E imbalance
** the increased blood volume can precipitate HF and Pulmonary edema
** with ICP will need lasix or bumex
- Headache
- N&V
- F&E imbalance
Nursing Interventions- Mannitol administration
- Determine compatibility with other IV solutions
- Infusion is regulated for Urine Output of 30-50mL/Hr
- Check for crystals- if present – warm the solution to body temp
****use inline filter and needle to reduce risk of crystals entering circulation
- Infusion is regulated for Urine Output of 30-50mL/Hr
- Check for crystals- if present – warm the solution to body temp
****use inline filter and needle to reduce risk of crystals entering circulation
Carbonic Anhydrase Inhibitors
- Inhibit carbonic anhydrase action --> decrease reabsorption of water, NA+ K+ and HCO3.
- Decreases carbonic anhydrase in CNS --> raises seizure threshold
- Decrease formation of aqueous humor in the eye.
- Decreases carbonic anhydrase in CNS --> raises seizure threshold
- Decrease formation of aqueous humor in the eye.
Drugs and Uses of Carbonic Anhydrase Inhibitors
** Drugs
- Diamox (acetazolamide)
- Trusopt (dorzolamide)– topical- eye drops
*** adverse effects-- bitter taste & occular stinging
USES
- Open-angle glaucoma
- Epilepsy
- Edema associated with heart failure
***Altitude (mountain) sickness
- Diamox (acetazolamide)
- Trusopt (dorzolamide)– topical- eye drops
*** adverse effects-- bitter taste & occular stinging
USES
- Open-angle glaucoma
- Epilepsy
- Edema associated with heart failure
***Altitude (mountain) sickness
Adverse Effects of Carbonic Anhydrase Inhibitors
*** contraindicated for those allergic to sulfonamides
- n,v and d or constipation
- Hematuria
- Glucosuria
- Drowsiness, lethargy, headache
- Tinnitus
- Hypokalemia
- n,v and d or constipation
- Hematuria
- Glucosuria
- Drowsiness, lethargy, headache
- Tinnitus
- Hypokalemia
Dopamine/ Dobutamine
- receptor effects--
dopamine, beta 1 and high dose alpha 1
dopamine, beta 1 and high dose alpha 1
Dopamine Action
- Activating dopamine receptors in the kidney
- low doses -- dilates the renal blood vessels
- high doses --effects alpha and beta -- *** vasoconstriction--inc B/P
**not used as much for renal perfusion
- low doses -- dilates the renal blood vessels
- high doses --effects alpha and beta -- *** vasoconstriction--inc B/P
**not used as much for renal perfusion
Etiology & pathogenesis of UTI
- E. coli-- normal in the colon
- Klebsiella, pseudomonas, enterococus staph
- Treatment:
--> empty bladder
--> increase fluids especially acidic
- Klebsiella, pseudomonas, enterococus staph
- Treatment:
--> empty bladder
--> increase fluids especially acidic
Treatment of UTIs
- Trimethoprim/sulfamethoxazole (TMP/SMZ, Bactrim, Septra)
- antibiotics (Bactrim):
+ pyridium (urine turns orange) for burning sensation
- antibiotics (Bactrim):
+ pyridium (urine turns orange) for burning sensation
Treatment for uncomplicated UTI:
**Education
Avoid direct sunlight
Contraindicated for allergy to sulfonamides/salicylates.
**Not for newborns or pregnant women
Avoid direct sunlight
Contraindicated for allergy to sulfonamides/salicylates.
**Not for newborns or pregnant women
About this deck
By: caitlin blue
Created: 2010-12-02
Size: 28 flashcards
Views: 47
Created: 2010-12-02
Size: 28 flashcards
Views: 47
About StudyBlue
STUDYBLUE makes things that make you better at school.
Things like online flashcards with photos and audio.
Things like personalized quizzes and friendly reminders about when (and what) to study next.
Think of it as a digital backpack™: access to all of your study materials online and on your phone.
STUDYBLUE exists to make studying efficient and effective for every student, for free. Join us.
“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis
Dennis