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2014-03-27 22:31:49

pharm test
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  1. diuretic therapy helps treat what
    • HTN
    • Heart Failure
    • Liver Failure
    • Pulmonary Edema
    • Increased Intercranial Pressure
    • Increased interocular pressure
  2. the purpose  of diuretic therapy
    to increase the rate of urine flow

    get rid of excess fluid
  3. loop diretic
    examples of
    • furosemide, lasix
    • Bumetanide, Bumex
    • Ethacrynic Acid, Edecrin
    • Torsemide, Demadex

    think (MIDE)
  4. mechanism of action
    Loop Diuretics
    blocks the re-absorption of sodium and chloride in the loop of Henle

    can increase urine flow even when blood flow to the kidneys is deminished
  5. Route of administration for Loop Diuretics
    • PO
    • IM
    • IV
  6. Kinetics for Loop Diuretics
    depends on Drug

    Can remove large amount of excess fluid in a short time if given IV
  7. adverse efects
    Loop Diuretics
    • electrolyte imbalance (esp k+)
    • dehydration
    • hypotension
    • weight loss
    • ototoxicity
  8. drug interaction Loop Diuretics
    • Digoxin
    • Corticosteroids
    • Lithium
    • Sulfonylureas and Insulin
  9. contraindications
    loop diuretics
    • Anurea
    • Hepatic Coma
    • Fluid and Electrolytes depletion
  10. loop diuretics
    • Hypotension
    • Replace fluids and electrolytes to correct
  11. Thiazide diuretics
    • HCTZ
    • Metolazone/Zaroxolyn
    • Chlorthalidone/Hygroton
    • Indapamide/Lozol
    • Methyclothiazide
  12. what are some things that pass through the glomerus and still be absorbed into the blood stream in the proximal and distal tubules
    • Glucose
    • Water
    • Amino Acids
  13. Some ions and large molecules that were too big to be filtered out through the glomerulus can still be filtered out in the proximal and distal tubules are
    • Potassium
    • Phosphorus
    • Hydrogen
  14. thiazide diuretics
    mec of action
    block sodium reabsorption and increase K+ and water excretion in the distal tubule

    less effective than Loop diuretics
  15. routes of admin thiazide diuretics
    • PO
    • IV
  16. Kinetics of thiazide diuretics
    all have similar mechanisms but differ in potency and duration of action
  17. Contraindications for thiazide diuretics
    • Anurea
    • Pregnancy induced HTN or pre-eclampsia
  18. overdose thiazide diuretics

    replace fluids and lytes to correct
  19. adverse effects thiazide diuretics
    • electrolyte imbanlances (Esp K+)
    • Dehydration
    • weight loss
    • hypotension
  20. drug interactions thiazide diuretics
    • Digoxin
    • Antihypertensives
    • Antidiabetic and anticoagulants
    • NSAIDS
    • Corticosteroids and amphotericin B
  21. Potassium Sparing Diuretics
    • Triamterene (Dyrenium)
    • Amiloride (Midamir)
    • Eplerenone (Inspra)
    • Spironolactone (Aldactone)
  22. Mec of action K+ Sparing diuretics

    Triamterene and Amiloride
    Interrupts Na+ and K+ exchange in the distal tubule

    causes Na+ to stay in the tubule and be excreted in urine and body retains the K+
  23. Mec of action K+ Sparing diuretics

    • Blocks aldosterone, hormone
    • that enhances the excretion of Na+ and the retention of K+
  24. K+ Sparing Diuretics
    Route of Admin
  25. Potassium sparing diuretics
    Long Acting; can have duration of 2-3 days
  26. adverse effects of potassium sparing diuretics
    • Hyperkalemia
    • Dysrhythmias
    • Dehydration
    • Hypernatremia
    • Gynecomastia only with Spironolactone
  27. Potassium sparing diuretics

    • Digoxin
    • Lithium
    • Salicylates (Spironolactone)
    • ACE Inhibitors
  28. Contraindications

    Potassium Sparing Diuretics
    • Anuria
    • Hyperkalemia
    • Pregnancy Category C
  29. Potassium Sparing Diuretics

    • Monitor for hypotension
    • Replace fluid and electrolytes
  30. Misc Diuretics that are mild
    name 2
    what do they do
    • Acetazolamide (Diamox)
    • Methazolamide (Neptazine)

    Inhibits carbonic anhydrase (which forms carbonic acid from water and carbon dioxide)
  31. Misc Diuretics Diamox and Neptazine can cause ????
    not used often because they can cause metabolic acidosis

    usually used for open angle glaucoma

    only causes mild diuresis
  32. Misc Diuretic that is very potent
  33. Mannitol
    • Osmotic Diuretic
    • Very Potent and only given IV
    • Draws excess fluid away from tissue spaces
    • increased blood volume>Pulmonary Edema
  34. when giving Diuretics
    what would you assess
    • Vitals (esp BP)
    • Daily weights
    • Medication History
  35. Nursing Process after administering Diuretic
    • Monitor for fluid overload/dehydration by measuring I/O & daily weights
    • Ensure pt moves from sitting to standing slowly
    • Monitor K+ intake (Loop & Thiazide should increase/K+ sparing should avoid excess)
  36. what are some reasons for fluid replacement
    • Loss of GI fluids (vomiting,diarhea)
    • Excessive sweat or prolonged fever
    • Burns
    • Hemorrhage
    • Excessive diuresis
  37. what are Crystalloids
    fluid that contain electrolytes and mimic the body's extracellular fluid composition

    Can contain dextrose to provide calories

    Sodium, Potassium and Sugar
  38. Crystalloids
    examples of Isotonic
    • normal saline 0.09% NaCl
    • lactated ringers
    • Plasma-Lyte 148
    • D5W
    • D5 in 0.2% NS
  39. Crystalloids

    examples of Hypotonic
    • 1/2 NS (0.45%)
    • Plasma-Lyte 56
  40. Crystalloids

    examples of hypertonic
    • Hypertonic saline (3% NaCl)
    • D5NS
    • D5LR
    • D5 Plasma Lyte 56
  41. Colloids
    Proteins, starches or other large molecules that stay in the blood for a long time; Molecules too large to cross the capillary membrane

    sometimes called Volume Expanders

    Used to treat hypovolemic shock (burns, hemorrhage or surgery)

    Have same effect as Hypertonic Solutions
  42. Colloids

    • 5% Albumin
    • Dextran 40 in NS
    • Dextran 40 in D5W
    • Dextran 70 in NS
    • Hetastarch 6% in NS
    • Plasma Protein fraction
  43. electrolyte imbalance is a sign of _____
    an underlying medical issue
  44. what is the goal for an electrolyte imbalance
    correct the imbalance and treat the underlying condition
  45. normal Sodium
  46. Hyponatremia
    • less than 135
    • can be caused by excessive ADH secretion, thyroid conditions, cancer, excessive sweating, burns, prolonged fever, diarrhea, vomiting, hypotonic IV solutions
  47. if Hyponatremia is left untreated it can cause _____
    • seizures
    • coma

    treatment is IV fluids containing NaCl
  48. Hypernatremia
    • greater than 145
    • causes cellular dehydration by drawing fluid out of the cells into the interstitial spaces

    most common cause is decreased Na+ secretion in kidney disease
  49. normal potassium
  50. hypokalemia
    • less than 3.5
    • can occur with loop diuretics, severs vomiting/diarrhea, strenuous activity

    if mild treat with diet

    if diet correction is not possible can give supplements
  51. hyperkalemia
    greater than 5

    high intake of K+ rich foods, K+ sparing Diuretics, Renal Failure

    can lead to cardiac dysrhythmias and heart block

    in very severe cases insulin can be given which causes the K+ to leave extracellular fluid and enter cells