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  1. Diuresis
    • the process of ridding the body of fluids through the
    • increased production of urine and the excretion of water and electrolytes
  2. A diuretic is a substance that causes
  3. Drugs that are diuretics are used to
    • to decrease fluid volume in pathologic conditions in
    • which the body cannot self-regulate fluid volume effectively

    • conditions include edema, congestive heart failure (CHF), pulmonary edema, hypertension, and
    • kidney disorders.
  4. Diuretics decrease
    renal reabsorption of sodium and promote its excretion in water.

    The various types of diuretics work differently in the body.
  5. Hypervolemia may result from excessive
    sodium and water retention
  6. Peripheral edema increases the
    cardiac work load and decreases tissue perfusion.
  7. When systemic edema is severe, the congestion will
    • back up into the lungs, affecting breathing and gas
    • exchange
  8. Nephron
    Smallest unit in the kidneys that produce urine
  9. Glomerulus
    blood come through and gets ride of waste products, ions, and some electrolytes, Filtration
  10. Proximal convoluted tubule
    lot of sodium and chloride are reabsorbed. Most happens here so diretics that work early on are more effective
  11. Loop of Henle
    water is permeable it leaves tubule and comes out into nephron
  12. Distal convoluted tubule
    more manipulation of sodium choloride
  13. Active tubular
    another way ions are brought back into the body or out. Water in loop of henle are done very passively
  14. Proximal Convoluted tubule

    65% NaCl reabsorption
  15. Loop of Henle

    20% NaCl reabsorption
  16. Early Distal Convoluted tubule

    10% NaCl reabsorption
  17. Late Distal Convoluted tubule

    Spirolactone and Triamterene:
    1-5% Na+ and K+
  18. High Ceiling Loop diuretics
  19. Thiazide diuretics
    ◦Hydrochlorothiazide (HCTZ)
  20. Osmotic diuretics
  21. Potassium Sparing diuretics

    Aldosterone antagonists:
  22. Potassium Sparing diuretics

    NonAldosterone antagonists
  23. Loop Diuretics
    Work in the loop of Henle to inhibit the reabsorption of sodium and chloride

    Exert a powerful effect of fluid and electrolyte balance

    Called high-ceiling diuretics

    • It inhibits the sodium chorlide and stay in the urine. Fluid will be pulled in to stay in the urine and goes out.
    • High-ceiling= powerful effect, works early on
  24. Loop Diuretic: Furosemide (Lasix) Other drugs in class
    bumetanide (Bumex), ethacrynic acid (Edecrin), and torsemide (Demadex)
  25. Loop Diuretic: Furosemide (Lasix) Therapeutic Uses
    • Potent diuretic, effective reducing peripheral edema from CHF, pulmonary edema, hepatic and
    • renal diseases, including nephrotic disease.

    Used in the treatment of HTN; first choice over thiazides in patients with pre-existing renal disease, because, unlike thiazides, it does not decrease glomerular filtration rate.
  26. Loop Diuretic: Furosemide (Lasix) Physiologic Actions
    Inhibits the reabsorption of sodium, chloride, and water in the ascending loop of Henle.

    Has some effect in the proximal and distal tubules.
  27. Loop Diuretic: Furosemide (Lasix) Side Effects
    • Adverse effects are related to fluid or electrolyte
    • imbalance, ototoxicity, dehydration, hypotension, hypokalemia, hyperglycemia, hyperuricemia, low
    • calcium and magnesium levels
  28. Loop Diuretic: Furosemide (Lasix) Interactions
    Digoxin, antihypertensives, lithium, NSAIDS
  29. Loop Diuretic: Furosemide (Lasix) Labs and Monitoring
    Excretion of sodium, chloride, potassium, magnesium, calcium and water increases.

    Increase blood glucose, low-density lipoprotein, total cholesterol, uric acid and triglyceride levels.

    Monitor weight, I and O, BP
  30. Loop Diuretic: Forosemide (Lasix) extra facts
    • Pregnancy Category C,
    • Potassium rich diet,
    • s/s electrolyte imbalance,
    • change position slowly
  31. Digoxin
    • works by manipulating potassium. These drugs
    • loose potassium.
  32. Lithium
    • think of salt,
    • when sodium levels are down lithium is reabsorbed, sodium is excreted ,
    • lithium is not excreted correctly and can get to toxicity
  33. NSAIDS
    • undermine effect of prostaglandis.
    • NSAIDS, if boy is taking them for pain pain relief is caused by prostaglandis.
    • If prostaglandis is altered it effects diuresis
  34. Baroreceptors
    decrease and manage dilation constriction in vessels so change position slowly
  35. Furosemide (Lasix) Effects with IV administration occur within
    10 minutes—cardiac arrest has been reported
  36. Furosemide (Lasix) Ototoxicity may occur with
    • rapid IV administration, therefore, 20-40 mg of IV
    • should be given over at least 1 to 2 minutes to decrease risk of ototoxicity
  37. Thiazide Diuretics
    The thiazides comprise the largest group of diuretics.

    They are related structurally to the antibacterial sulfonamides.

    The prototype thiazide diuretic is hydrochlorothiazide (HCTZ).
  38. Thiazide Diuretic: Hydrochlorothiazide (HydroDIURIL) Other drugs in the class
    • chlorothiazide (Diuril),
    • methyclothiazide (Euduron),
    • chlorthalidone (Hygrotin),
    • indapamide (Lozol)
    • metolazone (Zaroxolyn).
  39. Thiazide Diuretic: Hydrochlorothiazide (HydroDIURIL) Therapeutic Uses
    Manages HTN alone or with other drugs

    Also used in treating edema

    Diabetes insipidus
  40. Hydrochlorothiazide (HCTZ) Physiologic Actions
    Acts in the distal tubule and possibly in the diluting segment of the ascending loop of Henle

    Increases the excretion of sodium and chloride in the distal convoluted tubule by slightly inhibiting the ion pumps that work in sodium and chloride reabsorption

    A weak diuretic effect, because most of the sodium is reabsorbed before the distal tubule
  41. Hydrochlorothiazide (HCTZ) Side Effects
    • mostly due to the effects of fluid loss or imbalance,
    • dehydration, hypokalemia, hyperglycemia
  42. Hydrochlorothiazide (HCTZ) Interactions
    Digoxin, lithium, BP meds, NSAIDS
  43. HCTZ side effects Similar to lasix, but does not have
  44. Hydrochlorothiazide (HCTZ) Labs and Monitoring
    Increases excretion of potassium, bicarbonate, and magnesium and decreases the excretion of calcium

    Water-soluble vitamins also are lost

    May decrease glomerular filtration rate and increase BUN

    Monitor renal status, hepatic status, blood glucose levels, lipid, and uric acid levels
  45. Hydrochlorothiazide (HCTZ) Contraindications
    • severe renal impairment, hepatic coma, and hypersensitivity to the drug or to sulfonamide
    • antibiotics

    Check allergy to sulfa, Pregnancy category B
  46. Normal glucose
  47. Potassium-Sparing Diuretics promote
    sodium and water excretion in the distal tubule; at the same time, potassium is not excreted; rather, it is reabsorbed
  48. Potassium-Sparing Diuretics produce
    weak diuresis and antihypertensive effects when used alone
  49. Potassium-Sparing Diuretics are more frequently used in
    combination with loop and thiazide diuretics to minimize potassium loss because they work synergistically with other diuretics
  50. Less than 15 kidneys are
    not working and its renal failure
  51. Less than 90 means what to the kidneys
    Kidney disease
  52. Serum Creatine
    • Male: 0.5-1.5
    • female: 0.6-1.2,
    • if you are muscular yo have a lot of protien and these levels are altered. Clearance is more sensitive number
  53. Creatine clearance
    • Males: 90-137
    • Females: 88-128
  54. BUN
  55. Potassium-Sparing Diuretics may cause
  56. Potassium-Sparing Diuretics

    Aldosterone antagonists:
    spironolactone (Aldactone)
  57. Potassium-Sparing Diuretics

    Non Aldosterone antagonist:
    ◦triamterene (Dyrenium)

    ◦amiloride (Midamor)
  58. Potassium-Sparing Diuretics: Spironolactone (Aldactone)

    Works in the ...
    • distal tubule to increase sodium and water loss and to
    • retain potassium
  59. Potassium-Sparing Diuretics: Spironolactone (Aldactone)

    Is used for ...
    • hypertension,
    • edema,
    • heart failure,
    • PCOS,
    • acne in women,
    • premenstrual syndrome
  60. Potassium-Sparing Diuretics: Spironolactone (Aldactone)

    Interferes with..
    • testosterone synthesis, which leads to altered
    • estrogenic and androgenic (think male hormones) activity;

    a major use is in diagnosing and treating primary hyperaldosteronism
  61. Potassium-Sparing Diuretics: Spironolactone (Aldactone)

    Adverse effects...
    hyperkalemia, impotence, menstrual irregularities, and gynecomastia

    In cases of hyperkalemia, sodium polystyrene sulfonate (Kayexalate) may be given orally or rectally.
  62. Polly cystic ovarian syndrome (PCOS)
    imbalance of sex hormones, male pattern baldness, trunkal obestiy, a lot of facial hair are common
  63. Gynecomastia
    breast production in males
  64. Potassium-Sparing Diuretics: Triamterene (Dyrenium)

    Other drugs in the class..
    amiloride (Midamor),
  65. Potassium-Sparing Diuretics: Triamterene (Dyrenium)

    Pharmacologic Class
    Non Aldostrone antagonist
  66. Potassium-Sparing Diuretics: Triamterene (Dyrenium)

    Therapeutic Uses
    Used to manage edema and hypertension; typically used with other diuretics because it allows potassium to be reabsorbed and sodium to be excreted
  67. Triamterene (Dyrenium) Physiologic Actions
    • Inhibits transport of sodium in the distal tubules
    • independent of aldosterone;
    • this causes increased loss of sodium, chloride, water, bicarbonate, and calcium;
    • the drug promotes the retention of potassium and magnesium
  68. Triamterene (Dyrenium) Side Effects
    Adverse effects related to electrolyte imbalance, particularly hyperkalemia which may be fatal

    Nausea, vomiting, leg cramps, dizziness
  69. Triamterene (Dyrenium) Interactions
    ACE inhibitors, potassium supplements
  70. Triamterene (Dyrenium) Labs and Monitoring
    • Potassium
    • BP,
    • weight
  71. Triamterene (Dyrenium) Limit pts intake of
    potassium, potassium salt substitutes
  72. Osmotic Diuretics
    • Increase osmotic pressure and pull fluid into the vascular space; are not reabsorbed by the
    • tubules and so prevent water reabsorption; also prevent the reabsorption of sodium and chloride
  73. Mannitol
    Type of sugar
  74. Osmotic diuretic: mannitol (Osmitrol)

    Other drugs in class
    • glycerin (Osmoglyn), isosorbide (Ismotic), and
    • urea (Ureaphil)
  75. Osmotic diuretic: mannitol (Osmitrol)

    Therapeutic Uses
    Major uses include preventing and treating ARF, reducing intracranial pressure in cerebral edema, reducing intraocular pressure when other drugs have not worked, and promoting excretion of toxic substances in urine
  76. mannitol (Osmitrol)

    Physiologic Action
    Create diuresis by increasing blood osmolality which attracts fluid from other compartments (third spacing, cerebral fluid, intraocular fluid)
  77. Mannitol (Osmitrol)

    Side Effects
    Heart failure, pulmonary edema, renal failure, fluid and electrolyte imbalance, dehydration
  78. Mannitol (Osmitrol)

    Lasix may prevent rebound fluid retention
  79. Mannitol (osmitrol)

    Labs and Monitoring
    I and O, electrolytes and serum osmolality, BUN and Crt.

    s/s heart failure, renal failure
  80. Mannitol (Osmitrol) is given
    IV, administer with filter needle
  81. Osmotic Diuretics
    • Glycerin (Glycerol):
    • Isosorbide (Ismotic)
    • Urea (Ureaphil)
  82. Glycerin (Glycerol)
    • An osmotic agent give orally to reduce intraocular pressure before ophthalmic surgery and during
    • acute glaucoma attacks.
  83. Isosorbide (Ismotic)
    Used to provide short-term reduction of intraocular pressure before and after intraocular surgery, and to interrupt acute attacks of glaucoma
  84. Urea (Ureaphil)
    Administered by IV infusion

    Used to decrease intracranial pressure and to reduce intraocular pressure
  85. Iop
    aquesous humor is lymph for the eye, causes pressure on the eye, if firm humor is increased
  86. Open Angle
    everything is fine size wise but there is tooo much aqueous humor
  87. Closed Angle
    sits really tight , aqueous humor goes….iris and pupil sit too close to the cornea ***
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