Podcast
Questions and Answers
A patient with cirrhosis develops ascites. Which diuretic mechanism would be MOST beneficial in managing this specific complication?
A patient with cirrhosis develops ascites. Which diuretic mechanism would be MOST beneficial in managing this specific complication?
- Creating an osmotic gradient in the loop of Henle, drawing water into the renal tubule.
- Blocking the action of aldosterone in the distal tubule, reducing sodium and water retention. (correct)
- Inhibiting carbonic anhydrase in the collecting duct, promoting bicarbonate excretion and reducing fluid volume.
- Decreasing sodium reabsorption in the proximal tubule, increasing overall fluid excretion.
A patient with a history of heart failure and hypertension is prescribed a diuretic. Which additional effect of diuretics, beyond fluid volume reduction, contributes MOST to lowering blood pressure?
A patient with a history of heart failure and hypertension is prescribed a diuretic. Which additional effect of diuretics, beyond fluid volume reduction, contributes MOST to lowering blood pressure?
- Increased renin secretion leading to decreased angiotensin II production.
- Direct vasodilation of peripheral blood vessels, reducing systemic vascular resistance. (correct)
- Decreased sympathetic nervous system activity, reducing the release of norepinephrine.
- Increased potassium retention, which has a direct relaxing effect on vascular smooth muscle.
A patient is diagnosed with increased intracranial pressure following a traumatic brain injury. Which type of diuretic is MOST appropriate for rapidly reducing intracranial pressure?
A patient is diagnosed with increased intracranial pressure following a traumatic brain injury. Which type of diuretic is MOST appropriate for rapidly reducing intracranial pressure?
- A potassium-sparing diuretic, to minimize electrolyte imbalances during diuresis.
- An osmotic diuretic, to create an osmotic gradient and draw fluid from the brain tissue. (correct)
- A thiazide diuretic, to promote gradual sodium and water excretion.
- A loop diuretic, to cause a profound diuresis over several hours.
A patient with renal disease is prescribed a diuretic to manage fluid overload. Which factor is MOST crucial to monitor to prevent complications associated with diuretic use in this population?
A patient with renal disease is prescribed a diuretic to manage fluid overload. Which factor is MOST crucial to monitor to prevent complications associated with diuretic use in this population?
A patient with glaucoma is prescribed a diuretic. By what mechanism do diuretics help in managing glaucoma?
A patient with glaucoma is prescribed a diuretic. By what mechanism do diuretics help in managing glaucoma?
A patient with hypertension is prescribed hydrochlorothiazide (HCTZ). What physiological mechanism explains how this medication lowers blood pressure?
A patient with hypertension is prescribed hydrochlorothiazide (HCTZ). What physiological mechanism explains how this medication lowers blood pressure?
A patient taking HCTZ reports muscle weakness and cramping. Which electrolyte imbalance is most likely the cause?
A patient taking HCTZ reports muscle weakness and cramping. Which electrolyte imbalance is most likely the cause?
A patient with a history of gout is prescribed HCTZ for hypertension. Which potential adverse effect of HCTZ requires careful monitoring in this patient?
A patient with a history of gout is prescribed HCTZ for hypertension. Which potential adverse effect of HCTZ requires careful monitoring in this patient?
A patient is prescribed spironolactone in addition to their existing diuretic regimen. What is the primary rationale for adding spironolactone?
A patient is prescribed spironolactone in addition to their existing diuretic regimen. What is the primary rationale for adding spironolactone?
A patient with a history of heart failure is prescribed a diuretic. What is the primary mechanism by which diuretics help manage this condition?
A patient with a history of heart failure is prescribed a diuretic. What is the primary mechanism by which diuretics help manage this condition?
Which of the following laboratory values should a nurse prioritize monitoring in a patient taking diuretics to minimize adverse effects?
Which of the following laboratory values should a nurse prioritize monitoring in a patient taking diuretics to minimize adverse effects?
What dietary instruction is most important for a patient prescribed spironolactone?
What dietary instruction is most important for a patient prescribed spironolactone?
A patient taking spironolactone develops gynecomastia. Which mechanism is most likely responsible for this adverse effect?
A patient taking spironolactone develops gynecomastia. Which mechanism is most likely responsible for this adverse effect?
A patient taking a loop diuretic reports muscle weakness and cramping. Which electrolyte imbalance is the MOST likely cause of these symptoms?
A patient taking a loop diuretic reports muscle weakness and cramping. Which electrolyte imbalance is the MOST likely cause of these symptoms?
A patient with heart failure is prescribed both an ACE inhibitor and spironolactone. What electrolyte imbalance requires careful monitoring in this patient?
A patient with heart failure is prescribed both an ACE inhibitor and spironolactone. What electrolyte imbalance requires careful monitoring in this patient?
What is the MOST important instruction a nurse should provide to a patient who has just started taking furosemide (Lasix)?
What is the MOST important instruction a nurse should provide to a patient who has just started taking furosemide (Lasix)?
A patient develops symptomatic hyperkalemia while taking spironolactone. Which intervention is most appropriate to rapidly decrease serum potassium levels?
A patient develops symptomatic hyperkalemia while taking spironolactone. Which intervention is most appropriate to rapidly decrease serum potassium levels?
A patient with edema secondary to heart failure is prescribed furosemide. What assessment finding would indicate to the nurse that the medication is effective?
A patient with edema secondary to heart failure is prescribed furosemide. What assessment finding would indicate to the nurse that the medication is effective?
A patient is prescribed furosemide and reports experiencing tinnitus. What action should the nurse take FIRST?
A patient is prescribed furosemide and reports experiencing tinnitus. What action should the nurse take FIRST?
Which of the following conditions would warrant cautious use of loop diuretics like furosemide?
Which of the following conditions would warrant cautious use of loop diuretics like furosemide?
A patient's BUN level is elevated while taking a diuretic. Which intervention is MOST appropriate based on this lab result?
A patient's BUN level is elevated while taking a diuretic. Which intervention is MOST appropriate based on this lab result?
An elderly patient with heart failure is prescribed oral diuretics. What crucial instruction should the nurse provide regarding the timing of medication administration?
An elderly patient with heart failure is prescribed oral diuretics. What crucial instruction should the nurse provide regarding the timing of medication administration?
Oxybutynin is prescribed for a patient with an overactive bladder. What is the primary mechanism of action of this medication?
Oxybutynin is prescribed for a patient with an overactive bladder. What is the primary mechanism of action of this medication?
A patient taking oxybutynin reports blurred vision and constipation. The nurse recognizes these as adverse effects related to which pharmacological action?
A patient taking oxybutynin reports blurred vision and constipation. The nurse recognizes these as adverse effects related to which pharmacological action?
Which pre-existing condition would be a contraindication for a patient prescribed oxybutynin?
Which pre-existing condition would be a contraindication for a patient prescribed oxybutynin?
A patient with overactive bladder is prescribed mirabegron. What is the primary mechanism of action of mirabegron?
A patient with overactive bladder is prescribed mirabegron. What is the primary mechanism of action of mirabegron?
A patient taking mirabegron should be instructed to immediately report which of the following adverse effects to their healthcare provider?
A patient taking mirabegron should be instructed to immediately report which of the following adverse effects to their healthcare provider?
A patient with non-obstructive urinary retention is prescribed bethanechol. What parameter should the nurse prioritize monitoring to evaluate the effectiveness of this medication?
A patient with non-obstructive urinary retention is prescribed bethanechol. What parameter should the nurse prioritize monitoring to evaluate the effectiveness of this medication?
Bethanechol is contraindicated for a patient with which of the following conditions?
Bethanechol is contraindicated for a patient with which of the following conditions?
A patient is prescribed finasteride for benign prostatic hyperplasia (BPH). What is the primary mechanism of action of finasteride?
A patient is prescribed finasteride for benign prostatic hyperplasia (BPH). What is the primary mechanism of action of finasteride?
A patient is prescribed tamsulosin for benign prostatic hyperplasia (BPH). What is the primary pharmacological effect of tamsulosin?
A patient is prescribed tamsulosin for benign prostatic hyperplasia (BPH). What is the primary pharmacological effect of tamsulosin?
Flashcards
Diuretic
Diuretic
Drug that reduces fluid volume in body and increases urine output.
HTN
HTN
High blood pressure.
CHF
CHF
Congestive Heart Failure - heart can't pump enough blood.
Cirrhosis
Cirrhosis
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Increased Intracranial Pressure
Increased Intracranial Pressure
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Pharmacodynamics of Diuretics
Pharmacodynamics of Diuretics
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Diuretic Assessment
Diuretic Assessment
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Diuretic: Planning and Interventions
Diuretic: Planning and Interventions
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Diuretic Goals
Diuretic Goals
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Loop Diuretics Mechanism
Loop Diuretics Mechanism
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Loop Diuretic Indications
Loop Diuretic Indications
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Loop Diuretic Adverse Effects
Loop Diuretic Adverse Effects
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Loop Diuretic: Nursing Interventions
Loop Diuretic: Nursing Interventions
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Thiazide Diuretics: Action
Thiazide Diuretics: Action
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Thiazide Diuretics: Uses
Thiazide Diuretics: Uses
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Thiazide Diuretics: Adverse Effects
Thiazide Diuretics: Adverse Effects
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Thiazide Diuretics: Nursing
Thiazide Diuretics: Nursing
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Potassium-Sparing Diuretics: Action
Potassium-Sparing Diuretics: Action
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Potassium-Sparing Diuretics: Uses
Potassium-Sparing Diuretics: Uses
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Potassium-Sparing Diuretics: Adverse Effects
Potassium-Sparing Diuretics: Adverse Effects
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Potassium-Sparing Diuretics: Nursing
Potassium-Sparing Diuretics: Nursing
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Oxybutynin Mechanism
Oxybutynin Mechanism
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Anticholinergic Effects
Anticholinergic Effects
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Mirabegron (Myrbetriq)
Mirabegron (Myrbetriq)
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Mirabegron Adverse Effect
Mirabegron Adverse Effect
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Bethanechol (Urecholine) Action
Bethanechol (Urecholine) Action
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Bethanechol Adverse Effects
Bethanechol Adverse Effects
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Bethanechol Contraindications
Bethanechol Contraindications
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Finasteride Purpose
Finasteride Purpose
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Finasteride Adverse Effects
Finasteride Adverse Effects
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Tamsulosin Action
Tamsulosin Action
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Study Notes
- Diuretics are drugs reducing fluid volume and increasing urine output.
- Used for HTN, CHF, Cirrhosis, renal disease, increased intracranial pressure, pulmonary edema, and glaucoma.
- Diuretics block sodium and water reabsorption in the nephron, causing more sodium to be excreted in the urine.
- Diuresis is the increased production of urine.
- The degree of diuresis depends on the part of the tubule affected by the drug and its potency.
Nursing Process for Diuretics
- Assess patient's health history, baseline labs (electrolytes, CBC, liver, and renal studies).
- Baseline assessment includes weight, vital signs, breathing sounds, cardiac monitoring, and edema.
- Ensure therapeutic effects by monitoring increased urine output and decreased blood pressure.
- Monitor daily weights, intake, and output.
- Minimize adverse effects by monitoring vital signs, electrolyte levels, BUN (8-20), and creatinine (0.6-1.3) levels.
- Monitor nutritional status.
- Observe signs of gout or photosensitivity.
- Be aware that elevated BUN levels may indicate dehydration.
- Patient understanding is essential.
- Three goals for patients on diuretics are increased output, decreased weight, and decreased edema.
- Most diuretics promote sodium loss in the body.
Loop Diuretics (Furosemide aka Lasix)
- Block the chloride pump in the ascending loop of Henle.
- Decrease reabsorption of sodium and chloride.
- Cause diuresis, even with severe renal impairment.
- Used for pulmonary edema.
- Used for Edema caused by liver, cardiac, or kidney disease or HTN.
- Used to treat hypercalcemia related to kidney stone formation.
- Can be given PO, IV, or IM.
Adverse Effects of Loop Diuretics
- Dehydration
- Hypotension
- Electrolyte imbalance, including hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, hyperglycemia, and hyperuricemia.
- Ototoxicity
Nursing interventions/education for Loop Diuretics
- Daily weight/strict I&O/Edema
- Electrolyte levels should be monitored
- Monitor blood pressure
- Watch for orthostatic hypotension
- Monitor for tinnitus
- Educate clients to eat high potassium foods
- Monitor glucose and uric acid
- Use cautiously in patients with DM or gout
- Do not give late in day
- Potassium levels require regular monitoring in patients receiving loop diuretics.
Thiazide Diuretics (HCTZ)
- Purpose: Blocks the chloride pump to keep chloride and sodium in the tubule to be excreted in urine
- Promotes diuresis in healthy kidneys
- Produce a mild diuretic effect compared to loop diuretics
- First choice for HTN
- Treatment of mild-mod edema, r/t heart failure or liver or kidney disease
Adverse Effects of Thiazide Diuretics:
- Dehydration
- Hypotension
- Electrolyte imbalances:
- Hypokalemia
- Hyperglycemia
- Hypercalcemia
- Hyperuricemia
Nursing interventions/education for Thiazide Diuretics
- Daily weight/I&O/check skin turgor
- Monitor electrolyte levels, glucose and uric acid
- High potassium diet
- Do not give during pregnancy
- Give early in the day
- Increased risk for lithium or digoxin toxicity
- Thiazide diuretics are considered mild diuretics because they have little or no effect on electrolyte levels.
Potassium-Sparing Diuretics (Spironolactone aka Aldactone)
- Blocks action of aldosterone, causing excretion of sodium and water while retaining potassium
- Therapeutic uses: Usually combined with other diuretics, given to heart failure patients or high risk for hypokalemia
- Given orally
Adverse Effects of Potassium-Sparing Diuretics
- Hyperkalemia/arrhythmias
- Endocrine effects such as hirsutism, gynecomastia, and irregular menses
Nursing interventions/education for Potassium-Sparing Diuretics
- Monitor potassium
- Never administer potassium supplements with this drug
- Regular insulin to treat hyperkalemia (pulls potassium from blood to the cell)
- Do not give to clients with renal failure
- Do not give with ACE inhibitors
- Avoid salt substitutes with potassium
- Monitor BP and weight
General Diuretic Considerations
- Monitor blood pressure to determine the therapeutic effectiveness of Furosemide for HTN
- It's most important to check potassium when giving diuretics
- Spironolactone may be ordered to spare potassium and prevent hypokalemia in patients with ascites and edema
- Diuretics should be taken in the morning to avoid interfering with sleep
Drugs Affecting The Urinary Tract
- SNS (fight or flight) vs PNS (relaxation)
Urinary Tract Antispasmodics (Anticholinergics)
- Prototype: Oxybutynin
Purpose of Oxybutynin:
- Competes with Ach for binding with muscarinic receptors
- Blocks parasympathetic activity
Therapeutic uses of Oxybutynin
- Reduces muscle spasms of the bladder and urinary tract
- Treats symptoms of overactive bladder
Adverse effects of Oxybutynin
- Anticholinergic effects
- Can't see (blurred vision)
- Can't pee (urinary retention)
- Can't spit (dry mouth)
- Can't shit (constipation)
- Sympathetic effects
- Dilated pupils, decreased peristalsis, etc.
- CNS effects
- Nervousness, anxiety, apprehension
Nursing interventions/client education for Oxybutynin
- Rule out obstructive urinary tract problems
- Contraindicated for clients with glaucoma, myasthenia gravis or acute hemorrhage
- Can be administered orally, transdermally or topically
Medication for OAB, Beta-3 Adrenergic Agonists
- Prototype: Mirabegron (Myrbetriq)
Purpose of Mirabegron
- Beta-3 adrenergic agonist drug that targets beta-3 receptors in the bladder
- Inhibits the signaling pathways that tell the brain the bladder should be emptied
Therapeutic issues of Mirabegron
- Treats OAB by relaxing the bladder muscle and increasing its bladder's capacity without urinary urgency
Adverse effects of Mirabegron
- HTN
- UTI
- Headache
- Nasopharyngitis
- URI
- CALL PROVIDER IF THERE IS SWELLING OF THE UPPER AIRWAY, FACE, LIPS OR TONGUE
Nursing intervention/education for Mirabegron
- Contraindicated for clients with uncontrolled HTN, caution for clients taking anticholinergic med for OAB (urinary retention)
- Digoxin and Warfarin effects are increased when taken with Mirabegron
- Can be administered orally
Non-Obstructive Urinary Retention, Cholinergic, Muscarinic Agonist
- Prototype: Bethanechol (urecholine)
Purpose of Bethanechol
- Direct acting parasympathomimetic that binds to muscarinic cholinergic receptors that cause PSNS stimulation
- Mimics the effects of acetylcholine
Therapeutic uses of Bethanechol
- Treats non-obstructive urinary retention in patient with atony of the bladder
Adverse effects of Bethanechol
- PSNS stimulation, including salivation, sweating, abdominal cramping, and hypotension/bradycardia
- Cholinergic crisis
Nursing interventions/education for Bethanechol
- Contraindicated for patients with intestinal obstruction or recent bowel surgery
- Do not give in patients with asthma, epilepsy, Parkinson's, hyperthyroidism, PUD or bradycardia -Take 2 hour before or 2 hours after meals
- Monitor I&O
- Atropine is the antidote (Muscarinic antagonist)
Medications for BPH
- 5-alpha reductase inhibitor (Prototype: Finasteride)
- Purpose: blocks the enzyme DHT from converting to testosterone
- Therapeutic uses: Shrinks prostate
- Adverse effects:
Adverse Effetcs of Finasteride
- May cause ED
- Teratogenic to male fetus
- Increase risk of prostate cancer
- Decreases PSA levels
- Alpha-adrenergic receptor antagonists (Prototype: Tamsulosin)
- Purpose: blocks alpha 1 receptors, relaxes smooth muscle in the bladder neck and prostatic urethra
- Therapeutic uses: relieves obstruction and increase flow of urine
Adverse Effects of Tamsulosin
- Little to no effect on blood pressure, like other alpha blockers
- Abnormal ejaculation
- Headache, dizziness
- Avoid taking until after cataract surgery
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Description
This lesson covers diuretics, drugs that reduce fluid volume and increase urine output, and their uses in conditions like hypertension and heart failure. It explains how diuretics block sodium and water reabsorption in the nephron. The lesson also discusses the nursing process for patients on diuretics, including assessments and monitoring for therapeutic and adverse effects.
