Exam 18 - Drugs for the Urinary System

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Questions and Answers

Which diuretic is contraindicated for a patient with a history of gout?

Potassium-sparing diuretics

Osmotic diuretics

Thiazide diuretics (correct)

Loop diuretics

Why is it important to assess the cardiovascular system before administering mannitol?

Because it may induce heart failure (correct)

Due to the increased risk of dehydration

To prevent the risk of lithium toxicity

Because it can cause severe hypokalemia

A patient taking lithium is prescribed a diuretic. Which potential adverse effect should be of most concern?

Increased risk for lithium toxicity (correct)

Hypokalemia

Hyperkalemia

Hypertension

Which class of diuretics is most likely to cause ototoxicity?

Loop diuretics (C) Signup and view all the answers

Which instruction should be given to a patient taking a potassium-sparing diuretic?

Avoid salt substitutes (D) Signup and view all the answers

A patient is prescribed a thiazide diuretic. Which of the following blood pressure readings should prompt the nurse to hold the medication?

90/60 mm Hg (D) Signup and view all the answers

When should daily weights be taken for a patient on diuretic therapy?

Same time each morning with similar clothing (B) Signup and view all the answers

What is the primary mechanism by which thiazide diuretics lower blood pressure?

By preventing reabsorption of water, sodium, potassium, and chloride in the nephron, and dilating arterioles (A) Signup and view all the answers

Which of the following is a common cardiovascular condition for which diuretics are primarily used, rather than kidney problems?

Hypertension (C) Signup and view all the answers

Which of the following is NOT a potassium-sparing diuretic?

Furosemide (D) Signup and view all the answers

What is the primary action of osmotic diuretics in the kidney?

Increasing plasma osmotic pressure causing fluid to redistribute into circulatory vessels (C) Signup and view all the answers

What is a common side effect associated with the use of thiazide and loop diuretics?

Hypokalemia (A) Signup and view all the answers

In which part of the nephron do loop diuretics exert their primary effect?

Thick ascending loop of Henle (B) Signup and view all the answers

For which of the following conditions might an osmotic diuretic be used?

Cerebral edema (D) Signup and view all the answers

Why is methenamine mandelate typically prescribed?

To prevent recurrent urinary tract infections following antibiotic treatment (A) Signup and view all the answers

What is the recommended daily urinary output for a patient on methenamine mandelate?

2000 mL (C) Signup and view all the answers

What dietary recommendation might be given to a patient taking methenamine mandelate?

An acid-ash diet (D) Signup and view all the answers

What should a patient do for skin irritation while taking methenamine mandelate?

Soothe with cornstarch or a bicarbonate of soda or dilute vinegar bath (C) Signup and view all the answers

What are some signs of an allergic reaction to monitor for when a patient is receiving nitrofurantoin?

Erythema, chills, fever, and dyspnea. (A) Signup and view all the answers

What is the appropriate action when a patient on nitrofurantoin shows signs of an allergic reaction?

Discontinue the medication and notify the health care provider (D) Signup and view all the answers

What is the primary mechanism of action for selective alpha1 blockers in treating benign prostatic hyperplasia (BPH)?

Relaxation of smooth muscle in the prostate and bladder neck. (A) Signup and view all the answers

A patient is prescribed phenazopyridine for urinary tract infection symptoms. What should the nurse emphasize in patient education regarding this medication?

The urine will turn an orange-red color but this is not harmful. (A) Signup and view all the answers

Trial doses of nitrofurantoin may be used for what purpose?

To detect a possible allergic reaction (D) Signup and view all the answers

What is a key nursing consideration specific to patients taking tamsulosin?

Assess patient for a sulfa allergy prior to administration. (C) Signup and view all the answers

What is the most important dietary modification a patient should be advised to make when taking methenamine?

Eat foods that acidify the urine such as meats and prunes. (B) Signup and view all the answers

A patient taking an antispasmodic is engaging in vigorous outdoor activity. What is an important safety teaching point for them?

They should avoid intense activity to prevent over heating. (B) Signup and view all the answers

A patient is taking a DHT inhibitor. Which potential side effect should be reported to their healthcare provider immediately?

Breast enlargement, nipple discharge, or testicular pain. (A) Signup and view all the answers

How should quinolones be administered to enhance their effectiveness and minimise side effects?

On an empty stomach, 1 hour before or 2 hours after eating. (A) Signup and view all the answers

Study Notes

Diuretics

Diuretics increase urine output, primarily used for cardiovascular issues (e.g., high blood pressure, heart failure)
Types of Diuretics:
- Thiazide and Thiazide-like:
  - First-line for high blood pressure
  - Prevent water, sodium, potassium, and chloride reabsorption in the nephron
  - Relax arteriole smooth muscle
  - Examples: Chlorothiazide, hydrochlorothiazide, indapamide, metolazone
  - Lower potassium levels
- Loop Diuretics:
  - Most potent, blocking sodium, potassium, and chloride reabsorption in the loop of Henle
  - Used for conditions like heart failure, pulmonary edema, ascites
  - Examples: Bumetanide, furosemide
  - Potassium loss is a concern
- Potassium-Sparing Diuretics:
  - Increase water and sodium excretion without potassium loss
  - Slow sodium pump in the distal tubule
  - Examples: Amiloride, spironolactone, triamterene
- Osmotic Diuretics:
  - Increase plasma osmotic pressure, fluid redistribution
  - Used for edema, cerebral edema, intraocular pressure, and acute renal failure
  - Example: Mannitol
- Carbonic Anhydrase Inhibitor Diuretics:
  - Inhibit carbonic anhydrase in the proximal convoluted tubule
  - Example: Acetazolamide
Key Concept: Water follows sodium. Increased sodium excretion leads to increased urine output

Side Effects and Adverse Effects of Diuretics

Side effects:
- Urgency, frequency, dry mouth, increased thirst, lightheadedness, fluid/electrolyte imbalances, gout flare-ups (with thiazides)
Adverse effects:
- Dehydration, hyponatremia, severe low blood pressure, hypokalemia (with thiazides/loop), hyperkalemia (with potassium-sparing)
Important note: Potassium imbalances potentially life-threatening dysrhythmias

Drug Interactions

Thiazides/loop diuretics with corticosteroids/certain antibiotics increase potassium loss
Diuretics with lithium increase risk for lithium toxicity
Potassium-sparing diuretics with ACE inhibitors/ARBs can lead to hyperkalemia
Avoid salt substitutes with potassium-sparing diuretics
Diuretics may increase blood levels of other drugs, leading to possible toxicity

Nursing Implications for Diuretic Use

Monitor vital signs, especially blood pressure
Assess for dehydration before administering
Daily weights
Monitor potassium levels closely
Administer in the morning
Specific monitoring points (I&O, BMP, blood glucose) depend on the diuretic type.

Benign Prostatic Hyperplasia (BPH) Medications

Alpha1-adrenergic receptor blockers: Relax prostate and bladder outlet smooth muscle, improving urine flow (e.g., tamsulosin)
5-Alpha-Reductase inhibitors (DHT inhibitors): Shrink the prostate (e.g., finasteride, dutasteride)
Bladder Anesthetics (e.g., Phenazopyridine): Treat urinary irritation symptoms (2 days max use), no cure

Urinary Antispasmodics

Inhibit involuntary bladder contractions, increasing bladder capacity
Examples: oxybutynin, tolterodine, solifenacin, darifenacin, trospium chloride
Watch for side effects (dry mouth, dry eyes, constipation, etc.)
Monitor for possible drug interactions

Quinolones and Nitrofurantoin

Quinolones: Treat UTIs (gram-positive and gram-negative bacteria), take with water
Nitrofurantoin: Treat UTIs, common side effects include loss of appetite, nausea, vomiting
Monitor closely for possible allergic reactions with nitrofurantoin.

Methenamine

Treat chronic/recurrent UTIs as a preventive measure
Requires acidic urine (diet or acidifiers)
Common side effects: nausea, vomiting, skin rash

Complete full course of antibiotics, hydrate, and closely monitor for any adverse effects.
Consult healthcare provider about any concerns regarding medications or potential drug interactions.

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Description

This quiz covers the key aspects of diuretics, including their types, mechanisms of action, and applications in treating cardiovascular issues like high blood pressure and heart failure. Test your knowledge on thiazide, loop, potassium-sparing, and osmotic diuretics, along with their examples and effects on electrolyte levels.