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Questions and Answers
What is the primary mechanism by which diuretics increase urine flow?
What is the primary mechanism by which diuretics increase urine flow?
- Promoting potassium reabsorption in the nephron.
- Inhibiting sodium and water reabsorption in the kidney tubules. (correct)
- Stimulating aldosterone release from the adrenal gland.
- Enhancing chloride secretion into the collecting ducts.
A patient with heart failure is prescribed a diuretic. What is the most likely reason for this intervention?
A patient with heart failure is prescribed a diuretic. What is the most likely reason for this intervention?
- To prevent potassium loss due to other medications.
- To reduce edema related to CHF. (correct)
- To increase blood pressure and improve cardiac output.
- To promote sodium retention for better fluid balance.
A patient with significant renal artery stenosis is started on hydrochlorothiazide. What is a potential risk associated with this medication in this patient population?
A patient with significant renal artery stenosis is started on hydrochlorothiazide. What is a potential risk associated with this medication in this patient population?
- Exacerbation of renal dysfunction due to reduced renal perfusion. (correct)
- Improved creatinine clearance due to increased urine output.
- Increased potassium levels leading to hyperkalemia.
- Decreased risk of metabolic alkalosis.
Thiazide diuretics promote calcium reabsorption in the kidneys. Which of the following conditions might benefit from this effect?
Thiazide diuretics promote calcium reabsorption in the kidneys. Which of the following conditions might benefit from this effect?
Loop diuretics are known for their potent diuretic effect in the loop of Henle. What electrolyte imbalance is a common concern with this class of diuretics?
Loop diuretics are known for their potent diuretic effect in the loop of Henle. What electrolyte imbalance is a common concern with this class of diuretics?
A patient receiving furosemide (a loop diuretic) reports muscle weakness and leg cramps. Which electrolyte imbalance is most likely responsible for these symptoms?
A patient receiving furosemide (a loop diuretic) reports muscle weakness and leg cramps. Which electrolyte imbalance is most likely responsible for these symptoms?
In which clinical scenario would the use of osmotic diuretics like mannitol be most appropriate?
In which clinical scenario would the use of osmotic diuretics like mannitol be most appropriate?
Mannitol is administered to a patient with increased intracranial pressure. What is the primary mechanism by which mannitol decreases ICP?
Mannitol is administered to a patient with increased intracranial pressure. What is the primary mechanism by which mannitol decreases ICP?
Carbonic anhydrase inhibitors have a unique mechanism of action that affects acid-base balance. What is a primary effect of these diuretics on electrolyte excretion?
Carbonic anhydrase inhibitors have a unique mechanism of action that affects acid-base balance. What is a primary effect of these diuretics on electrolyte excretion?
A patient with glaucoma is prescribed acetazolamide. What is the expected therapeutic effect of this drug in this case?
A patient with glaucoma is prescribed acetazolamide. What is the expected therapeutic effect of this drug in this case?
Spironolactone is classified as a potassium-sparing diuretic. What is its primary mechanism of action in the kidneys?
Spironolactone is classified as a potassium-sparing diuretic. What is its primary mechanism of action in the kidneys?
A patient with heart failure is prescribed spironolactone in addition to an ACE inhibitor and a loop diuretic. Which of these potential benefits is this combination intended to achieve?
A patient with heart failure is prescribed spironolactone in addition to an ACE inhibitor and a loop diuretic. Which of these potential benefits is this combination intended to achieve?
When providing dietary teaching to a patient prescribed a thiazide diuretic, which of the following recommendations is most appropriate?
When providing dietary teaching to a patient prescribed a thiazide diuretic, which of the following recommendations is most appropriate?
A patient on furosemide is also taking digoxin. What electrolyte imbalance increases the risk of digoxin toxicity in this patient?
A patient on furosemide is also taking digoxin. What electrolyte imbalance increases the risk of digoxin toxicity in this patient?
A patient is prescribed spironolactone. What key instruction should the nurse provide to help the patient manage potential side effects?
A patient is prescribed spironolactone. What key instruction should the nurse provide to help the patient manage potential side effects?
A patient is prescribed furosemide for fluid overload. The nurse notes the patient's urine output has not increased after the first dose. What intervention should the nurse prioritize?
A patient is prescribed furosemide for fluid overload. The nurse notes the patient's urine output has not increased after the first dose. What intervention should the nurse prioritize?
A nurse is caring for a patient receiving mannitol. Which assessment finding is most important to report to the health care provider immediately?
A nurse is caring for a patient receiving mannitol. Which assessment finding is most important to report to the health care provider immediately?
Which instruction is most important for the nurse to provide to a patient who is starting on acetazolamide?
Which instruction is most important for the nurse to provide to a patient who is starting on acetazolamide?
A patient with heart failure is prescribed both furosemide and spironolactone. What is the rationale for using these two diuretics together?
A patient with heart failure is prescribed both furosemide and spironolactone. What is the rationale for using these two diuretics together?
A patient taking a loop diuretic is prescribed an aminoglycoside antibiotic. Why would the nurse be concerned about this combination?
A patient taking a loop diuretic is prescribed an aminoglycoside antibiotic. Why would the nurse be concerned about this combination?
What is the primary action of thiazide diuretics?
What is the primary action of thiazide diuretics?
Which statement accurately describes a key difference between thiazide and loop diuretics regarding their site of action?
Which statement accurately describes a key difference between thiazide and loop diuretics regarding their site of action?
What is the intended therapeutic outcome of thiazide diuretic therapy?
What is the intended therapeutic outcome of thiazide diuretic therapy?
If a patient with edema is prescribed furosemide, what specific instruction regarding timing of the medication should the nurse provide?
If a patient with edema is prescribed furosemide, what specific instruction regarding timing of the medication should the nurse provide?
A patient taking furosemide is also prescribed digoxin. The nurse should carefully monitor for which signs and symptoms?
A patient taking furosemide is also prescribed digoxin. The nurse should carefully monitor for which signs and symptoms?
Why are loop diuretics, such as furosemide, often described as "high-ceiling" diuretics?
Why are loop diuretics, such as furosemide, often described as "high-ceiling" diuretics?
What specific assessment is crucial for a nurse to perform when administering IV furosemide to a patient?
What specific assessment is crucial for a nurse to perform when administering IV furosemide to a patient?
Which condition is a primary indication for the use of osmotic diuretics like mannitol?
Which condition is a primary indication for the use of osmotic diuretics like mannitol?
Why is it important to monitor for signs and symptoms of heart failure (CHF) when administering osmotic diuretics like mannitol?
Why is it important to monitor for signs and symptoms of heart failure (CHF) when administering osmotic diuretics like mannitol?
What is the primary mechanism of action of carbonic anhydrase inhibitors like acetazolamide?
What is the primary mechanism of action of carbonic anhydrase inhibitors like acetazolamide?
A diuretic that inhibits the enzyme carbonic anhydrase in the kidneys, brain, and eyes, is contraindicated with which allergy?
A diuretic that inhibits the enzyme carbonic anhydrase in the kidneys, brain, and eyes, is contraindicated with which allergy?
A nurse caring for a patient receiving spironolactone should educate them to reduce which aspect of their diet?
A nurse caring for a patient receiving spironolactone should educate them to reduce which aspect of their diet?
When documenting the therapeutic effectiveness of spironolactone, what assessment finding would best demonstrate a positive response to the medication?
When documenting the therapeutic effectiveness of spironolactone, what assessment finding would best demonstrate a positive response to the medication?
Which pre-existing condition would be a contraindication for the prescription of mannitol as a diuretic?
Which pre-existing condition would be a contraindication for the prescription of mannitol as a diuretic?
Which one of the following diuretics are best known for their ability to promote the excretion of water, sodium, potassium, and bicarbonate?
Which one of the following diuretics are best known for their ability to promote the excretion of water, sodium, potassium, and bicarbonate?
Which of the following electrolytes are NOT excreted when someone is administered a carbonic anhydrase inhibitor?
Which of the following electrolytes are NOT excreted when someone is administered a carbonic anhydrase inhibitor?
Which of the following is the most potent?
Which of the following is the most potent?
Which of the following is considered a loop diuretic?
Which of the following is considered a loop diuretic?
Flashcards
Diuretics action
Diuretics action
Increase urine flow (diuresis) by inhibiting sodium and water reabsorption from kidney tubules.
Diuretics uses
Diuretics uses
Edema related to CHF, cirrhosis, renal disease, and hypertension
Main purpose of diuretics
Main purpose of diuretics
Reducing peripheral and pulmonary edema in heart failure and renal/liver disorders.
Thiazide diuretics action
Thiazide diuretics action
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Uses of thiazides
Uses of thiazides
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Thiazide therapeutic outcome
Thiazide therapeutic outcome
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Nursing implications: Thiazides
Nursing implications: Thiazides
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Loop diuretics: Action
Loop diuretics: Action
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Loop Diuretics: Uses
Loop Diuretics: Uses
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Osmotic diuretics Uses
Osmotic diuretics Uses
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Carbonic anhydrase inhibitors action
Carbonic anhydrase inhibitors action
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Carbonic anhydrase inhibitors uses
Carbonic anhydrase inhibitors uses
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Potassium-sparing diuretics action
Potassium-sparing diuretics action
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Spironolactone use
Spironolactone use
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Study Notes
- Diuretics increase urine flow, or diuresis.
- This is achieved by inhibiting sodium and water reabsorption in the kidney tubules.
- The delivery routes of diuretics can be PO, IV and IM.
- When taking diuretics it's important to watch out for:
- Weight change
- I&O balance
- Dehydration
- Hyperglycemia
Main Purpose of Diuretics
- Decrease blood pressure.
- Decrease edema, typically peripheral and pulmonary, in heart failure (HF) and renal or liver disorders.
Categories of Diuretics
- Thiazide and thiazide-like diuretics
- Loop or high-ceiling diuretics
- Osmotic diuretics
- Carbonic anhydrase inhibitors
- Potassium-sparing diuretics
Thiazide and Thiazide-Like Diuretics
- More commonly called thiazides, benzothiadiazides have been used since the 1960s as a diuretic and antihypertensive agent.
- Chlorothiazide was the first thiazide produced back in 1957.
Action of Thiazides
- They act on the distal convoluted renal tubule, beyond the loop of Henle, to promote sodium, chloride, and water excretion.
- Sodium and chloride ions that are not reabsorbed are passed into the collecting ducts, taking molecules of water with them, resulting in a diuresis.
Uses for Thiazides
- Used to treat hypertension and peripheral edema.
- They should not be used to promote fluid loss in patients with severe renal dysfunction and are not effective for rapid diuresis.
- Used primarily for patients with normal renal function, effectiveness greatly decreases if the patient has a renal disorder and creatinine clearance is less than 30 mL/min.
- Thiazides cause a loss of sodium, potassium, and magnesium, but they promote calcium reabsorption.
Therapeutic outcome of Thiazides
- Diuresis with reduction of edema and improvement in symptoms related to excessive fluid accumulation, and reduction in elevated blood pressure.
Nursing Implications for Thiazides
- Assess vital signs, weight, urine output, and serum chemistry values (electrolytes, glucose, uric acid) for baseline levels.
- Check both peripheral extremities for presence of edema, and note pitting edema.
- Obtain a history of drugs and herbal supplements taken daily, and review for drugs and herbs that may cause a drug interaction (digoxin, corticosteroids, antidiabetics, ginkgo, licorice).
- Monitor vital signs and serum electrolytes especially potassium, glucose, uric acid, and cholesterol levels.
- If a patient taking digoxin and hypokalemia occurs, digitalis toxicity frequently results.
- Note the half-life of spironolactone, and with its long half-life, administer once a day, or sometimes twice a day.
- Observe for signs and symptoms of hypokalemia, and review signs and symptoms like muscle weakness, leg cramps, and cardiac dysrhythmias.
- Monitor patient's weight daily, 2.2 lb weight gain is equivalent to 1 L of body fluids, and note urine output to determine fluid loss or retention. Suggest that the patient take the drug early in the morning to avoid sleep disturbance resulting from nocturia, and review side effects.
Loop (High Ceiling) Diuretics
- The first loop diuretic marketed was ethacrynic acid, followed by furosemide and then bumetanide, which is more potent than furosemide on a milligram for-milligram basis.
- Due to their high diuretic potential, they are called high-ceiling diuretics or potassium-wasting diuretics.
Action of Loop Diuretics
- They act on the thick ascending loop of Henle to inhibit chloride transport of sodium into the circulation and inhibit passive reabsorption of sodium.
- Resulting in sodium and water are lost, together with potassium, calcium, and magnesium.
Uses for Loop Diuretics
- Bumetanide, furosemide, and torsemide are used to treat edema resulting from heart failure, cirrhosis of the liver, and renal disease, including nephrotic syndrome.
- Furosemide and torsemide may also be used for the treatment of hypertension, alone or in combination with other antihypertensive therapy.
- Furosemide is also used in combination with 0.9% sodium chloride infusions to enhance the excretion of calcium in patients with hypercalcemia and to treat edema and heart failure.
Therapeutic outcome of Loop Diuretics
- Reduction of edema and improvement in symptoms related to excessive fluid accumulation, primary outcome associated with sulfonamide loop diuretic therapy
- Reduction of blood pressure is an outcome also expected of furosemide and torsemide.
Osmostic Diuretics
- Mannitol is the most frequently prescribed osmotic diuretic, followed by urea.
Action of Osmotic Diuretics
- They increase the osmolality (concentration) and sodium reabsorption in the proximal tubule and loop of Henle.
- Sodium, chloride, potassium (to a lesser degree), and water are excreted.
Uses of Osmotic Diuretics
- This group of drugs is used to prevent kidney failure, decrease intracranial pressure (ICP, such as in cerebral edema), and decrease intraocular pressure (IOP, such as in glaucoma).
- Frequently used in emergency situations like ICP and IOP, mannitol is a potent osmotic, potassium-wasting diuretic.
- Mannitol can be used with cisplatin and carboplatin in cancer chemotherapy to induce a frank diuresis and decrease side effects of treatment.
Action of Carbonic Anhydrase
- The carbonic anhydrase inhibitors acetazolamide and methazolamide block the action which is needed to maintain the body's acid-base balance
- It is vital to mainting body's hydrogen and bicarbonate ion balance.
Uses
- Primarily used to decrease IOP in patients with open-angle (chronic) glaucoma, not used in narrow-angle or acute glaucoma.
- Other uses include diuresis, management of epilepsy, and treatment of high-altitude or acute mountain sickness.
- Acetazolamide is a weak diuretic that inhibits carbonic anhydrase in the kidneys, brain, and eyes, which promotes excretion of sodium carbonate, potassium, and water.
- Primary action is to inhibit the enzyme carbonic anhydrase, the catalyst for the formation of sodium bicarbonate stored as alkaline reserve in the renal tubules.
- It slows down the movement of hydrogen ions which leads to greater amount of sodium and bicarbonate lost in the urine.
Potassium-Sparing Diuretics
- Weaker than thiazides and loop diuretics, they are used in combination with a diuretic and are considered mild.
- Discovered in 1958, Spironolactone, an aldosterone antagonist
- Aldosterone is a mineralocorticoid hormone that promotes sodium retention and potassium excretion.
Action of Potasium Sparing Diuretics
- Spironolactone blocks the sodium-retaining and potassium-excreting and magnesium-excreting properties of aldosterone, which results in a loss of water with the increased sodium excretion.
Uses of Potasium Sparing Diuretics
- Spironolactone can increase the effectiveness of thiazide diuretics and can reduce the hypokalemia induced by thiazides..
- Useful in relieving edema and ascites that do not respond to the usual diuretics.
- Reduces morbidity and mortality for patients with heart failure who are also being treated with an ACE inhibitor and a loop diuretic.
- Can be used to combat hyperaldosteronic state, used as an adjunct to K wasted diuretics, and treats Congestive heart failure
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