Pharmacology Diuretics Quiz

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Questions and Answers

What is the primary mechanism of action for furosemide?

Inhibiting potassium reabsorption in the distal tubule

Inhibiting sodium and chloride reabsorption in the ascending loop of Henle (correct)

Blocking the effects of aldosterone in the collecting duct

Promoting sodium and water reabsorption in the loop of Henle

A patient is prescribed furosemide. Which electrolyte imbalance is a significant concern?

Hypernatremia

Hypokalemia (correct)

Hypermagnesemia

Hyperkalemia

What is the typical onset of action for IV furosemide?

Within 5 minutes (correct)

Within 15 minutes

Within 1 hour

Within 30 minutes

A patient on digoxin and furosemide is at increased risk for which complication?

Digoxin toxicity and potential dysrhythmias (C) Signup and view all the answers

What is the primary reason for a patient to be readmitted to the hospital after receiving furosemide?

Ineffective treatment of their heart failure (C) Signup and view all the answers

What is considered a normal Glomerular Filtration Rate (GFR)?

125 mL/hr (D) Signup and view all the answers

What is a normal urine output per hour?

30 mL/hr or greater (A) Signup and view all the answers

Which of these findings requires further action when giving furosemide?

A patient reporting tinnitus with an existing ototoxic medication (B) Signup and view all the answers

Which diuretic is classified as a thiazide and a potassium-wasting diuretic?

Hydrochlorothiazide (B) Signup and view all the answers

A patient is prescribed hydrochlorothiazide. What electrolyte imbalance should the nurse monitor for?

Hypokalemia (B) Signup and view all the answers

Which of the following is a primary use for mannitol?

Reducing intraocular pressure (D) Signup and view all the answers

What is a key mechanism of action of spironolactone?

Blocking the action of aldosterone in the distal nephron (C) Signup and view all the answers

A patient taking hydrochlorothiazide should be educated to increase their intake of which nutrient?

Potassium (D) Signup and view all the answers

Which diuretic is administered via IV infusion, and the solutions may be warmed in water before administration?

Mannitol (B) Signup and view all the answers

If a patient taking hydrochlorothiazide is also taking digoxin, what is the concern?

Increased risk of digoxin toxicity (C) Signup and view all the answers

Which diuretic has an adverse effect of promoting sodium excretion and thereby retaining potassium?

Spironolactone (D) Signup and view all the answers

Which diuretic is classified as a potassium-sparing diuretic but is not an aldosterone antagonist?

Triamterine (Dyrenium) (A) Signup and view all the answers

A patient taking spironolactone (Aldactone) develops hyperkalemia. Which intervention is most likely to rapidly reverse this condition?

Administering intravenous insulin (C) Signup and view all the answers

Why is it crucial to avoid administering spironolactone (Aldactone) with ACE inhibitors or other potassium-sparing drugs?

To avoid the risk of severe hyperkalemia (A) Signup and view all the answers

What is the primary use for potassium chloride (KCl) intravenous infusion?

Treatment of hypokalemia (A) Signup and view all the answers

A patient is prescribed both spironolactone and an ACE inhibitor. What is the most crucial monitoring parameter?

Serum potassium levels (C) Signup and view all the answers

A patient is experiencing severe GI irritation while taking an oral form of potassium chloride. What is the likely cause?

Oral KCl can directly irritate the GI tract (C) Signup and view all the answers

Which of the listed medications is primarily used to counteract the potassium-wasting effects of loop diuretics like furosemide (Lasix)?

Triamterine (Dyrenium) (D) Signup and view all the answers

What cardiac related risk is associated with both hypo and hyperkalemia?

Cardiac dysrhythmias (A) Signup and view all the answers

Which of the following is NOT a potential side effect of potassium administration?

Hypokalemia (C) Signup and view all the answers

What is the maximum rate at which intravenous potassium should be administered?

10 mEq per hour (C) Signup and view all the answers

Why is it important to dilute liquid potassium chloride (KCl) in orange juice when administered orally?

To prevent esophageal irritation. (C) Signup and view all the answers

A patient with hyperkalemia is experiencing cardiotoxicity. Which of the following medications would be administered to counteract the effects on the heart?

Calcium gluconate (A) Signup and view all the answers

Which of the following is NOT a symptom associated with hyperkalemia?

Bradycardia (A) Signup and view all the answers

What is Kayexalate's mechanism of action in treating hyperkalemia?

It exchanges sodium for potassium in the intestines. (B) Signup and view all the answers

Why is insulin and glucose administered together to treat hyperkalemia?

To shift potassium from the extracellular space to the intracellular space. (B) Signup and view all the answers

What is the cardiac effect of mild hyperkalemia (5-7 mEq/L) as opposed to severe hyperkalemia (>7 mEq/L)?

Mild hyperkalemia can cause prolonged PR intervals and tented T waves, and severe hyperkalemia can lead to cardiac arrest due to V-tach or V-fib (B) Signup and view all the answers

Which effect would be expected from administering atropine to a patient?

Increased heart rate and reduced secretions (C) Signup and view all the answers

A patient is experiencing symptomatic bradycardia. Which medication would the nurse anticipate administering, per emergency protocols, to address this condition?

Atropine (A) Signup and view all the answers

What is the primary mechanism of action of Prazosin?

Inhibition of alpha-1 adrenergic receptors, causing vasodilation. (B) Signup and view all the answers

A patient is prescribed Propranolol. Which effect would indicate that the medication is achieving its intended therapeutic action?

Reduced heart rate and reduced force of cardiac contraction. (A) Signup and view all the answers

Which of the following adverse effects is most concerning for a patient taking Propranolol?

Bradycardia and bronchoconstriction (C) Signup and view all the answers

A patient taking Prazosin reports dizziness and lightheadedness upon standing. What is the most likely cause?

Postural hypotension due to alpha-1 adrenergic blockade. (A) Signup and view all the answers

A patient has been taking Propranolol for several months and is now being discharged. Which instruction is most important for the nurse to include in patient education?

Taper off the medication as a rapid withdrawel can cause angina or ventricular dysrhythmias. (B) Signup and view all the answers

A patient with HTN is prescribed Prazosin. Which additional condition could be a potential benefit of Prazosin treatment?

Benign prostatic hyperplasia (BPH) (B) Signup and view all the answers

Which of the following medications would not be used in the treatment of HTN?

Atropine (C) Signup and view all the answers

What is the expected effect of Beta-1 receptor stimulation?

Increased heart rate, force of contraction, and AV node conduction speed (C) Signup and view all the answers

Study Notes

Diuretics & Cardiac Drugs

Diuretics increase urine output (diuresis)
Normal urine output is 30 mL/hour or greater
Normal GFR = 125 mL/hour
Normal output = about 60 mL/hour
Diuretics mainly affect maintenance of the extracellular fluid (ECF)

Furosemide (Lasix)

Classification: Loop diuretic, potassium-wasting diuretic
Mechanism of Action (MOA): Rapid-acting loop diuretic; inhibits sodium and chloride reabsorption in the ascending loop of Henle; decreases edema and blood pressure
Uses: Very powerful diuretic, often used in acute situations or heart failure (CHF) to reduce fluid buildup
Dosage/Route: PO, IV, IM; 20-80 mg; IV starts in 5 minutes, lasts for 2 hours
Adverse effects: Postural hypotension, hypokalemia, hyponatremia, hypomagnesemia, hyperchloremia, nausea, vomiting, dehydration, tinnitus, aplastic anemia, circulatory collapse
Drug interactions: Low potassium increases risk of digoxin toxicity; digoxin toxicity causes various cardiac dysrhythmias; combined with other ototoxic drugs (e.g., aminoglycosides) can cause hearing loss; combined with other antihypertensives or lithium may cause hypotension
Patient education: Check potassium levels (3.5-5.0) before administration; check blood pressure before administration (>110/60); weigh daily to assess treatment effectiveness; inform patients about monitoring of symptoms during high volume diuresis, and to report any ineffective responses to their physician; advise patients to increase their dietary intake of potassium-rich foods/supplements.

Hydrochlorothiazide (HydroDIURIL)

Classification: Thiazide diuretic, potassium-wasting diuretic
MOA: Blocks sodium and chloride reabsorption in the early distal convoluted tubule; not effective if GFR is low (<15-20 ml/min).
Uses: Often first-line treatment for hypertension, especially in African Americans; used in mild to moderate heart failure to help mobilize edema
Dosage/Route: PO, dosage varies based on formulation
Adverse effects: Hyponatremia, hypochloremia, dehydration, hypokalemia; fetal harm; can enter breast milk; may elevate glucose levels in diabetics; may precipitate gouty arthritis
Drug interactions: Promotes digoxin toxicity due to potassium loss; increases risk of hypotension with other antihypertensive medications
Patient education: Not given to pregnant or breastfeeding patients, diabetics, or those with gouty arthritis; monitor potassium, sodium, and chloride levels; increase potassium intake in diet/supplements

Mannitol (Osmitrol)

Classification: Osmotic diuretic
MOA: Creates an osmotic effect in the proximal convoluted tubule, inhibiting passive water reabsorption. Has no significant effect on potassium excretion.
Uses: Preventing/reducing acute renal failure in severe hypertension, hypovolemic shock, reducing intracranial pressure (ICP), reducing intraocular pressure (IOP).
Dosage/Route: IV infusion (hospital use only), Solutions are 5-25% (infusion percentage)/usually crystallized warmed in water initially frozen; IV infusion rate is adjusted to monitor urine flow rate, which is typically 30-50 mL/min. Measured with a hydrometer.
Adverse effects: Headache, nausea, vomiting, electrolyte imbalance, pulmonary edema.
Patient education: Not for home use, only administered in a clinical environment. Inform patients on risks/warnings and importance of reporting observations.

Spironolactone (Aldactone)

Classification: Potassium-sparing diuretic (Aldosterone Antagonist)
MOA: Blocks the action of aldosterone in the distal nephron, promoting sodium excretion and potassium retention.
Uses: Hypertension, edema, heart failure.
Adverse effects: Hyperkalemia (>5.0), resulting in fatal cardiac dysrhythmias (e.g., ventricular fibrillation). Has endocrine effects similar to steroid hormones (e.g., gynecomastia, irregular menses)
Drug interactions: Caution with ACE inhibitors, ARBs, direct renin inhibitors.
Patient education: Monitor potassium levels. Never administer with potassium-sparing drugs or salt substitutes, or ACE inhibitors or ARBs.

Triamterene (Dyrenium)

Classification: Potassium-Sparing Diuretic (Non-Aldosterone Sparing)
MOA: Disrupts sodium-potassium exchange directly in the distal nephron.
Uses: Hypertension, edema. Counteracts the potassium-wasting effects of other diuretics.
Adverse effects: Nausea, vomiting, leg cramps, dizziness, hyperkalemia
Drug interactions: Caution with ACE inhibitors, ARBs, and direct renin inhibitors
Patient Education: Monitor potassium levels, do not administer with other potassium-sparing medications, or salt substitutes.

Potassium Chloride (K+ Supplementation)

Classification: Potassium Supplement
MOA: Replacement of potassium for nerve impulse transmission
Uses: Replaces potassium lost via other medications or conditions requiring potassium replacement.

Additional Information (from further pages)

Potassium Removal: Symptoms of excess potassium can include confusion, anxiety, shortness of breath, heaviness/tingling in legs and hands, lips, and feet. Steps/treatments include holding potassium-containing foods/medications, infusion with calcium gluconate, insulin, sodium bicarbonate, exchange resin (such as Kayexalate).
Oral Potassium Chloride(KCL): Irritates the GI tract, potentially severe intestinal ulcers, causing bleeding or perforation. Also causes hyperkalemia (excess potassium) which can cause cardiac dysrhythmias, ranging from mild to severe life-threatening issues.
Potassium sparing Diuretics: Should be used with caution, with monitored potassium levels, and in conjunction with other potassium-sparing drugs or salt substitutes, and ACE inhibitors or ARBs.
Blood Pressure Categories: Normal range is below 120/80.
Misc. Antihypertensive Agents (e.g., atropine, prazosin, propranolol) and additional details are further described in subsequent sections.
Numerous other drugs are discussed that relate to hypertension control, and their mechanism of action, adverse effects, etc, which are all mentioned in their designated sections on the subsequent pages.

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Description

Test your knowledge on pharmacology related to diuretics, including furosemide, hydrochlorothiazide, and mannitol. This quiz covers mechanisms of action, potential electrolyte imbalances, and nursing considerations. Perfect for nursing students or anyone studying pharmacological agents in medical practice.