Podcast
Questions and Answers
What diuretic would you use in a patient with low GFR (renal impairment)?
What diuretic would you use in a patient with low GFR (renal impairment)?
Furosemide
Low potassium can put a patient at risk for what when taking a diuretic?
Low potassium can put a patient at risk for what when taking a diuretic?
Heart arrhythmia
What patient education should you teach when prescribing Furosemide?
What patient education should you teach when prescribing Furosemide?
Monitor blood pressure, S/S of postural hypotension, eat K-rich foods (dried fruit, nuts, spinach, potatoes)
What drugs should you avoid prescribing while a patient is taking Furosemide (Lasix)?
What drugs should you avoid prescribing while a patient is taking Furosemide (Lasix)?
Signup and view all the answers
What is the difference between a loop diuretic and a thiazide diuretic?
What is the difference between a loop diuretic and a thiazide diuretic?
Signup and view all the answers
Would you prescribe Hydrochlorothiazide (Microzide) to a patient with inadequate renal functioning and a GFR below 30?
Would you prescribe Hydrochlorothiazide (Microzide) to a patient with inadequate renal functioning and a GFR below 30?
Signup and view all the answers
How long does it take for diuresis to start in a patient taking Hydrochlorothiazide (Microzide)?
How long does it take for diuresis to start in a patient taking Hydrochlorothiazide (Microzide)?
Signup and view all the answers
What is important to check in your patient before prescribing Hydrochlorothiazide (Microzide)?
What is important to check in your patient before prescribing Hydrochlorothiazide (Microzide)?
Signup and view all the answers
What diuretic has a higher risk of ototoxicity?
What diuretic has a higher risk of ototoxicity?
Signup and view all the answers
Spironolactone (Aldactone) is what type of diuretic?
Spironolactone (Aldactone) is what type of diuretic?
Signup and view all the answers
What are the uses for Diltizem (Cardizem)?
What are the uses for Diltizem (Cardizem)?
Signup and view all the answers
What baseline data is needed before starting Diltizem (Cardizem)?
What baseline data is needed before starting Diltizem (Cardizem)?
Signup and view all the answers
Does Nifedipine (Procardia) produce very little blockade of calcium channels in the heart?
Does Nifedipine (Procardia) produce very little blockade of calcium channels in the heart?
Signup and view all the answers
What is the start and peak time of Diltizem (Cardizem)? Works in minutes and peaks in ______min.
What is the start and peak time of Diltizem (Cardizem)? Works in minutes and peaks in ______min.
Signup and view all the answers
What is the contraindication of Diltizem (Cardizem)?
What is the contraindication of Diltizem (Cardizem)?
Signup and view all the answers
Match the medication with its classification:
Match the medication with its classification:
Signup and view all the answers
What is the therapeutic goal of Hydralazine?
What is the therapeutic goal of Hydralazine?
Signup and view all the answers
Metoprolol is preferred for people with lung issues because it only affects the heart, not the lungs.
Metoprolol is preferred for people with lung issues because it only affects the heart, not the lungs.
Signup and view all the answers
What does Metoprolol treat?
What does Metoprolol treat?
Signup and view all the answers
What is the medication preference for African Americans?
What is the medication preference for African Americans?
Signup and view all the answers
What is the primary mechanism of action of loop diuretics in the kidneys?
What is the primary mechanism of action of loop diuretics in the kidneys?
Signup and view all the answers
Which of the following is a potential complication of diuretic use?
Which of the following is a potential complication of diuretic use?
Signup and view all the answers
What is the effect of Furosemide on potassium levels?
What is the effect of Furosemide on potassium levels?
Signup and view all the answers
Which of the following medications should be avoided when taking Furosemide?
Which of the following medications should be avoided when taking Furosemide?
Signup and view all the answers
What is the primary difference between loop diuretics and thiazide diuretics?
What is the primary difference between loop diuretics and thiazide diuretics?
Signup and view all the answers
What is the primary indication for using Spironolactone (Aldactone)?
What is the primary indication for using Spironolactone (Aldactone)?
Signup and view all the answers
What is the risk associated with Furosemide use?
What is the risk associated with Furosemide use?
Signup and view all the answers
What is the primary goal of patient education when prescribing Furosemide?
What is the primary goal of patient education when prescribing Furosemide?
Signup and view all the answers
What is the primary effect of Spironolactone on potassium levels?
What is the primary effect of Spironolactone on potassium levels?
Signup and view all the answers
Why would you avoid using Spironolactone in rats?
Why would you avoid using Spironolactone in rats?
Signup and view all the answers
What is the effect of Triamterene on sodium absorption?
What is the effect of Triamterene on sodium absorption?
Signup and view all the answers
What should you instruct a patient to do regarding potassium-rich foods while taking Spironolactone?
What should you instruct a patient to do regarding potassium-rich foods while taking Spironolactone?
Signup and view all the answers
What is the main reason for prescribing Spironolactone alongside other diuretics?
What is the main reason for prescribing Spironolactone alongside other diuretics?
Signup and view all the answers
What should a patient be educated about when prescribed Lisinopril?
What should a patient be educated about when prescribed Lisinopril?
Signup and view all the answers
What is the type of diuretic that Triamterene belongs to?
What is the type of diuretic that Triamterene belongs to?
Signup and view all the answers
What should be monitored before starting a patient on Lisinopril?
What should be monitored before starting a patient on Lisinopril?
Signup and view all the answers
What is a potential adverse effect of Spironolactone?
What is a potential adverse effect of Spironolactone?
Signup and view all the answers
What should you not prescribe to a patient with elevated potassium levels?
What should you not prescribe to a patient with elevated potassium levels?
Signup and view all the answers
What increases the chances of a cough while taking Lisinopril?
What increases the chances of a cough while taking Lisinopril?
Signup and view all the answers
What is the primary difference between ACE inhibitors and ARBs?
What is the primary difference between ACE inhibitors and ARBs?
Signup and view all the answers
Why is an ARB like Losartan preferred over an ACE inhibitor like Lisinopril?
Why is an ARB like Losartan preferred over an ACE inhibitor like Lisinopril?
Signup and view all the answers
What is Losartan approved for?
What is Losartan approved for?
Signup and view all the answers
Can a patient be prescribed both an ACE inhibitor and an ARB simultaneously?
Can a patient be prescribed both an ACE inhibitor and an ARB simultaneously?
Signup and view all the answers
What is the class of drug that Losartan belongs to?
What is the class of drug that Losartan belongs to?
Signup and view all the answers
What is the target A1C level for patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications?
What is the target A1C level for patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications?
Signup and view all the answers
What medication is started for youth who are overweight with new onset diabetes and an A1C less than 8.5%?
What medication is started for youth who are overweight with new onset diabetes and an A1C less than 8.5%?
Signup and view all the answers
What is the target for fasting glucose levels in pregnant women?
What is the target for fasting glucose levels in pregnant women?
Signup and view all the answers
Why should Metformin and glyburide not be used as first-line treatment in pregnancy?
Why should Metformin and glyburide not be used as first-line treatment in pregnancy?
Signup and view all the answers
When should Metformin be discontinued when used to treat polycystic ovary syndrome and induce ovulation?
When should Metformin be discontinued when used to treat polycystic ovary syndrome and induce ovulation?
Signup and view all the answers
What is the ideal A1C target in pregnancy?
What is the ideal A1C target in pregnancy?
Signup and view all the answers
What is the primary mechanism of action of Digoxin?
What is the primary mechanism of action of Digoxin?
Signup and view all the answers
What is the primary indication for prescribing Digoxin?
What is the primary indication for prescribing Digoxin?
Signup and view all the answers
What is important to monitor while prescribing Digoxin?
What is important to monitor while prescribing Digoxin?
Signup and view all the answers
What is the antidote for Digoxin overdose?
What is the antidote for Digoxin overdose?
Signup and view all the answers
Why is Metoprolol preferred for people with lung issues?
Why is Metoprolol preferred for people with lung issues?
Signup and view all the answers
What is the first line blood pressure medicine for someone with diabetes and or kidney disease?
What is the first line blood pressure medicine for someone with diabetes and or kidney disease?
Signup and view all the answers
What is the preferred medication when treating diabetic patients with high blood pressure?
What is the preferred medication when treating diabetic patients with high blood pressure?
Signup and view all the answers
What is the first medication to prescribe when treating a patient with type 2 diabetes?
What is the first medication to prescribe when treating a patient with type 2 diabetes?
Signup and view all the answers
Study Notes
Diuretics
- Furosemide (loop diuretic) is used in patients with low GFR (renal impairment)
- Low potassium levels can increase the risk of heart arrhythmia when taking diuretics
- Patient education for furosemide includes:
- Monitoring blood pressure
- Watching for signs of postural hypotension
- Eating potassium-rich foods
- Furosemide should not be prescribed with digoxin, NSAIDS, antihypertensive drugs, and lithium
- Loop diuretics work by inhibiting sodium and chloride reabsorption in the loop of Henle, leading to significant urine production
- Thiazide diuretics act on the distal convoluted tubule, inhibiting sodium reabsorption to a lesser extent, resulting in a moderate increase in urine output
Hydrochlorothiazide (Microzide)
- Not suitable for patients with inadequate renal function (GFR below 30)
- Diuresis starts in 2 hours and peaks in 4-6 hours
- Important to check BP, HR, weight, signs of hypokalemia, and signs of gout before prescribing
Spironolactone (Aldactone)
- Potassium-sparing diuretic
- Produces a modest increase in urine and a substantial decrease in potassium excretion
- Often used alongside other diuretics to counteract potassium loss
- Main reason for prescription is to counteract potassium loss caused by thiazide and loop diuretics
- Adverse effects include hyperkalemia, gynecomastia, menstrual irregularities, impotence, hirsutism, and deep voice
- May cause tumors in rats, so avoid unnecessary use
Triamterene (Dyrenium)
- Potassium-sparing diuretic
- Works by disrupting sodium and potassium exchange, resulting in decreased sodium absorption and reduced potassium secretion
- Should not be prescribed to patients with elevated potassium levels
- Adverse effects include hyperkalemia, nausea, vomiting, leg cramps, and dizziness
- Diuresis starts in a few hours
Hypertension
- Diuretics are the first-choice drug for treating hypertension in African Americans
- In African Americans, monotherapy with beta blockers and ACEIs is less effective
- ACEIs and beta blockers may be used in combination, especially in African Americans with type 1 diabetes with proteinuria or hypertensive nephrosclerosis
- Recommended combinations for hypertension include:
- ACEI plus a thiazide diuretic
- ACEI plus a calcium channel blocker (CCB)
- Beta blocker plus a thiazide diuretic
Angiotensin-Converting Enzyme (ACE) Inhibitors
- Lisinopril is an ACEI
- ACEIs lower angiotensin II levels, dilate blood vessels, and reduce blood volume, leading to lower blood pressure
- Uses include hypertension, CHF, acute MI, left ventricular dysfunction, and nephropathy
- Contraindications include pregnancy and renal artery stenosis
- Baseline data needed before starting includes blood pressure and renal function
- Adverse effects include first-dose hypotension, hyperkalemia, cough, renal failure, angioedema, and neutropenia
- Fetal injury is a black box warning
Angiotensin II Receptor Blockers (ARBs)
- Losartan is an ARB
- ARBs block the actions of angiotensin II, reducing blood pressure
- Uses include hypertension, MI, diabetic nephropathy, and prevention of stroke and death
- Adverse effects are similar to ACEIs, but with a lower risk of cough and hyperkalemia
- Not recommended for use with ACEIs
Aldosterone Antagonists
- Eplerenone is a selective aldosterone antagonist
- MOA: Selective blockade of aldosterone receptors, promoting retention of potassium and increased secretion of sodium and water
- Recommended for adding to standard HF therapy in patients with persistent symptoms despite adequate treatment with ACEI and beta blocker
- Contraindications include use with potassium supplements, potassium-sparing diuretics, elevated potassium levels, and impaired renal function
- Important to monitor blood pressure, potassium levels, and GFR
Calcium Channel Blockers (CCBs)
- Diltiazem is a CCB
- Uses include angina, hypertension, and dysrhythmia (A-flutter, A-fib, PSVT)
- Baseline data needed before starting includes blood pressure, heart rate, liver function, and kidney function
- Adverse effects include dizziness, swelling of hands and feet, bradycardia, and exema-like rash in older adults
Direct Renin Inhibitors (DRIs)
- Aliskiren is a DRI
- MOA: Inhibits the conversion of angiotensinogen to angiotensin I
- Adverse effects include cough, hyperkalemia, and diarrhea
- Fetal injury is a black box warning
Vasodilators
- Hydralazine is a vasodilator
- MOA: Dilates arterioles and reduces peripheral resistance, reducing blood pressure
- Therapeutic goal: Reduce blood pressure and reduce afterload in CHF
- Adverse effects include reflex tachycardia, myocardial contractility, and NA and water retention
- Lupus-like syndrome can occur, with symptoms including muscle pain, joint pain, fever, nephritis, and pericarditis
Beta Blockers
- Metoprolol is a selective beta blocker (B1)
- Preferred for patients with lung issues
- Uses include angina, HF, hypertension, and MI
- Interactions: Use with caution in patients with diabetes, and monitor for hypoglycemia
Diabetes
- Metformin is the first-line medication for type 2 diabetes
- For patients with diabetes and hypertension, ACEI or ARB is the preferred medication
- For patients with diabetes and cardiovascular disease, kidney disease, or heart failure, sodium-glucose cotransporter 2 inhibitor or glucagon-like peptide 1 receptor agonist is recommended
- Target A1C level is below 7.0 for most patients, and below 8.0 for patients with severe hypoglycemia, limited life expectancy, or advanced micro- and macrovascular complications
Diuretics
- Furosemide (loop diuretic) is used in patients with low GFR (renal impairment).
- Low potassium levels can increase the risk of heart arrhythmia when taking diuretics.
- When prescribing Furosemide, patient education should include:
- Monitoring blood pressure
- Recognizing signs and symptoms of postural hypotension (e.g., standing slowly to avoid dizziness)
- Eating potassium-rich foods (e.g., dried fruit, nuts, spinach, potatoes)
- Furosemide (Lasix) should not be prescribed with:
- Digoxin (due to potassium loss causing dysrhythmia)
- NSAIDS
- Antihypertensive drugs
- Lithium
- Loop diuretics (e.g., Furosemide) work by inhibiting sodium and chloride reabsorption in the loop of Henle, leading to a significant increase in urine production.
- Thiazide diuretics act on the distal convoluted tubule, inhibiting sodium reabsorption to a lesser extent, resulting in a moderate increase in urine output.
Hydrochlorothiazide (Microzide)
- Hydrochlorothiazide should not be prescribed in patients with inadequate renal functioning (GFR < 30).
- Diuresis starts in 2 hours and peaks in 4-6 hours with Hydrochlorothiazide.
- Important patient monitoring before prescribing Hydrochlorothiazide includes:
- Blood pressure
- Heart rate
- Weight
- Signs and symptoms of hypokalemia (e.g., constipation, heart palpitation, fatigue, muscle weakness, tingling)
- Signs and symptoms of gout
Furosemide (Loop Diuretic)
- Furosemide has a higher risk of ototoxicity.
- Spironolactone (Aldactone) is a potassium-sparing diuretic.
- Spironolactone produces a modest increase in urine and a substantial decrease in potassium excretion.
- Spironolactone can be used alongside other diuretics to counteract potassium loss.
Spironolactone (Aldactone)
- Spironolactone is prescribed to counteract potassium loss caused by thiazide and loop diuretics.
- Adverse effects of Spironolactone include:
- Hyperkalemia (which can cause dysrhythmia)
- Gynecomastia
- Menstrual irregularities
- Impotence
- Hirsutism
- Deep voice
- Spironolactone is shown to cause tumors in rats, so it should be avoided unless necessary.
- Important baseline data needed before prescribing Spironolactone includes:
- Weight
- Vital signs
- Electrolytes
- Testosterone levels (if prescribed in transgender patients)
Triamterene (Dyrenium)
- Triamterene is a potassium-sparing diuretic.
- Triamterene works by disrupting the sodium and potassium exchange, resulting in decreased sodium absorption and reduced potassium secretion.
- Triamterene should not be prescribed in patients with elevated potassium levels.
- Diuresis starts in a few hours with Triamterene.
Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor
- Patient education when prescribing Lisinopril includes:
- Educating about first-dose hypotension
- Avoiding potassium supplements
- Notifying the provider if cough or facial swelling develops
- Important patient monitoring before starting Lisinopril includes:
- Blood pressure
- Proteinuria
- GFR rate
- Factors that increase the risk of cough while taking Lisinopril include:
- Advanced age
- Female sex
- Asian ancestry
- The cough should decrease after 3 days and resolve within 10 days after stopping the medication.
Losartan (Cozar): Angiotensin II Receptor Blocker (ARB)
- Losartan is approved for hypertension, MI, diabetic nephropathy, and prevention of stroke and death in high-risk patients.
- Losartan differs from ACE inhibitors (e.g., Lisinopril) in that it blocks the actions of angiotensin II, whereas ACE inhibitors block the production of angiotensin II.
- The primary difference between Losartan and Lisinopril is that ARBs pose a lower risk of cough and hyperkalemia.
Digoxin (Lanoxin)
- Digoxin increases myocardial contractility and alters the electrical activity of the heart.
- Digoxin is used to treat dysrhythmia (A-fib or flutter) or CHF.
- Interactions of Digoxin include:
- Hypokalemia, which increases the risk of dysrhythmia
- Avoid use in V-fib or V-tach
- Important patient monitoring while prescribing Digoxin includes:
- Digoxin levels (narrow therapeutic window: 0.5-0.8)
- Apical pulse
- Assessing for decreased signs and symptoms of CHF
- Patient education when prescribing Digoxin includes:
- Monitoring heart rate
- Holding the medication if heart rate is below 50
- Recognizing signs of toxicity (e.g., altered heart rate or rhythm, visual or gastrointestinal disturbances)
Metoprolol (Lopressor)
- Metoprolol is a selective beta-1 (B1) adrenergic blocker.
- Metoprolol is preferred for patients with lung issues because it only affects the heart, not the lungs.
- Metoprolol is used to treat angina, HF, HTN, and MI.
- Metoprolol is the preferred medication for African Americans.
Diabetes Management
- For patients with diabetes and hypertension, ACE inhibitors (e.g., Lisinopril) or ARBs (e.g., Losartan) are preferred.
- For patients with diabetes and cardiovascular disease, kidney disease, or heart failure, sodium-glucose cotransporter 2 inhibitors and/or glucagon-like peptide 1 receptor agonists are preferred.
- The target A1C level for most patients with diabetes is < 7.0.
- For patients with severe hypoglycemia, the target A1C level is < 8.0.
- The first-line medication for youth with new-onset diabetes is metformin.
- Youth with A1C > 8.5% and acidosis should be managed with insulin and IV fluids until acidosis resolves.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Test your knowledge of diuretics, their uses, and patient education with this quiz. Learn about loop diuretics, potassium levels, and heart arrhythmia risks.
