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Questions and Answers
Which class of diuretics is generally considered the most potent when administered orally?
Which class of diuretics is generally considered the most potent when administered orally?
What is the expected outcome of administering a diuretic to a patient?
What is the expected outcome of administering a diuretic to a patient?
If a patient's glomerular filtration rate (GFR) is 125 mL/hr, what is considered to be the normal hourly urine output?
If a patient's glomerular filtration rate (GFR) is 125 mL/hr, what is considered to be the normal hourly urine output?
What is the primary mechanism of action of furosemide (Lasix)?
What is the primary mechanism of action of furosemide (Lasix)?
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A patient who is prescribed furosemide has a potassium level of 3.0 mEq/L. Which potential drug interaction should the healthcare provider be most concerned about?
A patient who is prescribed furosemide has a potassium level of 3.0 mEq/L. Which potential drug interaction should the healthcare provider be most concerned about?
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A patient receiving furosemide is also prescribed an aminoglycoside antibiotic. What serious adverse effect should the healthcare provider monitor for?
A patient receiving furosemide is also prescribed an aminoglycoside antibiotic. What serious adverse effect should the healthcare provider monitor for?
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What important pre-administration assessment should a nurse perform when administering furosemide?
What important pre-administration assessment should a nurse perform when administering furosemide?
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What patient education is essential for those taking furosemide regarding potassium?
What patient education is essential for those taking furosemide regarding potassium?
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Which diuretic is known to block the reabsorption of sodium and chloride in the early segment of the distal convoluted tubule?
Which diuretic is known to block the reabsorption of sodium and chloride in the early segment of the distal convoluted tubule?
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A client with a history of gouty arthritis is prescribed a diuretic. Which medication should the nurse question?
A client with a history of gouty arthritis is prescribed a diuretic. Which medication should the nurse question?
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Which of the following is a potential adverse effect specifically associated with mannitol?
Which of the following is a potential adverse effect specifically associated with mannitol?
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A patient is prescribed spironolactone. What primary electrolyte imbalance does the nurse need to monitor for?
A patient is prescribed spironolactone. What primary electrolyte imbalance does the nurse need to monitor for?
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A nurse is administering an IV medication that must be warmed due to crystallization. Which medication would require this preparation?
A nurse is administering an IV medication that must be warmed due to crystallization. Which medication would require this preparation?
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Which diuretic acts by creating an osmotic action in the proximal convoluted tubule?
Which diuretic acts by creating an osmotic action in the proximal convoluted tubule?
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What is a potential severe side effect of administering large potassium chloride pills without adequate water?
What is a potential severe side effect of administering large potassium chloride pills without adequate water?
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Which of the following diuretics has a significant interaction with digoxin due to it promoting potassium loss?
Which of the following diuretics has a significant interaction with digoxin due to it promoting potassium loss?
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Which medication's mechanism of action involves inhibiting aldosterone at the distal nephron?
Which medication's mechanism of action involves inhibiting aldosterone at the distal nephron?
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A patient's potassium level is 6.2 mEq/L. Which of the following EKG changes would be most indicative of this level of hyperkalemia?
A patient's potassium level is 6.2 mEq/L. Which of the following EKG changes would be most indicative of this level of hyperkalemia?
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With IV administration of potassium, what is the maximum safe rate, in mEq/hour, to infuse?
With IV administration of potassium, what is the maximum safe rate, in mEq/hour, to infuse?
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In which fluid should liquid potassium chloride (KCl) be diluted for oral administration?
In which fluid should liquid potassium chloride (KCl) be diluted for oral administration?
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When administering intravenous potassium chloride, which practice is contraindicated?
When administering intravenous potassium chloride, which practice is contraindicated?
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A patient is experiencing symptoms of hyperkalemia. Which medication is used specifically to counteract the cardiotoxicity associated with hyperkalemia?
A patient is experiencing symptoms of hyperkalemia. Which medication is used specifically to counteract the cardiotoxicity associated with hyperkalemia?
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Which of the following is NOT a way to lower an elevated potassium level?
Which of the following is NOT a way to lower an elevated potassium level?
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A patient is experiencing hyperkalemia. Which of the following could be a sign or symptom, besides cardiac issues?
A patient is experiencing hyperkalemia. Which of the following could be a sign or symptom, besides cardiac issues?
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Which of the following is a common adverse effect of spironolactone (Aldactone)?
Which of the following is a common adverse effect of spironolactone (Aldactone)?
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A patient is prescribed spironolactone. Which of the following should the nurse teach the patient to avoid?
A patient is prescribed spironolactone. Which of the following should the nurse teach the patient to avoid?
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Which of the following best describes the mechanism of action of triamterene (Dyrenium)?
Which of the following best describes the mechanism of action of triamterene (Dyrenium)?
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A patient is receiving triamterene. Which of these findings should be reported to the provider immediately?
A patient is receiving triamterene. Which of these findings should be reported to the provider immediately?
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Why is Potassium Chloride (KCl) frequently administered?
Why is Potassium Chloride (KCl) frequently administered?
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What is a potential adverse effect of oral potassium chloride (KCl)?
What is a potential adverse effect of oral potassium chloride (KCl)?
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What condition is treated with Potassium Chloride?
What condition is treated with Potassium Chloride?
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Which of the following medication combinations would require careful monitoring due to the risk of hyperkalemia?
Which of the following medication combinations would require careful monitoring due to the risk of hyperkalemia?
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What is the primary mechanism of action of atropine?
What is the primary mechanism of action of atropine?
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A patient receiving atropine is experiencing tachycardia. Which action should the nurse take?
A patient receiving atropine is experiencing tachycardia. Which action should the nurse take?
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Which of the following is NOT an expected effect of beta-1 receptor activation?
Which of the following is NOT an expected effect of beta-1 receptor activation?
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What is the primary action of prazosin at the receptor level?
What is the primary action of prazosin at the receptor level?
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A patient taking prazosin reports dizziness and lightheadedness upon standing. What is the most likely cause?
A patient taking prazosin reports dizziness and lightheadedness upon standing. What is the most likely cause?
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What is the key teaching point for patients who are prescribed a beta-blocker such as propanolol?
What is the key teaching point for patients who are prescribed a beta-blocker such as propanolol?
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What is a common adverse effect associated with beta-blocker medications like propanolol?
What is a common adverse effect associated with beta-blocker medications like propanolol?
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Which effect would be anticipated in a patient taking propanolol?
Which effect would be anticipated in a patient taking propanolol?
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Which of the following blood pressure readings would be considered normal?
Which of the following blood pressure readings would be considered normal?
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What do antihistamines, phenothiazines, antipsychotics and TCAs have in common regarding drug interaction with atropine?
What do antihistamines, phenothiazines, antipsychotics and TCAs have in common regarding drug interaction with atropine?
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Study Notes
Diuretics & Cardiac Drugs
- Diuretics increase urine output (diuresis).
- Normal urine output is 30 mL/hour or greater.
- Normal GFR = 125 mL/hr.
- Normal output = about 60 mL/hr.
- GFR = 1 mL/min = 60 mL/hr.
- Diuretics maintain extracellular fluid (ECF) by affecting kidney filtration, reabsorption, and secretion.
Furosemide (Lasix)
- Classification: Loop diuretic, potassium-wasting diuretic.
- Mechanism of Action (MOA): Rapid-acting loop diuretic inhibiting sodium and chloride reabsorption in the ascending loop of Henle, decreasing edema and blood pressure.
- Uses: Very effective for massive fluid shifts, in both acute situations and congestive heart failure (CHF). Thiazide diuretics are preferable if possible.
- Dosage/Route: PO, IV, IM; 20-80 mg; IV starts in 5 minutes, lasting 2 hours.
- Adverse Effects: Postural hypotension, hypokalemia, hyponatremia, hypomagnesium, hyperchloremia, nausea, vomiting, dehydration, tinnitus, and potentially aplastic anemia and circulatory collapse.
- Drug Interactions: Increased risk of digoxin toxicity with low potassium. Possible hearing loss when combined with other ototoxic drugs, e.g. aminoglycosides; Lithium and antihypertensive drug interactions are also noted.
- Patient Education: Check potassium levels (3.5–5.0), blood pressure before administration; weigh daily to assess effectiveness; Closely monitor for hypotension and circulatory collapse with high fluid diuresis; Increase potassium in diet and supplements (e.g. orange juice).
Hydrochlorothiazide (Hydrodiuril)
- Classification: Thiazide diuretic, potassium-wasting diuretic.
- Mechanism of Action (MOA): Blocks sodium and chloride reabsorption in the early segment of the distal convoluted tubule. Ineffective if glomerular filtration rate (GFR) is low (<15-20 mL/min).
- Uses: Primarily for hypertension (HTN), often first-line in African Americans; also used in mild-to-moderate heart failure (HF) to mobilize edema; hepatic or renal disease.
- Dosage/Route: PO, dosage depends on formulation.
- Adverse Effects: Hyponatremia, hypochloremia, dehydration, hypokalemia; fetal harm, elevated glucose in diabetes mellitus (DM), potential for gouty arthritis.
- Drug Interactions: Risk of increased digoxin toxicity. Can potentiate hypotension with other antihypertensive drugs.
- Patient Education: Contraindicated during pregnancy, breast feeding, in DM or gouty arthritis, Monitor electrolytes (K, Na, Cl); Increase potassium intake.
Mannitol (Osmitrol)
- Classification: Osmotic diuretic.
- Mechanism of Action (MOA): Creates osmotic action in the proximal convoluted tubule, inhibiting water reabsorption and affecting K excretion minimally.
- Uses: Prevents/slows renal failure in severe hypertension and hypovolemic shock; reduces intracranial pressure (ICP) from cerebral edema; reduces intraocular pressure.
- Dosage/Route: IV infusion (hospital use only). Solutions range from 5% to 25%.
- Adverse Effects: Headache, nausea, vomiting (N/V), electrolyte imbalance, pulmonary edema, and congestive heart failure (CHF) edema.
- Patient Education: Hospital use only. Monitor electrolyte levels closely; use only as prescribed.
Spironolactone (Aldactone)
- Classification: Potassium-sparing diuretic, aldosterone antagonist.
- Mechanism of Action (MOA): Blocks aldosterone action in the distal nephron, promoting potassium retention and sodium excretion.
- Uses: Hypertension and edema, often used in combination with loop or thiazide diuretics due to low diuresis.
- Adverse Effects: Hyperkalemia > 5.0; potentially fatal cardiac dysrhythmias, endocrine effects (gynecomastia/menstrual irregularities).
- Drug Interactions: Caution with ACE inhibitors, ARBs, and direct renin inhibitors.
- Patient Education: Monitor potassium levels; do not use with other potassium-sparing drugs or salt substitutes. Avoid use with ACE inhibitors or other related agents.
Triamterene (Dyrenium)
- Classification: Potassium-sparing diuretic (non-aldosterone sparing).
- Mechanism of Action (MOA): Interrupts sodium-potassium exchange in the distal tubule, directly causing potassium retention and inhibiting potassium loss.
- Uses: Treats HTN and edema. Used to help offset the potassium loss caused by diuretics such as furosemide.
- Adverse Effects: Nausea, vomiting, leg cramps, and hyperkalemia.
- Drug Interactions: Caution with ACE inhibitors, ARBs, and direct renin inhibitors.
- Patient Education: Monitor potassium levels closely. Do not use with other potassium-sparing agents or salt substitutes.
Potassium Chloride (K) Supplements
- Classification: Potassium supplement.
- Mechanism of Action (MOA): Replaces potassium, necessary for nerve impulse transmission.
- Uses: Dietary supplementation, treating or preventing potassium deficiency.
- General Considerations: Oral potassium chloride (KCl) can irritate the gastrointestinal (GI) tract. Large doses can lead to potentially fatal hyperkalemia (high potassium), which should be monitored.
Removal of Potassium
- Remove K-containing foods and medications, including potassium-sparing diuretics.
- Infuse calcium gluconate to counteract cardiotoxicity.
- Infuse insulin/glucose to move potassium inside cells.
- Use sodium bicarbonate to increase cellular potassium uptake.
- Use sodium polystyrene sulfonate (Kayexalate), an exchange resin; infuse sodium to bring potassium down
- Use peritoneal or hemodialysis to lower potassium levels.
Other Drugs and considerations
- A large number of additional drugs are discussed to address various hypertension and cardiac conditions.
- Important patient instructions for each drug are given in each case to ensure proper usage.
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Description
Test your knowledge on diuretics, focusing primarily on their mechanisms, effects, and patient care considerations. This quiz covers essential pharmacological principles and administration guidelines related to diuretics such as furosemide. Perfect for nursing and pharmacology students!