Pharmacology Diuretics Quiz

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Questions and Answers

Which class of diuretics is generally considered the most potent when administered orally?

  • Osmotic diuretics
  • Thiazide diuretics
  • Potassium-sparing diuretics
  • Loop diuretics (correct)

What is the expected outcome of administering a diuretic to a patient?

  • Decreased fluid in the extracellular component
  • Increased urine output (correct)
  • Decreased urine output
  • Increased sodium reabsorption

If a patient's glomerular filtration rate (GFR) is 125 mL/hr, what is considered to be the normal hourly urine output?

  • 125 mL/hr
  • 60 mL/hr (correct)
  • 30 mL/hr
  • 1 mL/hr

What is the primary mechanism of action of furosemide (Lasix)?

<p>Inhibits sodium and chloride reabsorption in the ascending Loop of Henle (C)</p> Signup and view all the answers

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?

<p>Increased risk of digoxin toxicity (D)</p> Signup and view all the answers

A patient receiving furosemide is also prescribed an aminoglycoside antibiotic. What serious adverse effect should the healthcare provider monitor for?

<p>Increased risk of hearing loss (D)</p> Signup and view all the answers

What important pre-administration assessment should a nurse perform when administering furosemide?

<p>Check the patient's potassium level (C)</p> Signup and view all the answers

What patient education is essential for those taking furosemide regarding potassium?

<p>Increase intake of potassium-rich foods or supplements. (A)</p> Signup and view all the answers

Which diuretic is known to block the reabsorption of sodium and chloride in the early segment of the distal convoluted tubule?

<p>Hydrochlorothiazide (C)</p> Signup and view all the answers

A client with a history of gouty arthritis is prescribed a diuretic. Which medication should the nurse question?

<p>Hydrochlorothiazide (A)</p> Signup and view all the answers

Which of the following is a potential adverse effect specifically associated with mannitol?

<p>Pulmonary edema (C)</p> Signup and view all the answers

A patient is prescribed spironolactone. What primary electrolyte imbalance does the nurse need to monitor for?

<p>Hyperkalemia (A)</p> Signup and view all the answers

A nurse is administering an IV medication that must be warmed due to crystallization. Which medication would require this preparation?

<p>Mannitol (D)</p> Signup and view all the answers

Which diuretic acts by creating an osmotic action in the proximal convoluted tubule?

<p>Mannitol (D)</p> Signup and view all the answers

What is a potential severe side effect of administering large potassium chloride pills without adequate water?

<p>Intestinal ulcers leading to bleeding or perforation (D)</p> Signup and view all the answers

Which of the following diuretics has a significant interaction with digoxin due to it promoting potassium loss?

<p>Hydrochlorothiazide (C)</p> Signup and view all the answers

Which medication's mechanism of action involves inhibiting aldosterone at the distal nephron?

<p>Spironolactone (B)</p> Signup and view all the answers

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?

<p>Prolonged PR interval and tented T waves (D)</p> Signup and view all the answers

With IV administration of potassium, what is the maximum safe rate, in mEq/hour, to infuse?

<p>10 (C)</p> Signup and view all the answers

In which fluid should liquid potassium chloride (KCl) be diluted for oral administration?

<p>Orange juice (A)</p> Signup and view all the answers

When administering intravenous potassium chloride, which practice is contraindicated?

<p>Adding KCl to an existing IV solution (B)</p> Signup and view all the answers

A patient is experiencing symptoms of hyperkalemia. Which medication is used specifically to counteract the cardiotoxicity associated with hyperkalemia?

<p>Calcium gluconate (B)</p> Signup and view all the answers

Which of the following is NOT a way to lower an elevated potassium level?

<p>Administering a potassium-sparing diuretic (D)</p> Signup and view all the answers

A patient is experiencing hyperkalemia. Which of the following could be a sign or symptom, besides cardiac issues?

<p>Tingling or numbness in extremities (B)</p> Signup and view all the answers

Which of the following is a common adverse effect of spironolactone (Aldactone)?

<p>Hyperkalemia (B)</p> Signup and view all the answers

A patient is prescribed spironolactone. Which of the following should the nurse teach the patient to avoid?

<p>Potassium supplements and salt substitutes (A)</p> Signup and view all the answers

Which of the following best describes the mechanism of action of triamterene (Dyrenium)?

<p>Directly disrupting the sodium-potassium exchange in the distal nephron (D)</p> Signup and view all the answers

A patient is receiving triamterene. Which of these findings should be reported to the provider immediately?

<p>Elevated potassium level (B)</p> Signup and view all the answers

Why is Potassium Chloride (KCl) frequently administered?

<p>To provide a source of potassium for nerve function (D)</p> Signup and view all the answers

What is a potential adverse effect of oral potassium chloride (KCl)?

<p>Gastrointestinal irritation (D)</p> Signup and view all the answers

What condition is treated with Potassium Chloride?

<p>Hypokalemia (B)</p> Signup and view all the answers

Which of the following medication combinations would require careful monitoring due to the risk of hyperkalemia?

<p>Triamterene (Dyrenium) and an ACE inhibitor (D)</p> Signup and view all the answers

What is the primary mechanism of action of atropine?

<p>Selective blockade of acetylcholine at muscarinic receptors. (B)</p> Signup and view all the answers

A patient receiving atropine is experiencing tachycardia. Which action should the nurse take?

<p>Decrease rate of infusion. (D)</p> Signup and view all the answers

Which of the following is NOT an expected effect of beta-1 receptor activation?

<p>Decreased force of contraction. (A)</p> Signup and view all the answers

What is the primary action of prazosin at the receptor level?

<p>Antagonist of alpha-1 adrenergic receptors (C)</p> Signup and view all the answers

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

<p>Orthostatic hypotension resulting from vasodilation. (B)</p> Signup and view all the answers

What is the key teaching point for patients who are prescribed a beta-blocker such as propanolol?

<p>Rapid withdrawal can be dangerous. (A)</p> Signup and view all the answers

What is a common adverse effect associated with beta-blocker medications like propanolol?

<p>Bronchoconstriction and bradycardia. (C)</p> Signup and view all the answers

Which effect would be anticipated in a patient taking propanolol?

<p>Decreased HR and decreased peripheral vascular resistance. (A)</p> Signup and view all the answers

Which of the following blood pressure readings would be considered normal?

<p>110/70 (C)</p> Signup and view all the answers

What do antihistamines, phenothiazines, antipsychotics and TCAs have in common regarding drug interaction with atropine?

<p>They may potentiate the effects of atropine. (C)</p> Signup and view all the answers

Flashcards

Diuretics

Drugs that increase urine output. This is achieved by inhibiting sodium and chloride reabsorption in different parts of the kidney.

Loop Diuretics

A type of diuretic that acts on the loop of Henle to block sodium and chloride reabsorption, resulting in powerful diuresis. They are often used for acute conditions like heart failure or edema.

Thiazide Diuretics

A type of diuretic that acts on the distal convoluted tubule, blocking sodium and chloride reabsorption. They are usually used for chronic conditions like hypertension.

Potassium-Sparing Diuretics

A type of diuretic that acts on the collecting duct to block sodium and chloride reabsorption, leading to potassium retention. Used for conditions like hyperkalemia.

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Furosemide (Lasix), MOA

A powerful loop diuretic used for rapid fluid removal in heart failure, edema, or other conditions. It works by blocking sodium and chloride reabsorption in the ascending loop of Henle.

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Furosemide (Lasix), Adverse Effect

Furosemide is a potassium-wasting diuretic, meaning it can lower potassium levels in the blood. This can increase the risk of digoxin toxicity.

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Furosemide (Lasix), Drug Interaction

Furosemide can cause hearing loss, especially when combined with other ototoxic drugs like aminoglycosides.

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Furosemide (Lasix), Drug Interaction

Furosemide can cause hypotension, especially when taken with other antihypertensive drugs.

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Osmotic Diuretics

A type of diuretic that works by creating an osmotic action in the proximal convoluted tubule, inhibiting passive reabsorption of water.

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Potassium-Wasting Diuretic

A diuretic that causes the body to lose potassium.

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What is the primary use of Hydrochlorothiazide?

Hydrochlorothiazide is a thiazide diuretic that is often the first choice drug for hypertension, especially in African Americans.

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What are some potential side effects of Hydrochlorothiazide?

Hydrochlorothiazide can cause hyponatremia, hypochloremia, dehydration, hypokalemia, and can increase the risk of gouty arthritis.

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What is Mannitol used for?

Mannitol, an osmotic diuretic, is used to prevent or slow down acute renal failure, reduce intracranial pressure, and decrease intraocular pressure in cases that don't respond to usual therapy.

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How does Spironolactone work?

Spironolactone, a potassium-sparing diuretic, blocks the action of aldosterone in the distal nephron, causing potassium retention and sodium excretion.

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Aldosterone Antagonist Diuretic

A type of diuretic that works by blocking the action of aldosterone in the kidneys, which helps to conserve potassium while increasing the excretion of sodium and water.

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What is a potential side effect of Aldosterone antagonists?

A drug that is similar in chemical structure to steroid hormones, therefore can cause side effects mimicking hormones like gynecomastia (breast enlargement in men) and menstrual irregularities.

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What is a significant adverse effect of Aldosterone antagonists?

A condition that can be caused by high potassium levels (hyperkalemia) due to the action of Aldosterone Antagonists in the kidneys. Can be fatal in severe cases due to cardiac dysrhythmias (irregular heartbeat).

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What should you avoid giving Aldosterone antagonists with?

Aldosterone antagonists should not be given together with potassium supplements, salt substitutes, or other potassium-sparing drugs (ACE inhibitors).

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What is Triamterene (Dyrenium)?

A type of diuretic that works by directly interfering with the sodium-potassium exchange in the distal nephron. It's not an Aldosterone antagonist, so it directly blocks the channels.

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Why is Triamterene (Dyrenium) used?

This class of diuretics is known for causing potassium retention. The main use for it is to counter the potassium-wasting effects of other diuretics.

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Why is potassium important for the heart?

Potassium is essential for nerve impulse transmission, especially in the heart. Abnormal potassium levels (hypokalemia or hyperkalemia) can both cause cardiac dysrhythmias.

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How can Potassium Chloride be administered?

Potassium chloride supplements can be administered orally (pills, liquid), and intravenously (diluted).

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Hyperkalemia

High potassium levels in the blood, can be caused by many factors like kidney failure, medications, or dehydration, and can lead to dangerous heart rhythm problems

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Hyperkalemic Cardiac Arrest

A life-threatening condition caused by excessive potassium levels in the blood, characterized by severe cardiac arrhythmias like ventricular tachycardia or fibrillation.

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Symptoms of Hyperkalemia

Cardiac arrhythmias, confusion, anxiety, shortness of breath, numbness or tingling of hands, lips, and feet.

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What to Avoid for Hyperkalemia

Potassium-sparing diuretics like spironolactone (Aldactone) or triamterene (Dyrenium), Potassium-rich foods like bananas, avocados, and spinach.

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IV Calcium Gluconate for Hyperkalemia

Calcium gluconate is given intravenously, its main role is to protect the heart from the negative effects of high potassium.

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Insulin, Glucose, and Sodium Bicarbonate for Hyperkalemia

Insulin, glucose, and sodium bicarbonate work by driving potassium into the cells, lowering its concentration in the bloodstream.

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Kayexalate (Sodium Polystyrene Sulfonate)

A medication that removes potassium from the body by exchanging it for sodium in the intestines, given orally or via enema. Often used for hyperkalemia.

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Dialysis for Hyperkalemia

A medical procedure that filters the blood, removing excess potassium and other waste products. Used for severe hyperkalemia.

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What is Atropine?

A drug that blocks the effects of acetylcholine at muscarinic receptors, causing a decrease in parasympathetic activity. It is used to treat bradycardia, dry secretions before surgery, and other conditions.

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What is Prazosin (Minipress)?

A medication that blocks alpha 1 receptors, leading to vasodilation and a decrease in blood pressure. It is used for hypertension, benign prostatic hyperplasia, and Raynaud's phenomenon.

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What are beta-blockers?

A type of drug that blocks beta-adrenergic receptors in the body. The most common uses for beta-blockers include treating hypertension, angina, cardiac dysrhythmias, and heart failure.

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What is Propranolol (Inderal XL)?

A nonselective beta-blocker, which means it blocks both beta 1 and beta 2 receptors. It reduces heart rate, contractility, and renin secretion. This medication is used for hypertension, angina, and cardiac dysrhythmias. It is important to avoid rapid withdrawal as it can lead to serious complications.

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What is the function of the Alpha 1 receptor in the heart?

This receptor causes vasoconstriction in arterioles and veins, increasing blood pressure.

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What is the function of the Alpha 2 receptor in the heart?

This receptor is located primarily in nerve tissue and is not directly involved in cardiovascular function.

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What is the function of the Beta 1 receptor in the heart?

This receptor increases heart rate, contractility, and AV conduction speed. It also stimulates renin release from the kidneys.

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What is the function of the Beta 2 receptor in the heart?

This receptor is responsible for bronchodilation, vasodilation, and relaxation of the smooth muscles.

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What is Atropine?

This drug is classified as an anticholinergic medication, which means it blocks acetylcholine receptors, leading to a decrease in parasympathetic activity. It is used in emergency situations to increase heart rate and blood pressure.

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What is Prazosin (Minipress)?

This drug is an alpha-adrenergic antagonist which blocks alpha 1 receptors, leading to vasodilation and a decrease in blood pressure. It is used for hypertension, benign prostatic hyperplasia, and Raynaud's phenomenon.

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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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