IV therapy/Pharm Test Urinary drugs part 1

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary mechanism by which loop diuretics reduce fluid volume in the body?

By increasing the excretion of sodium and chloride, leading to water loss. (correct)

By promoting the excretion of potassium and bicarbonate.

By blocking the action of aldosterone to reduce fluid volume.

By directly inhibiting the reabsorption of water in the kidneys.

Which of the following is a common electrolyte imbalance associated with the use of loop diuretics?

Hypermagnesemia

Hypernatremia

Hyperkalemia

Hypocalcemia (correct)

A patient taking a loop diuretic develops hypokalemia. Why is this significant when digoxin is also taken?

Hypokalemia has no significant interaction with digoxin.

Hypokalemia increases the risk of digoxin toxicity. (correct)

Hypokalemia interferes with the effectiveness of digoxin.

Hypokalemia decreases the risk of digoxin toxicity.

Which of the following is a significant contraindication for the use of loop diuretics?

Severe kidney failure Signup and view all the answers

What is the most common adverse effect associated with potassium-sparing diuretics?

Hyperkalemia Signup and view all the answers

In addition to glaucoma, what other conditions can be treated with carbonic anhydrase inhibitors?

Heart failure, altitude sickness, and seizures Signup and view all the answers

Why is it important to assess kidney function when administering medications?

To predict how well the kidneys will excrete the medication Signup and view all the answers

Which of the following drug classes, when combined with loop diuretics, poses a risk of excessively low blood pressure?

Antihypertensives Signup and view all the answers

What is a primary action of osmotic diuretics in the kidneys?

Increasing osmotic pressure in the proximal convoluted tubule. Signup and view all the answers

A patient taking a potassium-sparing diuretic should avoid which of the following?

Potassium supplements. Signup and view all the answers

Which of the following is a contraindication for the use of osmotic diuretics like mannitol?

Active intracranial bleeding Signup and view all the answers

Which electrolyte imbalance is a potential adverse effect of thiazide diuretics?

Hyponatremia Signup and view all the answers

What is a crucial monitoring parameter when a patient is taking diuretics and has increased intracranial pressure?

Neurological assessments. Signup and view all the answers

A patient taking potassium-wasting diuretics should be advised to consume:

Foods high in potassium. Signup and view all the answers

What is an indication of effective diuretic therapy relating to blood pressure?

Decreased blood pressure. Signup and view all the answers

What is an appropriate time to administer diuretic medication to minimize nighttime urination?

8 am and 2 pm. Signup and view all the answers

Which of the following laboratory values indicates normal kidney function?

Creatinine: 0.8 mg/dL, BUN: 15 mg/dL. Signup and view all the answers

A patient taking diuretics should be educated to avoid:

Consuming alcohol. Signup and view all the answers

A patient on diuretics reports dizziness and weakness. What initial intervention is generally appropriate?

Increase fluid intake. Signup and view all the answers

What is an indication of fluid volume deficit (dehydration) in a patient taking diuretics?

Dry mucous membranes. Signup and view all the answers

Which medication is classified as a loop diuretic?

Lasix. Signup and view all the answers

What condition is a contraindication for thiazide diuretics?

Pregnancy. Signup and view all the answers

Why are baseline assessments important before initiating diuretic therapy for a patient?

To identify existing fluid and electrolyte disturbances. Signup and view all the answers

A patient with a known sulfa allergy is prescribed a diuretic. Which of the following diuretics should be avoided?

Hydrochlorothiazide Signup and view all the answers

A patient taking a potassium-wasting diuretic receives education regarding dietary considerations. Which food choice demonstrates a need for further teaching?

Salted french fries Signup and view all the answers

A patient on diuretic therapy reports muscle cramps and increased thirst. Which lab value should be prioritized for assessment, considering these symptoms?

Serum potassium Signup and view all the answers

A patient with diabetes is prescribed a thiazide diuretic for hypertension. What adverse effect should the nurse monitor, specifically related to the patient's diabetes?

Hyperglycemia Signup and view all the answers

A patient is prescribed a diuretic. Which of the following instructions is most important to teach the patient regarding how to take this medication?

Take the medication early in the day Signup and view all the answers

A patient with chronic kidney disease has a serum creatinine level of 2.8 mg/dL and a BUN of 35 mg/dL. Which diuretic class would require the most careful dose adjustment due to impaired kidney function?

Loop diuretics Signup and view all the answers

A patient is prescribed a loop diuretic for heart failure. Which of the following medication classes could potentially reduce the effectiveness of the prescribed diuretic?

Nonsteroidal anti-inflammatory drugs (NSAIDs) Signup and view all the answers

Which diuretic class is most likely to induce metabolic acidosis as a side effect due to its mechanism of action?

Carbonic anhydrase inhibitors Signup and view all the answers

A patient with hyperaldosteronism is prescribed a diuretic. Which of the following effects would most closely indicate the effectiveness of a potassium-sparing diuretic in this patient?

Decreased serum potassium levels Signup and view all the answers

A patient with suspected acute angle-closure glaucoma is being treated. Which intervention could be a beneficial side effect of administering an intravenous osmotic diuretic in conjunction with standard treatment?

Reduction in cerebral edema if present Signup and view all the answers

Study Notes

Kidney Function and Medication

Kidneys filter medications from the blood.
Renal disease impairs kidney function, leading to drug toxicity.
BUN and creatinine levels assess kidney function.
Renal disease, urine pH changes, and age can impair medication effectiveness.
If a person has renal disease the doctor may chose to put them on reduced amounts of medication so it doesn’t damage the kidney further and prevent drug toxicity.
Altered urinary PH affect the absorption rate of certain
Normal creatinine levels range from 0.6 to 1.3 mg/dL.
Normal BUN levels range from 10 to 20 mg/dL.

Carbonic Anhydrase Inhibitors

This class of diuretics excretes sodium, potassium bicarbonate, and water.
Used primarily for glaucoma, also for altitude sickness, seizures, and heart failure (as diuretics)
Decreases aqueous humor production, reducing intraocular pressure resulting in glaucoma being treated.
Side effects include rare but serious blood disorders, nausea, vomiting, diarrhea, electrolyte imbalances(sodium and potassium) glucose disturbances, flu-like symptoms, and paresthesias.
Notify doctor if pain in eye doesn’t decrease

Loop Diuretics

These drugs excrete sodium and chloride (salt).
Sodium excretion leads to water excretion. (Sodium follow water)
Work in the loop of Henle
Used for nephrotic syndrome, heart failure, pulmonary edema, and hypertension.
Decreasing the amount of fluid in the body can lead to these Adverse effects include dehydration(dry mucus membranes and weight loss) hyponatremia, hypokalemia, hypochloremia,hypocalcemia, hypomagnesemia, hypotension, ototoxicity, and hyperglycemia.
If we lose to much potassium our heart can increase or decrease (Low potassium=Heart issues)
Assess for hearing loss or tinnitus (ototoxicity)
Watch blood glucose (hyperglycemia) especially in diabetic patient because it can result in issues
Contraindications are pregnancy,(only use if necessary)anuria, and severe kidney failure.
Precautions include cardiovascular disease, diabetes, dehydration, electrolyte imbalances, gout, digoxin, lithium, ototoxic medications, NSAIDs, and antihypertensives.
Hypokalemia increases digoxin toxicity risk. VERY IMPORTANT
Excessive potassium loss requires potassium supplements because potassium keeps dropping.
Combining with other antihypertensives can cause hypotension.
Hypoatremia increases lithium toxicity.
NSAIDs reduce kidney blood flow, decreasing loop diuretic effectiveness.

Potassium-Sparing Diuretics

Used for hypertension, edema, and heart failure.
Blocks aldosterone action in hyperaldosteronism.
Major side effect is hyperkalemia (high potassium) because it holds potassium
Other side effects include endocrine effects (deepened voice, impotence in men; menstrual irregularities in women), drowsiness, and metabolic acidosis.
Interactions include ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors.
Contraindicated in hyperkalemia, anuria, and severe kidney failure.
Avoid high-potassium foods, salt substitutes, and potassium supplements.

Osmotic Diuretics

Used for systemic or critically ill patients.
Increases osmotic pressure in the proximal convoluted tubule of the kidney.
Fluid shifts from tissues to circulatory vessels.
Used for edema, diuresis, cerebral edema, intraocular pressure reduction, and acute renal failure management.
Mannitol is a common osmotic diuretic.
Contraindications include active intracranial bleeding, aneurysm, severe pulmonary edema, severe dehydration, and kidney failure.
Adverse effects include heart failure, pulmonary edema, rebound intracranial pressure increase, fluid and electrolyte imbalances, and metabolic acidosis.
Increases lithium excretion.
Causes hypokalemia, increasing digoxin toxicity risk.
Monitor urine output, blood pressure, pulse, respiratory rate, and neurological status in patients with increased intracranial pressure.

Used for systemic edema, mild to moderate hypertension, diabetes insipidus, and calcium reabsorption in postmenopausal osteoporosis.
Diabetes insipidus-Rare disorder that causes the body to produce too much urine and feel thirsty all the time.
Adverse effects include electrolyte imbalances, dehydration, hyperglycemia, hyperuricemia, and joint pain.
Precautions include liver disease, diabetes, lupus erythematosus, and diarrhea.
Contraindicated in pregnancy, breastfeeding, and kidney impairment.
Interactions include ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors.
No increased risk of hearing loss as with loop diuretics.
Do not administer to patients allergic to sulfa.

Diuretic Assessments

Baseline assessments: Vital signs, weight, and lab values.
Ongoing assessments: Fluid intake/output, dehydration signs, electrolytes, heart rate, and orthostatic hypotension.
Education: Full treatment course, dietary changes, and potential adverse effects.

Effectiveness of Diuretics

Effectiveness: Decreased intracranial/intraocular pressure, increased urine output, decreased blood pressure.
Monitoring: BUN and creatinine levels for renal function, uric acid levels for gout, and glucose levels for diabetes.

General Tips

Avoid late-day dosing to prevent nighttime urination and falls.
Potassium-wasting diuretics patients eat potassium-rich foods.
Potassium-sparing diuretics patients avoid potassium-rich foods, salt substitutes, and potassium supplements.
Adequate kidney function is essential.
Urine output should be at least 30 ml/hour for effectiveness.

Diuretic Medications

Proper timing is crucial for effective condition management.
Avoid reducing fluid intake to prevent dehydration, especially in elderly patients.
Optimal administration times are typically 8 am and 2 pm, with a maximum dosage before 4:30 pm.
Take with food or milk to reduce adverse effects.
Avoid alcohol, as it's a diuretic and can interfere with medication.
Avoid non-prescription medication use without medical approval.
Caution while driving or performing hazardous tasks due to potential hypotension and dizziness.
Increase fluid intake if dizziness/weakness occurs; seek medical attention if symptoms persist.
Monitor weight weekly (more frequently as needed).
Closely monitor blood glucose in patients with diabetes or those taking loop or thiazide diuretics.

Nursing Interventions

Monitor for fluid overload (increased pulse/respiration, fluid in lungs, edema, unwell feeling) and deficit (decreased urine output, dry membranes, thirst, confusion).
Daily morning weight.
Frequent vital signs until stable.
Monitor electrolytes (potassium, creatinine), and urine output.
Encourage prescribed fluid intake.
Limit salt intake.
Recommend potassium-rich foods for patients on potassium-wasting diuretics (baked potatoes, bananas, apricots, oranges, dates, tomatoes, tomato juice, sweet potatoes, kale, and raisins).

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers essential concepts related to kidney function, medication filtering, and various classes of diuretics. It discusses the implications of renal disease on medication effectiveness and the specific uses and side effects of carbonic anhydrase inhibitors and loop diuretics. Test your knowledge on how these concepts are intertwined in pharmacology.