NURS 3210 CH 28 PPT
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Questions and Answers

In which part of the nephron do potassium-sparing diuretics work?

Collecting ducts and distal convoluted tubules

How do potassium-sparing diuretics prevent potassium loss?

By preventing potassium from being pumped into the tubule

What is a unique adverse effect of spironolactone?

Gynecomastia

What type of diuretics inhibit tubular resorption of sodium, chloride, and potassium ions?

<p>Thiazide and thiazide-like diuretics</p> Signup and view all the answers

What is the primary site of action of thiazide and thiazide-like diuretics?

<p>Distal convoluted tubule</p> Signup and view all the answers

What is the effect of potassium-sparing diuretics on sodium and water?

<p>Promote their excretion</p> Signup and view all the answers

Which potassium-sparing diuretic is less effective in the long term?

<p>Amiloride</p> Signup and view all the answers

What medication class does metolazone belong to?

<p>Thiazide-like diuretics</p> Signup and view all the answers

What is the primary mechanism of action of osmotic diuretics in the proximal tubule?

<p>Producing an osmotic effect, pulling water into the renal tubules from the surrounding tissues, and inhibiting tubular resorption of water and solutes.</p> Signup and view all the answers

When administering a loop diuretic to a patient, what is the most important drug interaction to consider?

<p>Lithium, as it can increase the risk of lithium toxicity.</p> Signup and view all the answers

What is the name of the most commonly used loop diuretic?

<p>Furosemide (Lasix)</p> Signup and view all the answers

What is the primary effect of thiazide diuretics on the sequential nephron blockade?

<p>Blockade of the sequential nephron</p> Signup and view all the answers

Which type of diuretic is mannitol, and what is its mechanism of action?

<p>Osmotic diuretic, producing an osmotic effect and pulling water into the renal tubules from the surrounding tissues.</p> Signup and view all the answers

What is the potential interaction between loop diuretics and NSAIDs?

<p>Increased risk of drug interactions.</p> Signup and view all the answers

What is the primary effect of loop diuretics on the kidneys?

<p>Increased urine production and diuresis.</p> Signup and view all the answers

What is the name of another type of osmotic diuretic, besides mannitol?

<p>Urea</p> Signup and view all the answers

What is the primary effect of osmotic diuretics on glomerular filtration rate and renal plasma flow?

<p>Increases</p> Signup and view all the answers

What percentage of sodium and water is returned to the bloodstream from the filtered fluid in the proximal convoluted tubule?

<p>60% to 70%</p> Signup and view all the answers

What is the indication for using osmotic diuretics in patients with head trauma?

<p>Reduces intracranial pressure or cerebral edema</p> Signup and view all the answers

What is a potential adverse effect of osmotic diuretics?

<p>Convulsions</p> Signup and view all the answers

In which part of the nephron does the remaining 5% to 10% of sodium resorption take place?

<p>distal convoluted tubule</p> Signup and view all the answers

What is the administration route for mannitol (Osmitrol)?

<p>Intravenous (IV) infusion only</p> Signup and view all the answers

What is the mechanism of action of carbonic anhydrase inhibitors in the proximal tubules?

<p>Inhibition of carbonic anhydrase, preventing the exchange of H+ ions with sodium and water</p> Signup and view all the answers

What type of diuretic is acetazolamide (Diamox)?

<p>Carbonic anhydrase inhibitor (CAI)</p> Signup and view all the answers

What should the nurse do when noticing small crystals in the IV tubing during a mannitol (Osmitrol) infusion?

<p>Discard the solution and obtain another bag of medication</p> Signup and view all the answers

What is the primary indication for using osmotic diuretics in patients with acute renal failure (ARF)?

<p>Treatment of patients in the early, oliguric phase</p> Signup and view all the answers

What is the primary site of action of loop diuretics in the nephron?

<p>ascending loop of Henle</p> Signup and view all the answers

What is another indication for using osmotic diuretics?

<p>To promote excretion of toxic substances</p> Signup and view all the answers

Which type of diuretic is known to spare potassium in the kidneys?

<p>Potassium-sparing diuretics</p> Signup and view all the answers

What is the purpose of using a filter during the administration of mannitol (Osmitrol)?

<p>To prevent crystallization of the solution</p> Signup and view all the answers

What is the primary mechanism of action of osmotic diuretics?

<p>Increase in osmotic pressure in the renal tubules, inhibiting sodium and water reabsorption</p> Signup and view all the answers

What is the primary site of action of thiazide and thiazide-like diuretics in the nephron?

<p>distal convoluted tubule</p> Signup and view all the answers

What is the primary mechanism of action of thiazide and thiazide-like diuretics on arterioles?

<p>Direct relaxation, leading to dilation</p> Signup and view all the answers

What is the consequence of using thiazide diuretics in patients with severe renal impairment?

<p>Ineffective, as creatinine clearance is less than 30-50 mL/min</p> Signup and view all the answers

What is the primary indication for using thiazide and thiazide-like diuretics in patients with hypertension?

<p>To lower peripheral vascular resistance and reduce blood pressure</p> Signup and view all the answers

What is the adverse effect of thiazide and thiazide-like diuretics on the metabolic system?

<p>Hypokalemia, hyperglycemia, hyperuricemia, and hypochloremic alkalosis</p> Signup and view all the answers

What is the importance of assessing baseline fluid volume status, intake, and output in patients taking thiazide and thiazide-like diuretics?

<p>To monitor for potential dehydration and electrolyte imbalances</p> Signup and view all the answers

What is the reason for conducting a thorough patient history and physical examination before administering thiazide and thiazide-like diuretics?

<p>To identify potential contraindications or cautions</p> Signup and view all the answers

How do thiazide and thiazide-like diuretics differ from other types of diuretics in terms of their effectiveness in patients with renal impairment?

<p>Metolazone remains effective in patients with creatinine clearance as low as 10 mL/min</p> Signup and view all the answers

What is the role of thiazide and thiazide-like diuretics in the management of heart failure and hepatic cirrhosis?

<p>Adjunctive therapy to reduce edema and fluid overload</p> Signup and view all the answers

Study Notes

Diuretics

  • Classified according to their sites of action within the nephron, chemical structure, and diuretic potency
  • Types of diuretic drugs:
    • Carbonic anhydrase inhibitors (CAIs)
    • Loop diuretics
    • Osmotic diuretics
    • Potassium-sparing diuretics
    • Thiazide and thiazide-like diuretics

Carbonic Anhydrase Inhibitors (CAIs)

  • Chemical derivative of sulfonamide antibiotics
  • Inhibit the activity of the enzyme carbonic anhydrase
  • Found in kidneys, eyes, and other parts of the body
  • Acetazolamide (Diamox) is the most commonly used CAI
  • Mechanism of action:
    • Block the action of carbonic anhydrase, preventing the exchange of H+ ions with sodium and water
    • Inhibition of carbonic anhydrase reduces H+ ion concentration in renal tubules
    • Dilate arterioles by direct relaxation

Loop Diuretics

  • Most commonly used loop diuretic: Furosemide (Lasix)
  • Uses:
    • Pulmonary edema
    • Edema associated with heart failure (HF), liver disease, nephrotic syndrome, ascites, and hypertension
  • Important to determine if the patient is also taking lithium, as it can increase the risk of lithium toxicity

Osmotic Diuretics

  • Most commonly used osmotic diuretic: Mannitol (Osmitrol)
  • Mechanism of action:
    • Work mostly in the proximal tubule
    • Nonabsorbable, producing an osmotic effect
    • Pull water into the renal tubules from the surrounding tissues
    • Inhibit tubular resorption of water and solutes, producing rapid diuresis
  • Drug effects:
    • Increases glomerular filtration rate and renal plasma flow
    • Helps to prevent kidney damage during acute renal failure (ARF)
    • Reduces intracranial pressure or cerebral edema associated with head trauma
    • Reduces excessive intraocular pressure
  • Indications:
    • Treatment of patients in the early, oliguric phase of ARF
    • To promote excretion of toxic substances
    • To reduce intracranial pressure
    • Treatment of cerebral edema
  • Adverse effects:
    • Convulsions
    • Thrombophlebitis
    • Pulmonary congestion

Potassium-Sparing Diuretics

  • Examples:
    • Amiloride (Midamor)
    • Spironolactone (Aldactone)
    • Triamterene (Dyrenium)
  • Mechanism of action:
    • Work in collecting ducts and distal convoluted tubules
    • Interfere with sodium-potassium exchange
    • Competitively bind to aldosterone receptors
    • Block resorption of sodium and water usually induced by aldosterone
  • Drug effects:
    • Prevent potassium from being pumped into the tubule, thus preventing its secretion
    • Competitively block aldosterone receptors and inhibit their action
    • Promote the excretion of sodium and water
  • Indications:
    • Spironolactone and triamterene:
      • Hyperaldosteronism
      • Hypertension
      • Reversing potassium loss caused by potassium-losing drugs
      • Certain cases of HF: prevention of remodeling
    • Amiloride:
      • Similar to spironolactone and triamterene, but less effective in the long term
  • Adverse effects:
    • Body system:
      • CNS: dizziness, headache
      • GI: cramps, nausea, vomiting, diarrhea
      • Other: urinary frequency, weakness, hyperkalemia
    • Spironolactone (Aldactone):
      • Gynecomastia
      • Amenorrhea
      • Irregular menses
      • Postmenopausal bleeding

Thiazide and Thiazide-Like Diuretics

  • Examples:
    • Thiazide diuretics: hydrochlorothiazide (Esidrix, HydroDIURIL), chlorothiazide (Diuril)
    • Thiazide-like diuretics: metolazone (Mykrox, Zaroxolyn), chlorthalidone (Hydone, Thalitone), indapamide (Lozol)
  • Mechanism of action:
    • Inhibit tubular resorption of sodium, chloride, and potassium ions
    • Action primarily in the distal convoluted tubule
    • Result: water, sodium, and chloride are excreted, and potassium is also excreted to a lesser extent
  • Drug effects:
    • Lowered peripheral vascular resistance
    • Depletion of sodium and water (and potassium)
    • Thiazides should not be used if creatinine clearance is less than 30 to 50 mL/min (normal is 125 mL/min)
    • Metolazone remains effective to a creatinine clearance of 10 mL/min
  • Indications:
    • Hypertension (one of the most prescribed group of drugs for this)
    • Edematous states
    • Idiopathic hypercalciuria
    • Diabetes insipidus
    • Adjunct drugs in management of heart failure and hepatic cirrhosis
  • Adverse effects:
    • Body system:
      • CNS: dizziness, headache, blurred vision
      • GI: anorexia, nausea, vomiting, diarrhea
      • Genitourinary: impotence
      • Hematologic: jaundice, leukopenia
      • Integumentary: dizziness, headache, blurred vision
      • Metabolic: hypokalemia, hyperglycemia, hyperuricemia, hypochloremic alkalosis

Nursing Implications

  • Perform a thorough patient history and physical examination
  • Assess baseline fluid volume status, intake and output, serum electrolyte values, weight, and vital signs (especially postural blood pressure)
  • Assess for disorders that may contraindicate or necessitate cautious use of these drugs

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Diuretics- Chapter 28.pptx

Description

This quiz tests your knowledge of diuretics, including thiazide, loop diuretics, and nonsteroidal antiinflammatory drugs, as well as their uses and indications.

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