Nursing Pharmacology 1 First Semester (2024) PDF

Nursing Pharmacology 1 First Semester (2024) aezyyy ○ Diuretics will decrease the Renal Pharmacology blood volume and serum...

Nursing Pharmacology 1 First Semester (2024) aezyyy ○ Diuretics will decrease the Renal Pharmacology blood volume and serum sodium Treatment of Glaucoma ○ Diuretics will provide osmotic pull to remove some of the fluid from the eye to decrease the IOP Time of Administration of the Diuretics Usually in the morning Diuretics Comparison Diuretic Class Major Site of Special Side Action Effect(s) Diuretics Carbonic Proximal Acidosis anhydrase tubule Agents that increase the amount of inhibitor urine produced by the kidneys Thiazide and Proximal Hyperuricemia thiazide-like tubule Hypokalemia Classes of Diuretics Loop diuretics Loop of Henle Hypokalemia Five Major Classes Ototoxicity ○ Thiazides and Thiazide-like ○ Loop diuretics Potassium Distal tubule Hyperkalemia sparing ○ Potassium-sparing ○ Carbonic anhydrase Osmotic Glomerulus Hypovolemia & inhibitors diuretic hypotension ○ Osmotic diuretics General Indications for the Use of the Diuretics Diuretic Class Special Uses Treatment of Edema ○ Urine output will increase Carbonic anhydrase Mountain sickness and excess fluid is flushed inhibitor Meniere’s disease out of the body Thiazide and Nephrolithiasis due to Treatment of CHF thiazide-like calcium stones ○ The sodium loss in the Hypocalcemia kidney is associated with water loss Loop diuretics Hypercalcemia Treatment of Hypertension Nursing Pharmacology 1 First Semester (2024) aezyyy Loop Diuretics Potassium sparing CHF taking digoxin Prototype: Furosemide Osmotic diuretic Increased ICP ○ Bumetanide Lithium toxicity ○ Ethacrynic acid ○ Torsemide Pharmacodynamics Thiazides ○ High-ceiling diuretics ○ Block the chloride pump in Prototype: Hydrochlorothiazide the ascending loop of Henle ○ Bendroflumethiazide ○ Sodium and chloride ○ Benzthiazide reabsorption is prevented ○ Chlorothiazide (Diuril) ○ Potassium is also excreted ○ Hydroflumethiazide together with Na and Cl ○ Methyclothiazide ○ Trichlormethiazide Pharmacodynamics ○ These drugs block the chloride pump ○ This will keep the chloride and sodium in the distal tubule to be excreted into the urine ○ Potassium is also flushed out Special Pharmacodynamics: Side Effects Special Pharmacodynamics: Side ○ Hypokalemia Effects ○ Decreased calcium excretion ○ Hypokalemia → hypercalcemia ○ Bicarbonate is lost in the ○ Decreased uric acid secretion urine → hyperuricemia ○ Increased calcium excretion ○ Hyperglycemia → hypocalcemia ○ Ototoxicity - due to the Thiazide-like electrolyte imbalances Indapamide Potassium Sparing Diuretics Quinethazone Metolazone Prototype: Spironolactone Chlorthalidone ○ Amiloride Nursing Pharmacology 1 First Semester (2024) aezyyy ○ Triamterene Pharmacodynamics Pharmacodynamics ○ Mannitol is a sugar not well ○ Spironolactone is an absorbed in the nephron → aldosterone antagonist osmotic pull of water → ○ Triamterene and Amiloride diuresis block the potassium secretion Pharmacokinetics: Side Effects in the distal tubule ○ Sudden hypovolemia ○ Diuretic effect is achieved by Important for the nurse to warm the the sodium loss to offset solution to allow the crystals to dissolve in potassium retention the bottle Carbonic Anhydrase Inhibitors Prototype: Acetazolamide ○ Methazolamide Pharmacodynamics ○ Carbonic Anhydrase forms sodium bicarbonate ○ Block of the enzyme results to slow movement of hydrogen and bicarbonate Pharmacokinetics: Side Effects into the tubules ○ Hyperkalemia ○ Plus sodium is lost in the ○ Avoid high potassium foods: urine Bananas Pharmacokinetics: Side Effects Potatoes ○ Metabolic acidosis happens Spinach when bicarbonate is lost Broccoli ○ Hypokalemia Nuts Prunes The Nursing Process and The Diuretics Tomatoes Oranges Assessment Peaches ○ Assess the reason why the drug is given Osmotic Diuretics ○ The nurse must elicit history of allergy to the drugs Prototype: Mannitol Allergy to ○ Glycerin sulfonamides may ○ Isosorbide contraindicate the use ○ Urea of thiazides Nursing Pharmacology 1 First Semester (2024) aezyyy ○ Assess fluid and electrolyte ○ Resolution of edema balance ○ Decreased congestion ○ Assess other conditions like ○ Normal BP gout, diabetes, pregnancy and lactation ○ Physical Assessment Vital signs Special electrolyte and laboratory examination ○ Assess symptom of body weakness which may indicate hypokalemia Nursing Diagnosis ○ Fluid volume deficit related to diuretic effect ○ Alteration in urinary pattern ○ Potential for injury (ototoxicity, hypotension) ○ Knowledge deficit Implementation ○ Administer IV drug slowly ○ Safety precaution for dizziness/hypotension ○ Provide potassium rich foods for most diuretics, with the exception of spironolactone ○ Provide skin care, oral care and urinary care ○ Monitor daily weight – to evaluate the effectiveness of the therapy ○ Monitor urine output, cardiac rhythm. Serum electrolytes ○ Administer in the morning ○ Administer with food Evaluation: For effectiveness of therapy ○ Weight loss ○ Increased urine output