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32 Cards in this Set

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high-ceiling loop diuretics
proto: furosemide
others: ethacrynic acid (Edecrin)
bumetanide (Bumex)
torsemide (Demadex)
high-ceiling loop diuretics MOA
work in the ascending loop of Henle
blocks reabsorption of sodium and chloride and to prevent reabsorption of water
causes extensive diuresis even with severe renal impairment
high-ceiling loop diuretics uses
used when there is an emergent need for rapid mobilizations of fluid
pulmonary edema caused by heart failure
conditions not responsive to other diuretics, such as edema caused by liver, cardiac, or kidney disease, or hypertension
used to treat hypercalcemia related to kidney stone formation
high-ceiling loop diuretic adverse
dehydration, hypernatremia, hypochloremia
hypotension
ototoxicity
hypokalemia
hyperglycemia, hyperuricemia, decrease in calcium and magnesium levels
high-ceiling loop diuretic contraindications
pregnancy
diabetes or gout
high-ceiling loop diuretics interactions
digoxin (Lanoxin) toxicity can occur in the presence of hypokalemia
concurrent use of antihypertensives can have additive hypotensive effect
lithium carbonate serum levels can increase which may lead to toxicity if hyponatremia occurs due to the loop diuretic
NSAIDS increase blood flow to kidney which reduces diuretic effect
high-ceiling loop diuretic considerations
avoid adminstering late in the day to prevent nocturia
normal dosing time is 0800 and 1400
administer furosemide orally, IV bolus dose, or continuous IV infusion
Infuse IV doses at 20mg/min or slower to avoid abrupt hypotension and hypovolemia
monitor potassium, eat foods high in potassium
monitor magnesium levels, blood glucose levels
high-ceiling loop diuretic effectiveness
decrease in pulmonary or peripheral edema
weight loss
decrease in BP
increase in urine output
thiazide diuretics
Proto: hydrochlorothiazide
others: chlorothiazide (Diuril)
methyclothiazide (Enduron)
thiazide-type diuretics:
indapamide (Lozide, Lozil)
chlorthalidone (Hygroton)
metolazone (Zaroxolyn)
thiazide diuretic MOA
work in the early distal convuluted tubule
blocks reabsorption of sodium and chloride, and prevents the reabsorption of water at this site
promotes diuresis when renal function is not impaired
thiazide diuretic use
often medication of first choice for essential hypertension
edema of mild-to-moderate heart failure and liver and kidney disease
often used in combination with antihypertensive agents for blood pressure control
thiazide diuretic adverse
dehydration
hypokalemia (< 3.5 mEq/l)
hyperglycemia
thiazide diuretic contraindications
pregnancy, lactation, breastfeeding
thiazide diuretics interactions
same as loop-diuretic meds
cause no risk of hearing loss and can be combined with ototoxic drugs
thiazide diuretic considerations
monitor potassium levels
take meds first thing in the morning
if twice daily is prescribed- make sure to give last dose no later than 1400 to prevent nocturia
diet high in potassium and plenty of fluids
take with or after meals if GI upset occurs
alternate-day dosing can decrease electrolyte imbalances
thiazide diuretic effectiveness
decrease in BP
decrease in edema
Increase in urine output
potassium-sparing diuretics
sprionolactone (Aldactone)
other meds: triamterene (Dyrentium)
amiloride (Midamor)
potassium-sparing diuretics MOA
block the action of aldosterone which results in potassium retention and the secretion of sodium and water
potassium-sparing diuretics uses
combined with other loop diuretics for potassium sparing effects
administered for heart failure
therapeutic effects may take 12-8 hours
postassium-sparing diuretic adverse
hyperkalemia (>5.0 mEq/l)- discontinue meds restrict potassium, administer insulin injections to drive potassium back into the cell
should not be administered with spirolactone
caution with angiotensin-converting enzyme, angiotensin receptor blockers, and direct renin inhibtors because they may cause elevated potassium levels
Endocrine effects
potassium-sparing diuretics contraindications
hyperkalemia
severe kidney failure and anuria
potassium-sparing diuretics interactions
concurrent use of ACE inhibitors increases risk of hyperkalemia
concurrent use of potassium supplements increase the risk of hyperkalemia
potassium-sparing diuretic considerations
avoid salt substitutes that contain potassium
monitor BP and weight
triameterine may turn urine a bluish color
monitor potassium levels
potassium-sparing diuretic effectiveness
weight loss, maintenance of normal potassium levels, decrease in blood pressure and edema
osmotic diuretics
mannitol (Osmitrol)
osmotic diuretics MOA
reduce intracranial pressure and intraocular pressure by raising serum osmolarity and drawing fluid back into the vascular and extravascular space
osmotic diuretics uses
prevent kidney failure in specific situations such as hypovolemic shock and severe hypotension, because mannitol is not reabsorbed and remains in the nephron, drawing off water, thus preserving urine flow and preventing kidney failure
decreases intracranial pressure caused by cerebral edema by drawing off fluid form the brain into the bloodstream
decreases IOP
promote sodium retention and water excretion in clients who have hyponatremia and fluid volume excess
administered for the oliguria phase of acute kidney injury
osmotic diuretic adverse
heart failure, pulmonary edema, kidney failure, fluid and electrolyte imbalances
osmotic diuretic contraindications
heart failure
osmotic diuretic interactions
lithium excretion through the kidneys is increased (monitor lithium levels)
osmotic diuretic considerations
administer mannitol through continuous IV infusion
monitor for signs of dehydration, acute kidney injury, and edema
osmotic diuretic effectiveness
urine output of at least 30 mL/hour
serum creatinine between 0.6 to 1.2 mg/dL for men and 0.5-1.1 mg/dL for women
BUN levels between 10-20 mg/dL
decrease in intracranial pressure
decrease in intraocular pressure