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65 Cards in this Set
- Front
- Back
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Indications for Diuretics
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CHF
HTN Hepatic Ascites Pulmonary Edema Increased intracranial pressure Renal Disease Premenstrual edema Edema in pregnancy |
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Mode of Action for Diuretics
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Prevent reabsorption of sodium and water; increase urine and sodium excretion
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Hydrochlorothiazide (HydroDiuril)
Class & Action |
Thiazide
Increases urinary excretion of Na and water at early distal tubule |
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Hydrochlorothiazide (HydroDiuril)
Administration consideration |
Give with meals to decrease GI irritation
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Hydrochlorothiazide (HydroDiuril)
Side Effects (Hyper-) |
hypercalcemia
hyperuricemia->gout hyperglycemia hyperlipidemia |
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Hydrochlorothiazide (HydroDiuril)
Side Effects (Hypo-) |
hyponatremia
hypovolemia hypokalemia->heart rhythms hypomagnesium |
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Furosemide (Lasix)
Class & Action |
Loop Diuretic
inhibits reabsorption of Na & Cl in proximal and distal tubules but mainly in the Loop |
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Furosemide (Lasix)
Administration |
IV to promote rapid diuresis
Slowly to prevent ototoxicty Usually given with K+ supplement b/c it has a greater effect than HCTZ |
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Furosemide (Lasix)
Side effects (hyper-) |
hyperglycemia
hyperuricemia |
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Furosemide (Lasix)
Side Effects (hypo-) |
hyponatremia
hypovolemia hypokalemia hypomagnesemia ototoxicity |
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Triamterene (Dyrenium)
Class & Action |
Potassium-sparing diuretic
counteracts potassium loss induced by other diuretics |
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Triamterene (Dyrenium)
Administration |
Can be given with thiazides or loop diuretics
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Triamterene (Dyrenium)
Side Effects |
Hyponatremia
Hypovolemia Hyperkalemia (b/c of increased concentration from sparing) n/v, anorexia, dry mouth, h/a |
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Triamterine (Dyrenium)
Patient Education |
Avoid Potassium-rich food or supplements
Avoid salt substitute containing potassium chloride |
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Mannitol (Osmitrol)
Class & Action |
Osmotic diuretics
Causes diuresis by increasing the osmolarity of glomerular filtrate; inhibits the reabsorption of water |
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Mannitol (Osmitrol)
Indications |
Acute renal failure
reduction of increased intraocular pressure (glaucoma) |
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Mannitol (Osmitrol)
Storing consideration |
It is a form of concentrated sugar
May crystalize because of a temperature drop; still may use, just warm up to dissolve crystals |
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Mannitol (Osmitrol)
Side Effects (hyper-) same as Thiazides |
hypercalcemia
hyperuricemia->gout hyperglycemia hyperlipidemia |
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Mannitol (Osmitrol)
Side Effects (hypo-) same as Thiazides |
hyponatremia
hypovolemia hypokalemia hypomagnesium |
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When should you discontinue use of Mannitol (Osmitrol)?
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If urine output doesn't increase after 2 test doses
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Acetazolamide (Diamox)
Class & Action |
Carbonic Anhydrase Inhibitors
Inhibits carbonic anhydrase (abundant in kidneys); inhibits bicarbonate reabsorption which alkalinizes the urine & acidifies the blood (acidosis) Increases loss of Na, K, Bicarb, H20 |
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Acetazolamide (Diamox)
Indications |
glaucoma-decreases aqueous humor production
hydrocephalus seizures (petit mal) treat overdose of acidic-based drugs (ASA or phenobarbital) |
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Acetazolamide (Diamox)
Side Effects |
So gentle, no real side effects
Used to boost other medications (not primarily used as diuretic) |
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Acetazolamide (Diamox)
Administration |
Give every other day or every 2 days, with the next day off
-gives time for kidneys to recover |
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Nursing Implications for Diuretics
(Teaching) |
fluid restriction or awareness
daily weights (consistent time/clothes/scale) |
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Nursing Implications for Diuretics
(Actions) |
I/O & daily weight
orthostatic hypotension monitor bp & electrolytes mucous membrane, skin turgor (hydration) peds: presence/absence of tears |
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Catopril (Capoten)
Class & Action |
ACE inhibitors
Inhibit or block conversion of angiotensin I to angiotensin II by inhibiting ACE |
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Catopril (Capoten)
Indications |
Treat mild to moderate HTN
Vasodilation to treat moderate to severe CHF |
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Catopril (Capoten)
CI/Side Effects |
Impaired renal function
Hyperkalemia "first dose effect"-rapid fall of bp=syncope |
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What class of drugs helps to enhance the response of ACE inhibitors?
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Diuretics-blunts the hypokalemic response of diuretics
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What side effects shows a lack of tolerance with ACE inhibitors?
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dry cough at night
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Losartan (Cozaar)
Class |
Angiotensin II Receptor Antagonists (ARBs)
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Losartan (Cozaar)
Action |
block receptor sites of angiotensin II
prevents vasoconstriction & fluid retention |
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Losartan (Cozaar)
Indications |
Treats HTN and kidney damage in patients with type II diabetes
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Losartan
AE |
upper resp. infections
dizziness diarrhea |
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What is a major benefit of ARBs over ACE inhibitors?
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No dry chronic cough
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What is a drawback to ARBs?
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More expensive: newest class of antihypertensives, so no generic version yet
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Losartan (Cozaar)
Nursing Implications |
Watch kidney function & K+
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Propanolol (Inderal)
Class |
Beta Adrenergic Blockers
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Propanolol (Inderal)
Action for Treating HTN |
1. Decrease peripheral resistance (decreasing venous return to heart)
2. Plasma renin activity is reduced 3. Possibly resets sensitivity of central baroreceptors to a lower level (body can accept lower bp as standard) 4. Decrease CO |
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Propanolol (Inderal)
CI |
1. cardiac failure (lessens the effect of necessary compensatory mechanisms); failure would worsen
2. Bradycardia & A-V conduction disturbance (b/c bronchoconstriction) 3. Asthma & COPD 4. Hypoglycemia (signs may be masked) |
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What is the appropriate way to discontinue Beta Blockers such as Propanolol?
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Taper because of rebound HTN
Do not stop abruptly! |
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What can be determined if client fails to respond to Beta Blockers for HTN?
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They will not benefit from any in Adrenergic Agonists
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Clonidine (Catapres)
Class & Action |
Alpha Adrenergic Agonists
Works in CNS to lower bp Decreases sympathetic outflow from brain to CV system |
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How is Clonidine (Catapres) administered?
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patch
-hairless area -every 7 days |
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Nursing Measures with All Adrenergic Agonists:
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orthostatic hypotension-move slowly
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Nursing Measures with Clonidine (Catapres):
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drowsy: don't operate machinery or drive
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Nursing Measures with Beta Blockers:
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speech is not as fast
more tolerable over time |
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Hydralazine (Apresoline)
Class & Action |
Direct Acting Vasodilators
(outpatient) Relaxes arterioles Decreasing peripheral resistance/lower BP |
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Hydralazine
AE |
Palpitations
Tachycardia Angina Anorexia N/V |
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Hydralazine
Administration |
Usually given with 2 beta blockers and diuretics b/c of AE tachycardia
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Hydralazine
SLE |
systemic lupus erythematosis is most severe AE
Report signs of SLE: tiredness, fever, aching joints & muscles |
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Direct Acting Vasodilators
Action |
1. Directly dilate arterioles w/out affecting SNS or smooth muscle cells
2. Results in peripheral vasodilation and decreased bp |
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Direct Acting Vasodilators
Nursing Measures |
Orthostasis
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Nitroprusside (Nipride)
Class |
Direct Acting Vasodilators
(inpatient-ICU) |
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Nitroprusside (Nipride)
Administration |
IV with pump because of emergency settings
Used for HTN crisis |
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What storage precautions are necessary for Nitroprusside (Nipride)?
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Because it's sensitive to light, keep in foil pouch or no prolonged light exposure for drug
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Nitroglycerine
Class |
Organic Nitrate Vasodilator
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Nitroglycerine
Action |
Directly relaxes vascular smooth muscle (vasodilation)
Decreases oxygen demand on heart by decreasing preload Decreases bp->reflex tachycardia |
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Nitroglycerine
Administration Routes |
Sublingual
Patch IV Pace Spray |
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Nitroglycerine
Administration Dose |
3 doses 5 min. apart in outpatient
If symptoms persist->ER! |
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Nitroglycerine
Side Effects |
Headache from dilation
Hypotension Reflex Tachycardia Burning/tingling in mouth Dermatitis from ointment |
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Nitroglycerine
Nursing Implications |
Date/time on patch
One patch at a time Dispose of old patches Wear gloves Keep pt lying down to prevent orthostatic hypotension & during attacks |
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What is the nitrate-free interval?
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A period during the day with no drug, so patient doesn't develop a tolerance (10-12 hrs q 24 hrs)
Take off at bedtime (safest b/c less activity) |
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Nitroglycerine
Patient Education |
Keep tablets in cool, dark place
Take tablets with you Tablets should fizz under tongue Expiration date |
