Diuretics

Front 1

Drugs that increase renal excretion of water, sodium, and other electrolytes, thereby increasing urine formation and output.

Back 1

Diuretics

Front 2

What is the primary function of the kidneys?

Back 2

to regulate the volume, composition, and pH of body fluids

Front 3

Approximately how much does the kidneys receive of cardiac output?

Back 3

25%

Front 4

what is the functional unit of the kidney?

Back 4

Nephron

Front 5

Approximately how many nephrons does each kidney contain?

Back 5

1 million

Front 6

In which three processes does the nephron function?

Back 6

glomerular filtration
tubular reabsorption
tubular secretion

Front 7

approximately how much urine output is required minimally to remove normal amounts of metabolic end products

Back 7

400 mL

Front 8

the glomerular filtration rate (GFR) is about how many liters per day?

how many mL per minute?

Back 8

180 liters per day

125 mL per minute

Front 9

What is the end product for urine output daily?

Back 9

2 liters

Front 10

most reabsorption occurs in which tubule?

Back 10

proimal tubule

Front 11

almost all of what two products is reabsorbed?

Back 11

glucose and amino acids

Front 12

about what percent of water, sodium, potassium, chloride, and most other substances is reabsorbed?

Back 12

80%

Front 13

what percent of the glomerular filtrate enters the loop of Henle?

Back 13

20%

Front 14

In the descending limb of the loop of Henle, what is reabsorbed?

Back 14

water

Front 15

in the ascending limb of the loop of Henle, what is reabsorbed?

Back 15

sodium

Front 16

what fraction of the total amount of sodium filtered by the glomeruli is reabsorbed in the loop of Henle?

Back 16

up to 30%

Front 17

where else is sodium reabsorbed?

Back 17

in the distal tubule

Front 18

which hormone from the adrenal cortex promotes sodium-potassium exchange mainly in the distal tubule and collecting ducts?

Back 18

Aldosterone

Front 19

Where does secretion occur?

Back 19

in the proximal and distal tubules, across the epithelial cells that line the tubules

Front 20

What is secreted in the proximal tubule?

Back 20

uric acid, creatinine, hydrogen ions, and ammonia

Front 21

what is secreted in the distal tubules?

Back 21

potassium ions, hydrogen ions and ammonia are secreted.

Front 22

Why is the secretion of hydrogen ions so important?

Back 22

it is important in maintaining acid-base balance in body fluids

Front 23

excessive accumulation of fluid in body tissues

Back 23

edema

Front 24

how does edema effect blood flow

Back 24

it interferes with blood flow to tissues

Front 25

a common type of localized edema occurs in the feet and ankles, especially with prolonged sitting or standing

Back 25

dependent edema

Front 26

a life-threatening condition that occurs with circulatory overload (of IV fluids, blood transfusions) or acute heart failure.

Back 26

pulmonary edema

Front 27

generalized massive edema that interferes with the functions of many body organs and tissues

Back 27

anasarca

Front 28

how do diuretics act on the kidneys?

Back 28

to decrease reabsorption of sodium, chloride, water, and other substances

Front 29

what are the major subclasses of diuretic drugs?

Back 29

thiazides and related diuretics
loop diuretics
potassium-sparing diuretics

Front 30

what are the clinical indications for diuretics?

Back 30

edema, heart failure, and hypertension

Front 31

these diuretics are synthetic drugs that are chemically related to the sulfonamides and differ mainly in their duration of action

Back 31

thiazide diuretics

Front 32

is the most commonly used thiazide diuretic?

Back 32

Hydrochlorothiazide

Front 33

What is the only thiazide diuretic that can be given IV?

Back 33

Chlorothiazide

Front 34

what are thiazides and related diuretics most frequently prescribed for?

Back 34

long-term management of heart failure and hypertension

Front 35

Where in the Nephron do thiazides act to decrease reabsorption of sodium, water, chloride, and bicarbonate?

Back 35

in the distal convoluted tubule

Front 36

where is most sodium reabsorbed?

Back 36

before reaching the distal convoluted tubule

Front 37

Are thiazides considered a strong, or weak diuretic drug?

Back 37

weak

Front 38

Do thiazides have a slow or rapid onset?

Back 38

slow

Front 39

a dose of diuretic that yields a near-maximum diuretic response is called......

Back 39

ceiling dose, or threshold

Front 40

thiazide diuretics only work when WHAT is adequate?

Back 40

urine flow

Front 41

where do thiazide diuretics accumulate?

Back 41

ONLY in the kidneys

Front 42

what is the onset of thiazide diuretics?

Back 42

within 2 hours

Front 43

what is the peak of thiazide diuretics?

Back 43

at 4-6 hours

Front 44

how long do thiazide diuretic effects usually last?

Back 44

6-24 hours

Front 45

which two patients should thiazide and related diuretics be used cautiously in?

Back 45

patients allergic to sulfonamide drugs, and pregnant patients

Front 46

these diuretics inhibit sodium and chloride reabsorption in the ascending limb of the loop of Henle (where reabsorption of most filtered sodium occurs).

Back 46

loop diuretics

Front 47

loop diuretics produce significant diuresis, their sodium-losing effect being up to how many times greater than that of thiazide diuretics?

Back 47

10 times greater

Front 48

which diuretics are the most effective and versatile diuretics available for clinical use

Back 48

loop diuretics

Front 49

oral administration of loop diuretics will produce effects in how many minutes? and when do they peak? How long do they last?

Back 49

30-60 minutes,
and they peak in 1-2 hours
they last 6-8 hours

Front 50

IV administration of loop diuretics will produce effects in how many minutes? and when do they peak? how long do they last?

Back 50

within 5 minutes
peak within 30 minutes
lasts about 2 hours

Front 51

what happens in the post-diuretic phase?

Back 51

kidney tubules regain their ability to reabsorb sodium, and actually reabsorb more sodium than usual.

Front 52

what kind of dietary restriction is required for patients receiving loop diuretics in order to achieve optimum therapeutic benefits?

Back 52

sodium restricted diet

Front 53

where are loop diuretic drugs metabolized and excreted? where do they accumulate?

Back 53

they are metabolized and excreted in the kidneys. No accumulation occurs, not even with repeated doses.

Front 54

what diuretics are the best choice for a patient need rapid effects, such as patient with pulmonary edema OR when renal function is impaired?

Back 54

loop diuretics

Front 55

what is the most commonly used loop diuretic?

Back 55

Furosemide

Front 56

which loop diuretic is used for patients that are allergic to or no longer responds to furosemide?

Back 56

Bumetanide

Front 57

these diuretics act at the distal tubule to decrease sodium reabsorption and potassium excretion

Back 57

Potassium-sparing diuretics

Front 58

what are the three drugs included in the Potassium-sparing diuretics?

Back 58

spironolactone
amiloride
triamterene

Front 59

These diuretics are weak when used alone

Back 59

potassium-sparing diuretics

Front 60

potassium-sparing diuretics are usually given in combination with what other type of diuretic?

Back 60

potassium-losing diuretic

Front 61

Potassium-sparing diuretics are contraindicated for which patients?

Back 61

patients with renal insufficiency

Front 62

what is the major adverse effect of potassium-sparing diuretics?

Back 62

Hyperkalemia

Front 63

patients prescribed potassium-sparing diuretics should be educated specifically on what three dietary factors?

Back 63

should not take, or be given K+supplements. should not be encouraged to eat food high in K+, and should not use salt substitutes.

Front 64

Salt substitutes contain what?

Back 64

Potassium Chloride, NOT sodium chloride

Front 65

this diuretic produces rapid diuresis by increasing the solute load (osmotic pressure) of the glomerular filtrate.

Back 65

Osmotic diuretics

Front 66

This Osmotic diuretic drug is useful in managing oliguria or anuria, and it may prevent acute renal failure during prolonged surgery, trauma, or infusion of cisplatin, and atineoplastic agent.

Back 66

Mannitol

Front 67

what are other clinical uses for osmotic diuretics?

Back 67

reduction of intracranial pressure both before and after neurosurgery. Reduces intraocular pressure for certain types of opthalmic surgery, and urinary excretion of toxic substances

Front 68

what is the major purpose of the antihypertensive combination diuretics?

Back 68

to increase patient convenience and compliance with drug therapy regimens.

Front 69

what is the major purpose of the diuretic combination diuretics?

Back 69

to prevent potassium imbalances

Front 70

what baseline data would i want to include in my nursing assessment for a patient receiving diuretics?

Back 70

serum electrolytes, creatinine, glucose, blood urea nitrogen (BUN) and uric acid

Front 71

Digoxin is what kind of diuretic?

Back 71

potassium-losing diuretic

Front 72

what other data does the nurse want to have in her assessment?

Back 72

BP, weight, amount and appearance of urine output, and measurement of edematous areas such as ankles or abdomen.

Front 73

With a HF patient, congestion in the GI tract may cause which signs and symptoms?

Back 73

nausea and vomiting

Front 74

with a HF patient, liver congestion may cause which signs and symptoms?

Back 74

abdominal pain and tenderness

Front 75

with a HF patient, congestion in the lungs (pulmonary edema) may cause which signs and symptoms?

Back 75

rapid, labored breathing, hypoxemia, frothy sputum and other manifestations of severe respiratory distress

Front 76

Cerebral edema may be manifested by which signs and symptoms?

Back 76

confusion, headache, dizziness, convulsions, unconsciousness, bradycardia, or failure of the pupils to react to light

Front 77

Ascites, which occurs with hepatic cirrhosis, is an accumulation of fluid in the abdominal cavity. What sign can be seen with this patient?

Back 77

abdomen appears much enlarged

Front 78

these diuretics are sometimes given concurrently when an inadequate diuretic response occurs with one of the drugs.

Back 78

potassium-losing diuretics
ex: thiazide and loop diuretics given together

Front 79

for the patient with liver disease, what kind of dose are all diuretics given?

Back 79

small doses because diuretic-induced electrolyte imbalances may precipitate or aggravate hepatic coma

Front 80

for the patient with renal disease, what kind of dose for diuretics is given?

Back 80

large doses to achieve a diuretic response

Front 81

when diuretics are used to manage patients with edema, what should be addressed?

Back 81

the underlying cause of the edema!

Front 82

for HF patients receiving Digoxin and diuretics, what is the patient at an increased risk for?

Back 82

Digoxin toxicity; related to diuretic-induced hypokalemia

Front 83

Potassium is a ______ ________ and _________; it has essentially opposite cardiac effects to those of digoxin

Back 83

myocardial depressant and antidysrhythmic

Front 84

extracellular potassium does what to myocardial tissue?

Back 84

decreases excitability

Front 85

Digoxin does what to myocardial tissue?

Back 85

increases excitability

Front 86

high serum potassium does what to effects of given digoxin?

Back 86

it reduces the effects of a given dose of digoxin

Front 87

low serum potassium does what to effects of given digoxin?

Back 87

increases the likelihood of digoxin-induced cardiac dysrhythmias

Front 88

what measures are taken to prevent hypokalemia to maintain normal serum potassium levels with patients receiving both digoxin and diuretics?

Back 88

supplemental potassium chloride
a potassium-sparing diuretic
increasing food intake of potassium
restricting dietary sodium intake

Front 89

what measures are taken to prevent hyperkalemia to maintain normal serum potassium levels with patients taking potassium-sparing diuretics?

Back 89

avoid using K+-sparing diuretics with K+supplements in renal impaired pts.
avoid excess amts of K+ chloride suppl
avoid salt substitutes
maintain urine output

Front 90

when are diuretics used in children?

Back 90

to manage HF resulting from congenital heart disease, hypertension related to cardiac or renal dysfunction; bronchopulmonary dysplasia and respiratory distress syndrome

Front 91

what are adverse effects of furosemide in children?

Back 91

fluid and electrolyte imbalances (hyponatremia, hypokalemia, fluid volume deficit) and ototoxicity

Front 92

what is the most widely used potassium-sparing diuretic drug used in children?

Back 92

spironolactone

Front 93

Hyperkalemia is most likely to occur in which age group of patients receiving potassium-sparing diuretics?

Back 93

older adults because of the renal impairment that occurs with aging

Front 94

potassium-sparing diuretics are contraindicated in which patients?

Back 94

renal impaired because of the high risk of hyperkalemia

Front 95

with the hepatic impaired patient, why are diuretics used?

Back 95

to manage edema and ascites

Front 96

for patients with severe renal impairment why are large doses of loop diuretics given? what are the risks with giving large doses?

Back 96

high doses are required to produce diuresis. However, large doses may produce fluid volume depletion and worsen renal function.

Front 97

high-dose furosemide continuous IV infusions should be given at what rate to decrease or avoid risks of adverse effects, including ototoxicity

Back 97

4mg/min or less

Front 98

for patients with diabetes, how do diuretics effect blood sugar, and what kind of dose of antidiabetic meds should be given?

Back 98

some commonly used diuretics may increase blood sugar levels and cause or aggravate diabetes. DM patients may need larger doses of your antidiabetic medications

Front 99

diuretics may cause what type of sensitivity to the skin?

Back 99

sensitivity to sunlight

Front 100

what time of the day should a patient take their prescribe diuretic?

Back 100

in the morning, to decrease nighttime trips to the bathroom, and with or after food to decrease stomach upset.