Diuretics

Front 1

Identify the three ions that are primarily involved in renal transport.

Back 1

Na+, -K+, Cl-

Front 2

What steroid is responsible for making final adjustment in the collecting duct in order to
assure the correct amount of sodium is excreted?

Back 2

aldosterone

Front 3

What hormone regulates the removal of water during the concentration process in the
collecting duct?

Back 3

ADH

Front 4

What are the brand names for: (p. 744)
• Furosemide
• Bumetanide

Back 4

Lasix; Bumex

Front 5

Why are furosemide and bumetanide called loop diuretics?

Back 5

Action is in the loop of Henle.

Front 6

What ion stays in tubular fluid causing more to be excreted along with an osmotic equivalent
of water?

Back 6

sodium chloride

Front 7

What happens when the higher than normal amount of sodium reaches the distal tubule and
collecting duct?

Back 7

Promotes the exchange of sodium for potassium and hydrogen ions, increasing the urinary excretion of both ions.

Front 8

What other electrolyte is also excreted in larger amounts in response to loop diuretics?

Back 8

calcium

Front 9

Which loop diuretic is the most potent? How much more potent is bumetanide than
furosemide?

Back 9

bumetanide; 40 times stronger

Front 10

What class of diuretics are most effective in treating edema? What class of diuretics is a
better choice for treating hypertension?

Back 10

loop diuretics; thiazides

Front 11

How soon should the nurse expect urine output to increase following oral administration of a
loop diuretic? Past an IV dose? What is the term for this drug response?

Back 11

within 1 hour; 5-10 minutes; diuresis

Front 12

While some loop diuretics may be given intramuscularly, what is the preferred parenteral
route?

Back 12

IV route

Front 13

Identify seven possible signs of electrolyte depletion.

Back 13

weakness, lethargy, dizziness, leg cramps, anorexia, vomiting, mental confusion

Front 14

Identify three types of gastrointestinal disturbances common with loop diuretics.

Back 14

diarrhea,loss of appetite, stomach pain, cramping

Front 15

What is a common reaction to the large fluid loss and accompanying reduction of blood
volume caused by these potent loop diuretics? What serious danger should nursing actions
be aimed to prevent?

Back 15

orthostatic hypotension

Front 16

Due to the potential for excessive potassium loss, what do many health care practitioners
prescribe for patients receiving loop diuretics for prolonged periods?

Back 16

potassium supplements

Front 17

Besides bananas, list at least ten fruits that are high in potassium.

Back 17

study guide

Front 18

List four juices that are high in potassium.

Back 18

study guide

Front 19

List five green vegetables that are high in potassium.

Back 19

study guide

Front 20

List six types of beans that are high in potassium.

Back 20

study guide

Front 21

How common is calcium loss in patients taking loop diuretics?

Back 21

not common

Front 22

Which of the fives senses may be damaged due to toxicity related to high doses of loop
diuretics? What is this toxicity called?

Back 22

hearing; ototoxic

Front 23

Name one class of drugs that is particularly dangerous for patients on loop diuretics with
potassium depletion. Name one common drug (generic and brand name) in this drug class.

Back 23

cardiac glycosides; digoxin (Lanoxicaps, Lanoxin)

Front 24

Name one group of patients being treated for a mental illness that should not take loop diuretics.

Back 24

patients undergoing lithium treatment

Front 25

Name one class of antibiotics that should be avoided with patients taking loop diuretics.
Why? Name one common drug (generic and brand name) in this drug class.

Back 25

aminoglycoside antibiotics; they are ototoxic and the combination should be avoided because permanent deafness may result

Front 26

What may be the effect if a patient taking the anticoagulant warfarin (Coumadin) is started on
loop diuretics?

Back 26

loop diuretics may replace warfarin from their binding sites on plasma proteins. this action increases the concentration of the free, active form of the displaced drug. Higher concentrations of unbound warfarin produce increased anticoagulant effects and may produce toxicity.

Front 27

What are the generic names for: (p. 749)
• Diuril
• HydroDIURIL

Back 27

chlorthiazide; hydrochlorothiazide

Front 28

Where is the primary site of action for thiazide diuretics? What risk is significantly lower with
thiazide diuretics due to the site of action?

Back 28

distal tubule; risk of dangerous depletion of extracellular fluid volume

Front 29

In addition to controlling edema associated with heart or renal disease, for what other use are thiazide diuretics prescribed?

Back 29

treatment of hypertension

Front 30

What may long term use of thazides (as well as other diuretics) cause? What signs may be present? What electrolyte losses are most likely to occur? What may be required?

Back 30

fluid and electrolyte imbalance; thirst, weakness, lethargy, restlessness, muscle cramps and fatigue;K+ and Cl-; potassium supplements

Front 31

What may occur as a result of the inhibition of uric acid secretion? (p. 749) What is this?

Back 31

increase blood level of urate; gout

Front 32

What effect do thazides have on the gastrointestinal system?

Back 32

irritates the GI tract and may cause adverse effects ranging from simple nausea and vomiting to constipation, jaundice, and pancreatitis

Front 33

How may thiazides affect patients with diabetes?

Back 33

alters the requirements for insulin or other hypoglycemic drugs

Front 34

What is the generic name for Aldactone?

Back 34

spironolactone

Front 35

How are potassium-sparing diuretics often used?

Back 35

used in combination with loop or thiazide diuretics to counteract the tendency of those drugs to enhance urinary potassium losses

Front 36

Where is the site of action of spironolactone? The action of what hormone is altered by
spironolactone? How does this effect sodium and potassium? (p. 751) When is the onset of
spironolactone? (p. 746, table 46-2) When is the peak therapeutic effect of spironolactone?

Back 36

distal tubule; aldosterone; reduces sodium reabsorption and urinary losses of potassium; 8 hr.

Front 37

What patients are especially at risk for dangerous increases in serum potassium due to
potassium retention caused by spironolactone?

Back 37

patients with impaired renal function or high potassium intake

Front 38

What may happen if potassium-sparing diuretics are taken with (p. 752)
• Other antihypertensives
• Anticoagulants
• Lithium
• Digoxin

Back 38

Requires reduction of antihypertensives because potassium sparing diuretics may have additive antihypertensive effects.
Increases potency of anticoagulants which may result in excessive anticoagulation and the risk of bleeding.
May promote lithium retention.
Increases half-life of digoxin, leading to accumulation of digoxin.

Front 39

When administering a diuretic intravenously, what technique may decrease the risk of adverse effects?

Back 39

a slow administration rate

Front 40

What vital sign would be measured regularly during diuretic therapy? Describe the proper
method of measuring.

Back 40

Monitor the patient's BP regularly while he/she is standing, sitting, or lying down. Compare the measurements from each arm.

Front 41

In the acute care setting, how frequently should the patient on diuretic therapy be weighed?
At what time of day should it be scheduled?

Back 41

Daily; at the same time everyday (usually in the morning, after the patient has voided or the catheter bag emptied, but before breakfast)

Front 42

What may be the first sign that a patient is experiencing excessive diuresis?

Back 42

changes in BP or vital signs

Front 43

List eleven signs of possible dehydration.

Back 43

thirst, decrease in skin turgor, nausea, light headedness, weakness, increase in pulse rate, oliguria, decrease in BP, elevated hemoglobin, elevated hematocrit, elevated BUN levels

Front 44

What serious complication may dehydration lead to?

Back 44

thromembolic disorders

Front 45

Identify two different methods to monitor fluid retention.

Back 45

measure the patient's abdominal girth or the circumference of one or both legs, check dependent areas daily for the presence of or changes in the amount of edema

Front 46

If a diuretic is taken twice a day, what is the latest recommended time for the evening dose
so diuresis does not interfere with sleep?

Back 46

before 6 pm

Front 47

How may gastric irritation be avoided when taking oral diuretics?

Back 47

take with food

Front 48

Identify at least two important dietary precautions that should be included in patient teaching
for patients taking diuretics.

Back 48

not to use salt subs. without first consulting with the health care provider, identify and avoid foods high in sodium content