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41 Cards in this Set

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What structures are in the kidney?
Nephron
Glomerulus
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
Collecting ducts
What are the functions of the kidneys?
Cleansing of extracellular fluid
Maintenance of acid base balance
Excretion of metabolic wastes
What are the processes of the kidneys?
Filtration
Reabsorption of solutes
Active tubular secretion
What occurs in the loop of Henle?
It is freely permeable to H2O
What happens in the proximal Convoluted Tubule & Distal Convoluted Tubule?
Na+ and Cl- is absorbed.
What happens in the Distal Convoluted Tubule and Collecting Duct?
Na+ is exchanged for K+. Final concentration of urine is determined here.
Why are diuretics used?
Used to reduce fluid volume in the body. Decreases fluid volume, which decreases workload and BP.
What are the pharmacotherapeutics of diuretics?
Hypertension
Heart Failure
Cirrhosis (bad liver)
Renal disease
Increased intracranial pressure
Increased intraocular pressure
What are the actions of diuretics?
Decrease reabsorption of sodium and water along the renal tubule of the nephron in the kidney

Degree of diuresis depends on part of the tubule affected by the drug
What are the effects of diuretics on ECF?
Hypovolemia
Acid Base Imbalance
Disturbance of Electrolytes
What are the classifications of Diuretics?
High ceiling (Loop) diuretics (work in Loop of Henle)
Thiazide diuretics
Osmotic diuretics
Potassium-sparing diuretics
Carbonic anhydrase inhibitors
How long do po diuretics usually work?
6-8 hours
What is the prototype of loop diuretics?
furosemide (Lasix)
What is the action of loop diuretics?
Works in the loop of Henle to promote the excretion of sodium, chloride, potassium, and water
What are the pharmacokinetics of loop diuretics?
po – diuresis begins w/in 60 minutes
IV - diuresis begins w/in 5 minutes
Hepatic metabolism
Renal excretion
What are the therapeutic uses of loop diuretics?
Used to treat edema from heart failure, pulmonary edema, and hepatic and renal disease
Used to treat hypertension, especially if preexisting renal disease is present
What are the Adverse Effects of loop diuretics?
Dehydration
Hypotension
Hypokalemia, Hyponatremia, Hypochloremia
**Ototoxicity - usu. reversable
What are the Nursing Responsibilities when patients are on loop diuretics?
Monitor BP
Monitor for postural hypotension
Intake and output
Serum electrolytes - K+ is lost (may need K supplements & watch heart)
Daily weights
What drugs cause interactions?
Digoxin
Ototoxic drugs
Antihypertensive Agents
Nonsteroidal Anti-inflammatory Drugs
What are other Loop diuretics?
Bumetanide (Bumex)
Ethacrynic acid (Edecrin)
What is the prototype for Thiazide Diuretics?
hydrochlorothiazide (HCTZ)
What is the action of thiazide diuretics?
Weak diuretic that acts in the distal tubule.
Increases the excretion of sodium, chloride, potassium, and water.
Dependent on (glomerular infiltration) adequate kidney function.
What is the pharmacotherapeutics of Thiazide Diuretics?
po diuresis begins approx 2 hours after administration
peaks w/in 4-6 hours
lasts up to 12 hours,
What type of patient cannot use Thiazide Diuretics?
Will not work on renaly impaired patients.
What are the Therapeutic Uses for Thiazide Diuretics?
Hypertension
Edema associated with mild to moderate heart failure
Edema associated with hepatic and renal disease
What are the Adverse Effects of Thiazide Diuretics?
Dehydration
Hypotension
Hypokalemia, Hyponatremia, Hypochloremia
Hyperglycemia
Increased uric acid levels - retention of uric acid, painful for patients w/ gout
What Nursing Responsibilities do you have to do with patients on Thiazides Diuretics?
Monitor:
BP
Pulse
I & O
Weight
Serum electrolytes and serum glucose
dehydration (check skin turgur, lips, under eyes, pulse (thready))
Any postural changes in BP
What is the prototype of Potassium Sparing Diuretics?
Spironolactone (Aldactone)
What is the action of Potassium Sparing Diuretics?
Retention of potassium and increased excretion of sodium
Weak diuretic
What are the Therapeutic Uses of Potassium Sparing Diuretics?
HTN and edema
Commonly used in combination with a thiazide or a loop
What are the Adverse Effects of Potassium Sparing Diuretics?
Hyperkalemia
Hypovolemia
BP
BUN & Cretine
I/O
What are the Drug Interactions with Potassium Sparing Diuretics?
Thiazide and loop diuretics
Endocrine effects
Ace Inhibitors (monitor K+)
What is another Potassium Sparing Diuretics?
Triamterene (Dyrenium)
What are the actions of Triamterene (Dyrenium)?
Weakest diuretic effects
Works in the distal tubule to promote sodium and water excretion
Promotes reabsorption of potassium
Works well in combination with other diuretics
Common combination agent:
Triamterene & HCTZ (dyazide)
What is the prototype of Osmotic Diuretics?
Mannitol
What are the actions of Osmotic Diuretics?
Creates an osmotic force within the lumen of the nephron
Minimal reabsorption after filtration
Degree of diuresis is directly related to concentration of mannitol
What are the Therapeutic Uses of Osmotic Diuretics?
Increased ICP
Increased IOP
What are the adverse effects of Osmotic Diuretics
(Mannitol)?
Edema

Use cautiously in patients with CHF (make sure fluid does not build up in lungs)

fluid and electrolyte imbalances

Tends to "leak" but not in brain

If cristalized do not use

Headache, nausea, vomiting
What is the prototype of Carbonic Anhydrase Inhibitors?
acetazolamide (Diamox)
What are the actions of Carbonic Anhydrase Inhibitors?
Inhibits hydrogen ion secretion in the tubule and increases the loss of sodium, potassium, bicarbonate, and water
Also prevents formation of aqueous humor and decreases intraocular pressure
Used primarily in treating chronic, open-angle glaucoma
What precautions should you take with diuretics?
Avoid during pregnancy.
Can become toxic with Lithium.
Weight before and after to monitor edema.
Always take a base line assessment.