Pharm T4 Ch28

Front 1

In ____ there is a decrease in the kidneys ability to function, there fore_____.

Back 1

renal failure

drugs can accumulate to high levels

Front 2

With renal failure

Back 2

medication drugs need to be adjusted

Front 3

administering the average dose in person with____ can be ____

Back 3

Renal failure

fatal

Front 4

urinalysis examines the ___ and ___

Back 4

pH

protein

Front 5

pH levels

Back 5

4.0-8.0 (average 6)

Front 6

protein levels

Back 6

0 - trace
24 hr protein( quantitative)

150 mg/day

Front 7

persistent proteinuria

Back 7

characteristic of acute and chronic kidney

disease

Front 8

Measure for detecting kidney disease

best indicator of renal failure

Back 8

Serum creatinine

Front 9

serum creatinine levels

Back 9

0.6-1.5 mg/dL

Front 10

best marker for estimating renal funtion

Back 10

Glomerular Filtration Rate (GRF)

(70-135 ml/min/1.73 m)

Front 11

a decline in ____ indicates a decline in the number of functioning ____.

Back 11

nephrons

Front 12

____ drugs an cause acute or chronic renal failure

Back 12

nephrotoxic drugs

Front 13

diuretic drugs are classified according to their sites of action within___, and their__2__.

Back 13

the nephron

chemical structure and diuretic potency

Front 14

main adverse effect of diuretic therapy

Back 14

fluid and electrolyte disturbances

Front 15

60 to 70 % of sodium and water is return to the bloodstream by the ___.

Back 15

proximal tubule

Front 16

if water is not absorbed, then____

Back 16

it is excreted as urine.

Front 17

5 types of diuretic drugs PLOT-C

Back 17

potassium-sparing diuretics

loop diuretics: fastest, most potent

osmotic diuretics

thiazide and thiazide-like diuretics

carbonic anhydrase inhibitors

*remember PLOT-C

Front 18

Diuretic drug action

Back 18

Front 19

most commonly used Carbonic anhydrase inhibitors

Back 19

acetazolamide( Diamox)

Front 20

__- an enzyme hat helps to make H+ ions available for exchange with sodium and water in the proximal tubules

Back 20

carbonic anhydrase

Front 21

acetezolamide( Diamox)

dosage and contraindiations (5)

Back 21

250-500 mg per day

containdication: liver or kidney dysfunction, low serum potassium or sodium levels, acidosis or adrenal gland failure.

Front 22

carbonic anhydrase can cause____.

Back 22

metabolic acidosis

Front 23

adjunct drug in the long-term management of open angle glaucoma.

Back 23

carbonic anhydrase inhibitors

Front 24

used in the treatment of edema and high altitude sickness.

Back 24

carbonic anhydrase inhibitors (Diamox)

Front 25

carbonic anhydrase inhibitors:

inhibition of carbonic anhyrase reduces

H+ ion concentratin in renal tubules

As a result, there is increased excretion of bicarbonate, sodium, water and potassium.

Reabsorption of water___, and urine volume___.

Back 25

is decreased

is increased

Front 26

carbonic anhydrase inhibitors are used with___ to lower intraocular pressure before ocular surgery in certain cases

Back 26

miotics (drugs for the eyes)

Front 27

carbonic anhydrase inhibitors are____than loop diuretics or thiazides- the metabolic acidosis they induce reduces their diretic effect in 2 to 4 days

Back 27

less potent diuretics

Front 28

carbonic anhydrase inhibitors: adverse effects (pim2hug)

Back 28

photosensitivity

increased blood glucose levels

metabolic acidosis

melena

hypokalemia

urticaria

glycosuria in diabetic patients

Front 29

the most commonly used loop diuretic

Back 29

furosemide (Lasix)

Front 30

Loop Diuretics are useful in the treatment of ___

Back 30

Edema

control hypertension

HF resulting from diastolic

dysfunction

Front 31

Loop Diuretics have a (2)

Back 31

rapid onset of action and rapid diuresis

Front 32

Loop Diuretics increase renal prostagladins, resulting in the _____and reduced____

Back 32

dilation of blood vessels

peripheral vascular resistance

Front 33

onset of action for loop diuretics: IV or PO

Back 33

IV-5 min

PO- 60 min

Front 34

because of their ___ effects and the duration of action, loop diuretics are usually effective____

Back 34

potent diuretic

when given in a single daily dose.

Front 35

because loop diruetics potent diuretic effect, it allows the _____ time to partially compensate for the ____ and ____depletion

Back 35

renal tubule

potassium

sodium

Front 36

loop diuretics are used to control___ and in cases of ____ resulting from___.

Back 36

hypertension

heart failure

diastolic dysfunction

Front 37

use of loop diuretics with__3___can cause toxicity

Back 37

Limthium, NSAID, and vancomycin

Front 38

most used osmotic diuretic

Back 38

mannitol( Osmitrol)

Front 39

loop diuretics adverse effects ( STD)

Back 39

stevens-johnson syndrome

tennitus

dizziness

Front 40

loop diurectis have a distinct advantage over thiazide diureticcs in that their diuretic action continues even when ____ decreases below___

the dirureticc effect last at least____.

Back 40

creatinine clearence

25 mL/ min

2 hours

Front 41

osmotic diuretics(Mannitol) MOA

Back 41

inhibits reabsorption of water and Na.

Front 42

osmotic diuretic( Mannitol) reduce___ or _____ associated with head trauma.

Back 42

intracranial pressure

cerebral edema

Front 43

osmotic diuretics( Mannitol) are NOT indicated for _____

Back 43

peripheral edema

Front 44

osmotic diuretics adverse effects: Mannitol

Back 44

convulsions

tachycardia

chest pain

Front 45

Mannitol is always administered ____ through a filter, and vials of the drug are often stored in a ____.

Back 45

intravenously

warmer

Front 46

Mannitol may____ when expoed to ___. this is more likely to occur when concentrations exceed ____.

Back 46

crystallize

low temperatures

15%

Front 47

potassium-sparing diureticcs

Back 47

spironolactone (Aldactone)

Front 48

monitor ___ levels frequently in patients who have impaired renal funtion or who are currently taking____ because___ is a common complication of spironolactone therapy.

Back 48

serum potassium

potassium supplements

hyperkalemia

Front 49

potassium-sparing diuretic( spironolactone): adverse effect

Back 49

hyperkalemia

Front 50

Hyperaldosteron

hypertension

reversing potassium loss caused by potassium-wasting(loop-thiazide) diuretics

certain cases of heart failure

Back 50

spironolactone

Front 51

potassium wasting diuretics (2)

Back 51

loop and thiazide

Front 52

Potassium sparing diuretics adverse effects

Back 52

Hyperkalemia

Irregular menses

Postmenopausal bleeding

Amenorrhea

Front 53

Thiazide and Thiazide-like

Diuretics

Back 53

hydrocholorothiazide ( Esidrix, HydroDIURIL)

Front 54

dilate the arterioles by direct relaxation (think anti-hypertension therapy)

Back 54

thiazide and thiazide-like diuretics

Front 55

this best reflects the patients fluid volume status

Back 55

baseline fluid volume status

intake and output

weight

Front 56

instruct patients to take the medication _____ if possible to avoid interference with sleep patterns

Back 56

in the morning

Front 57

Diuretics:teach patient to change positions slowly and to rise slowly after sitting or lying to prevent __ and __ related to ____.

Back 57

dizziness

fainting

orthostatic hypotension

Front 58

adverse effect of thiazide diuretics is ____ therefore, the nurse should check ____.

Back 58

hyperglycemia; glucose levels

Front 59

location/ action

proximal tubules:

loop of Henle:

early distal:

late distal:

Back 59

proximal tubles: CAI( HCO3/H+/Na); Osmotic( Na+/ H20)

loop of Henle: loop (Na/Cl)

early distal: thiazide (CL)

late distal: K+ sparing (k+/Na)