Pharmacology Diuretics and Cortico Master Study Set

Both powerpoint flashcards in one spot

Diuretic Medications

Medications that accelerate the rate of urine formation

Removal of sodium and water

what is the result of diuretics?

Hypertension, Heart failure, Renal failure

Common conditions treated with diuretics

Where Na+ goes, H20 follows

Involving Sodium; in the nephron, 

60% to 70%

How much percentage of sodium and water is returned to bloodstream by the proximal tubule?

20% to 25%

percentage of sodium is resorbed into the bloodstream in the ascending loop of henle

5% to 10%

percentage of sodium reabsorbed in the distal convoluted tubule.

3%

Percentage of sodium reabsorbed in the collecting duct.

It is excreted as urine

If water is not absorbed, 

Glomerulus of the nephron within the kidney

The filtering of blood takes place where?

Glomeruler Filtration Rate

What can be estimated mathematically by calculating creatinine clearance

patient’s renal function

creatinine clearance is calculated by the pharmacist and is used to adjust drugs dosages based on what?

135-145 meq/l

sodium normal electrolyte lab results

3.5-5.0 meq/l

Normal potassium electrolyte lab results

9.0-10.5 mg/DL

normal range for calcium electrolyte lab results

Hyponatremia

A condition characterized by low sodium levels in the blood, typically defined as a serum sodium concentration below 135 meq/L.

Hypernatremia

A condition characterized by high sodium levels in the blood, typically defined as a serum sodium concentration above 145 meq/L.

Hypotension, Rapid thready pulse, HA, confusion, fatigue, lethargy

symptoms associated with hyponatremia

Restless, irritability, muscle weakness, thirst, nausea and vomitting, dry mm, diarrhea

symptoms associated with hypernatremia

arrhythemias, altered mental status, anxiety, lethargy, n&v, constipation

symptoms of hypokalemia

Hypotension, slow irregular pulse, restless, irritable, paresthesia, diarrhea

symptoms associated with hyperkalemia

tetany and chvostek’s sign (face), trousseau sign (cuff), hypotension, diarrhea, seizure

are symptoms of hypocalcemia.

mental confusion, polydipsia, polyuria, n&v, abd pain, muscle pain/weakness, thirst

are symptoms of hypercalcemia

Polydispisa

is excessive thirst resulting from dehydration or conditions like diabetes.

Tetany

is a condition characterized by muscle spasms, cramps, and twitching, often associated with low calcium levels in the blood.

Chvostek’s Sign (FACE)

is a clinical sign of neuromuscular excitability that is elicited by tapping the facial nerve, causing facial twitching. It is often associated with hypocalcemia.

Paresthesia

is a sensation of tingling, prickling, or numbness in the skin, often described as "pins and needles." It can occur due to nerve damage or compression.

1.8-2.6 meq/l

Normal range of magnesium electorlyte lab results

HTN, chvostek’s sign (face), trousseau sign (cuff)-increased nerve impulses, constipation, depression, agitation

Symptoms of Hypomagnesia

Hypotension, muscle weakness, HA, flushing, drowsiness, n&v

Symptoms of Hypermagnesemia

98-106 meq/l

Normal range of Chloride levels in Electrolyte lab results

confusion, dehydration, fatigue, n&v, difficulty breathing, fever, edema

Symptoms of Hypochloremia

Fatigue, polydipsia, irregular pulse, n&v, confusion, ABD pain, seizures

Signs and symptoms of Hyperchloremia

The medication “Furosemide” is what class?

Loop Diuretic

The purpose of Furosemide (Lasix)

Inhibits absporption of sodium and chloride in the ascending loop of henle and proximal/distal tubules = Diuresis (K+, NA+, CA+, MG+)

Loop Diuretic: Furosemide Lasix

Most used diuretic, most potent Diuretic (even with severe renal impairment 25ml/min or less creatinine clearance)

Loop Diuretic: Furosemide (Lasix) monitor what while using?

monitor bp and weight

Loop Diuretic Furosemide (Lasix) treats:

edema, HTN, pulmonary edema (PO, IV give slowly to avoid ototoxicity)

While your patient is taking Furosemide (Lasix) the loop diuretic, you should monitor:

dehydration, dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pain/ cramps, hypotension, oliguria, tachycardia, arrhythmia, n&v, gi upset

Key things to monitor with Furosemide (Lasix)

monitor electrolytes (imbalance), MONITOR DIGOXIN TOXICITY, monitor kidney function (bun, creatinine)

When it comes to the loop diuretic, Furosemide (Lasix) you should use cautiously in patients

with DM (hyperglycemia) and gout (hyperuricemia) and avoid use for clients with Sulpha allergy

Drug effects of loop diuretics

Potent diuresis and subsequent loss of fluid. Decreased fluid volume causes reduction in blood pressure, pulmonary vascular resistance, systemic vascular resistance, central venous pressure, left ventricular end-diastolic pressure

Decreased fluid volume causes a reduction in what when it comes to drug effects of loop diuretics?

Blood pressure, pulmonary vascular resistance, systemic vascular resistance, central venous pressure, left ventricular end-diastolic pressure

Loop Diuretics cause loss of what electrolytes and especially depletion in?

Causes loss of ALL electrolytes and Potassium & Sodium depletion

Hydrochlorothiazide/HCTZ (Hydrodiuril)

A thiazide diuretic used to treat hypertension and edema. It is most often given along with antihypertensive.

Hydrochlorothiazide and antihypertensives are usually given together, what should you monitor?

Blood pressure and weight

When it comes to Hydrochlorothiazide/HCTZ (Hydrodiuril) monitor:

dry mouth, increased thirst, minimal urine output, weightloss, n&v, general weakness and especially monitor for DIGOXIN TOXICITY

When it comes to Hydrochlorothiazide make sure to avoid what and why?

Black licorice because it causes increased low K+

When it comes to Hydrochlorothiazide, use caution with clients with

DM (hyperglycemia) and gout (hyperuricemia)

Medication: Spironolactone (Aldactone) class is

Potassium-sparing diuretic 

Potassium-Sparing Diuretic: Spironolactone does what?

blocks the action of aldosterone in collecting ducts and distal tubules and it is the weakest working diuretic.

Potassium-Sparing Diuretic: Spironolactone treats

edema, HF and WORSENS kidney failure

What is the first line defense for liver failure (high doses given for ascites)

Potassium-Sparing Diuretic: Spironolactone is often used as a first-line treatment for ascites in liver failure.

While your patient is using spironolactone, you should monitor:

dehydration, hypotension, renal impairment, gynecomastia, and use cautiously in clients with DM (hyperglycemia) and gout (hyperuricemia)

when it comes to potassium-sparing diuretic, spironolactone, what kind of toxicity should you monitor for?

Lithium toxicity

While using the potassium sparing diuretic, spironolactone, you should restrict foods that

are high in K+ and salt substitutes (hyperkalemia)

Monitor spironolactone the potassium-sparing diuretic, in clients taking

Ace inhibitor or ARB

When it comes to the potassium-sparing diuretic, spironolactone, you should monitor what and avoid what?

Monitor bp, weight and i&o. Avoid NSAIDS.

What is the class of the medication Mannitol (Osmitrol)

Osmotic Diuretic

Osmotic Diuretic, Mannitol, promotes

excretion h20 and electrolytes, treatment of clients in acute renal failure, and to promote excretion of toxic/poisons

The osmotic diuretic known as mannitol (osmitrol) is used to

reduce intracranial pressure and treatment of cerebal edema

How can you give the osmotic diuretic, mannitol?

It can be administered only by IV! Use of IV filter is required.

When exposed to low temperatures, what could the osmotic diuretic, mannitol do?

It may crystalize when exposed to low temperatures

During the use of the Osmotic Diuretic, Mannitol, you should monitor:

Dehydration, N&V, HA

First step when it comes to diuretic nursing implications

Perform a thorough client history and physical examination

second step for diuretic nursing implications

assess baseline fluid volume status, i&o, serum electrolyte values, weight, vital signs especially postural blood pressure and assess for disorders that may contraindicate or necessitate cautious use of these drugs

When it comes to Diuretics, instruct clients to

Take the medication in the morning (to avoid interference with sleep patterns), and notify the provider immediately if they experience rapid heart rates or syncope (reflects hypotension or fluid loss)

Excessive consumption of licorice can lead to what in clients taking Thiazides?

Additive hypokalemia

Why should clients who have been ill with nausea, vomiting or diarrhea notify their provider when it comes to diuretics?

Fluid and electrolyte imbalances can be a result/start

When your patient is taking a diuretic, you should teach the client to change positions slowly after sitting or lying down. Why?

To prevent dizziness and fainting related to Orthostatic Hypotension.

For a client taking a diuretic, they should keep

a log of their daily weight

Remind clients to return __  __________ and ____ _____.

for follow-up appointments and lab tests.

Clients taking diuretics along with digoxin should be taught to monitor for

Digitalis Toxicity

Degitalis Toxicity

a condition resulting from excessive levels of digoxin in the body, characterized by symptoms such as nausea, vomiting, and visual disturbances.

Clients with Diabetes Mellitus who are taking thiazide or loop diuretics should be told to monitor

Blood glucose and watch for elevated levels.

When it comes to diuretics, teach clients to

maintain proper nutritional and fluid volume status

For patients taking a diuretic, you should monitor what levels during therapy?

Serum Potassium Levels

When it comes to a patient taking diuretics, teach client to eat more of what kind of food?

Potassium-Rich foods (except for potassium-sparing drugs)

Examples of foods high in potassium include

Bananas, oranges, dates, apricots, yogurt, raisins, brocolli, green beans, potatoes, meats, fish, legumes, tuna, etc…

When it comes to a patient taking diuretics, you as the nurse should monitor for therapeutic effects. This includes:

Reduction of edema, reduction of fluid volume overload, improvement in manifestations of HF, and reduction of hypertension.

the adrenal cortex and adrenal medulla, which produce various hormones including cortisol and adrenaline. Feedback process of hormone regulation.

Adrenal glands include

Catecholamines such as epinephrine and norepinephrine

Adrenal medulla secretes what?

Corticosteroids including glucocorticoids (glucose metabolism), mineralocorticoids (primarily aldosterone), androgens (sex hormones)

Adrenal Cortex secretes what?

Glucose metabolism

Glucocorticoids is what?

Primarily aldosterone, and it regulates K+ and Na+

Mineralocorticoids is what?

Sex hormones produced by the adrenal glands that play a role in the development of male traits and reproductive activity.

Androgens are what?

Addison’s Disease

Adrenocortical hormones, Under secretion leads to what kind of disease?

Symptoms of Addison’s Disease

Includes bronze pigmentation of skin, changes in distribution of body hair, GI disturbances, weakness, hypoglycemia, postural hypotension, weight loss and adrenal crisis.

Symptoms of Adrenal Crisis in Addison’s Disease

profound fatigue, dehydration, vascular collapse, renal shut down, lowered serum NA and higher serum K.

Mineralocorticoid

What class is the medication Fludrocortisone (Florinef)

Mineralocorticoid, Fludrocortisone

Aldosterone replacement in addisons disease

glucocorticoids

Fludrocortisone is often given with

systemic fungal infection

Mineralocorticoid class medications like fludrocortisone is contraindicated in

HTN, edema, cardiac enlargement, HF, K+ loss, hypoglycemia, and hyponatremia

You should provide continuous monitoring for patients using mineralocorticoid, fludrocortisone because the medication may cause

are indications for adrenal insufficiency with fludrocortisone.

Low Na+, High K+ and low cortisol

cushings syndrome

When it comes to adrenocortical hormones, over secretion leads to

personality changes, moon face, higher susceptibility to infection, gynecomastia in males, fat deposits in face and back of shoulders, thin skin, purple striase, bruises and pestechiae, CNS irritability, hyperglycemia, osteoporosis

Cushing Syndrome symptoms include

Examples of Glucocorticoids

Prednisone (PO) (use lowest doses), Methylprednisolone (IV) (use lowest doses), Hydrocortisone (topical)

Predisone (PO) and Methylprednisolone (IV)

You use the lowest doses of which glucocorticoids?

apply sparingly and do not use for greater than 7 days!

When it comes to Hydrocortisone (Topical) you should: