pharm doc 5

What are the main reasons for using diuretics?

To decrease blood pressure (BP) and to decrease edema (whether peripheral, pulmonary, or 'third spacing').

What conditions are associated with edema that may require diuretics?

Congestive Heart Failure (CHF), renal disorders, and hepatic disorders.

What types of diuretics are there?

1. Potassium-wasting diuretics: Thiazide and thiazide-like, loop or high-ceiling, osmotic, carbonic-anhydrase inhibitor.

2. Potassium-sparing diuretics.

3. Combination of diuretics and antihypertensive drugs

What are thiazide and thiazide-like diuretics used for?

These diuretics act on the distal tubule and are used for patients with normal renal function for maintenance, not for rapid diuresis. Can elevate blood glucose levels so watch diabetics and those teetering on the edge of diabetics

What serum chemistry abnormalities are associated with thiazide diuretics?

HYPOkalemia, HYPOmagnesemia, hypercalcemia, HYPOchloremia, hyperuricemia, hyperglycemia, and hyperlipemia.

What should be monitored in diabetic patients taking thiazide diuretics?

Blood glucose levels, as thiazides can elevate them. Also watch for patients teetering on edge of diabetes

Can diuretics be combined with other medications?

Yes, potassium-sparing diuretics can be combined with antihypertensive agents, such as Maxzide and Zestoretic.

What common herbal interactions should be considered with diuretics?

Aloe, ginkgo, and licorice.

What is the primary function of loop diuretics?

Loop diuretics, such as furosemide (Lasix), primarily act on the ascending loop of Henle in the kidney. Their main function is to promote the excretion of sodium and water by inhibiting the reabsorption of sodium in this segment, thereby increasing urine production and renal blood flow. While they are effective for rapid diuresis, they have minimal impact on blood glucose levels compared to other types of diuretics.

What is the significance of loop diuretics in clients with renal failure?

Loop diuretics, such as Lasix, are a good choice in clients with renal failure because they can increase renal blood flow.

What is a critical consideration when administering IV loop diuretics?

They should be given slowly to prevent ototoxicity, and potassium (K+) levels must be monitored.

What are laboratory changes associated with loop diuretics?

1. Hypokalemia
2. HYPONATREMIA
3. HYPOCALCEMIA
4. Hypomagnesemia
5. Hypochloremia
6. Elevated BUN and creatinine
7. Elevated lipids
8. Thrombocytopenia and leukopenia

What can occur occasionally in diabetic patients taking loop diuretics?

Hyperglycemia may occur.

What is an example of an osmotic diuretic and its typical use?

Mannitol is an osmotic diuretic usually given IV to decrease intraocular and intracranial pressure.

What are common side effects or adverse effects of loop diuretics?

Fluid and electrolyte imbalance, tachycardia, and others; they are not usually given as diuretics for heart failure patients due to the potential for tachycardia.

What are carbonic anhydrase inhibitors used for?

They are primarily used to decrease intraocular pressure (IOP) in open-angle glaucoma and to treat epilepsy, for example, acetazolamide (Diamox).

What are potassium-sparing diuretics?

Potassium-sparing diuretics are usually mild diuretics that act on the collecting distal tubules to promote sodium and water excretion while retaining potassium. An example is Aldactone (Spironolactone).

What is a major adverse effect of potassium-sparing diuretics?

They can cause hyperkalemia due to increased potassium retention.

How do potassium-sparing diuretics interact with ACE inhibitors?

When given with ACE inhibitors, there is an increased risk of hyperkalemia because ACE inhibitors also promote potassium retention over time.

What nursing interventions should be taken for clients on diuretics?

1. Check for signs of hypo/hyperkalemia.
2. Monitor serum potassium levels.
3. Watch urinary output (average is 30 mL per hour).
4. Monitor intake and output; note that a weight gain of > 2 lbs can equal approximately 1 liter of extra fluid.
5. Watch for changes in edema and assess lung sounds for improvement (should return to clear from wet and crackly).

What are statins and their primary function?

Statins are antihyperlipidemic drugs that inhibit cholesterol synthesis in the liver, decreasing serum cholesterol, LDL, VLDL, triglycerides, and slightly elevating HDL.

What are examples of common statins?

Atorvastatin calcium, fluvastatin, lovastatin, pravastatin sodium, simvastatin, and rosuvastatin.

What should be monitored during statin therapy?

Serum liver enzymes should be monitored, and an annual eye examination is essential due to the risk of cataract formation.

What serious condition should patients on statins report immediately?

Any muscle aches or weakness, as they can lead to rhabdomyolysis, which can be fatal.

What happens if antihyperlipidemic therapy is discontinued?

Cholesterol and LDL levels return to pretreatment levels.

How should patients perceive antihyperlipidemic therapy?

Patients should understand that antihyperlipidemic therapy is a lifetime commitment to maintain decreased serum lipid levels.

What is the consequence of abruptly stopping a statin?

Stopping a statin abruptly can lead to a threefold rebound effect, significantly increasing the risk of acute myocardial infarction (AMI).