Pharm Exam 3 Renal

Kent State Pharmacology 1, exam 3, Renal drugs

Fluid volume excess

An imbalance marked by an abnormal increase of fluid in the extracellular compartment, commonly resulting in edema, ascites, and occasionally anasarca.

Anasarca

A severe, generalized edema causing widespread swelling throughout the body.

Ascites

The accumulation of fluid in the abdominal cavity, often seen in liver disease or severe heart failure.

Dependent edema

Swelling that occurs in the lowest parts of the body (e.g., feet and ankles when standing) due to gravity.

Intracellular fluid

The fluid contained within the cells, essential for cellular function.

Extracellular fluid

Fluid that surrounds the cells, including blood plasma and interstitial fluid.

Primary clinical manifestation of excess extracellular fluid

Edema or visible swelling.

Importance of renal anatomy in fluid volume excess

Because the kidneys regulate fluid balance, electrolytes, pH, and remove metabolic waste.

2 Functions of the kidneys

Filtration of blood/waste elimination

regulation of electrolytes + blood pressure

Structures surrounding the glomerulus in the nephron

Bowman's capsule and the capillary tuft of the glomerulus.

Normal glomerular filtration rate (GFR)

normal is about 125 mL/min.

Contraindication for diuretics

Anuria or complete lack of urine output.

Mechanism of Furosemide

They inhibit sodium reabsorption in the loop of Henle, which prevents water reabsorption.

(Loop Diuretic)

Furosemide administered too rapidly causes

can lead to ototoxicity if administered too rapidly. - Loop Diuretics

Common adverse effect of Furosemide

Electrolyte imbalances e.g., hypokalemia, hyponatremia

(loop diuretic)

Example of a thiazide diuretic

Hydrochlorothiazide (HCTZ).

Effect location of Hydrochlorothiazide (HCTZ)

In the distal convoluted tubule

(thiazide diuretics)

Adverse effect of Hydrochlorothiazide (HCTZ)

hypotension, dizziness, hypokalemia (potassium loss), and hyperglycemia

(thiazide diuretics)

Contraindications for Hydrochlorothiazide (HCTZ)

patients with severe renal failure or anuria and in those allergic to sulfonamides

(thiazide diuretics)

Example of a potassium-sparing diuretic

Spironolactone.

Spironolactone Action

It blocks aldosterone receptors, reducing sodium reabsorption while sparing potassium. - mild diuretic effect

(Potassium-Sparing)

Spironolactone adverse effects

hyperkalemia and androgen-like effects

e.g., gynecomastia, menstrual irregularities

(Potassium-Sparing)

Contraindication for spironolactone

Hyperkalemia or renal insufficiency.

(Potassium-Sparing)

Osmotic diuretics (Mannitol) Action

Create an osmotic gradient to draw water into the kidneys and increase urine output

Osmotic diuretics Example

Mannitol

Example of a carbonic anhydrase inhibitor

Acetazolamide.

Nursing teaching point for diuretics

Take the medication in the morning to prevent nocturnal urination.

Acetazolamide action

(Carbonic Anhydrase Inhibitor)

decreasing bicarbonate reabsorption in the kidneys = increased urinary excretion of bicarbonate, mild diuresis, and reduction in aqueous humor formation in the eye

Acetazolamide adverse effects

may cause metabolic acidosis

Acetazolamide Contraindications

patients with non-congestive glaucoma & severe renal / hepatic impairment

Essential monitoring before administering diuretics

Checking laboratory values (electrolytes, kidney function) and establishing a baseline weight.

Excess loss of potassium

With certain diuretics may necessitate dietary supplementation to prevent complications like cardiac arrhythmias.

Key concept in edema management with diuretics

Promoting urine output to reduce excess fluid accumulation in tissues.

Furosemide Location of action

Primary site of action is the Loop of Henle.

Spironolactone Site of action

Collecting ducts.

(Potassium-Sparing)

Mannitol adverse effects

Dehydration, Cardiac dysrhythmias.

(Osmotic Diuretic)

Mannitol Contraindications

patients with dehydration, severe pulmonary edema, or heart failure, and caution is advised in older adults

(Osmotic Diuretic)

Major nursing consideration for Furosemide

Observing for signs of electrolyte imbalances such as hypokalemia and monitoring blood pressure. (Loop diuretics)

Renal capsule

The fibrous covering that protects the kidney.

Importance of patient education with diuretics

To ensure adherence to diet, fluid restrictions, proper timing of medication, and awareness of side effects.

Which drug is often used to treat open-angle glaucoma

Carbonic anhydrase inhibitors

True/False: Diuretics are used to manage fluid overload in conditions such as heart failure, liver failure, and hypertension.

True

Are sodium restriction necessary when using diuretics?

Yes, Dietary sodium restrictions are important to help manage fluid retention

The functional unit of the kidney, responsible for filtration, secretion, and reabsorption, is called the __________

Nephron

Example of loop diuretic

Furosemide

Example of a thiazide-like diuretic

Metallocene / Metolazone

What is the mechanism of action of metolazone?

(thiazide-like diuretic) decreases sodium and chloride reabsorption in the distal convoluted tubule

increasing urine output and decreasing extracellular fluid volume.

What are the adverse effects for metolazone?

(thiazide-like diuretic) it can cause hypotension, dizziness, significant hypokalemia, and hyperglycemia.

Metolazone contraindications

patients with severe renal failure or known sulfonamide allergies

(thiazide-like diuretic)