DIURETICS, MAGSUL, INSULIN, OHA

Loop, thiazide, k+ sparring, osmotic diuretics

Types of diuretics

Loop

Most potent diuretics as it excretes 25% of Na+ and acts on the ascending limb of loop of henle

Furosemide (lasix), bumetanide, torsemide

Example of loop

HYPOKALEMIA

WOF for this kind of electrolyte imbalance that causes prominent U waves on ECG

Ototoxicity

Loop causes hearing loss and tinnitus if push rapidly

hypocalcemia

Loop causes this as it decreased calcium reabsroption causing osteoporosis

Hyperuricemia

Loop and thiazide competes with uric acid for excretion causing

Thiazide

It cats on the distal convulsed tubule (5-8% Na+ loss)

Hypercalcemia

This cause calcium goes back in the blood and good for patient with osteoporosis

Sulfa allergy

Thiazide is not given to patient with this kind of allergy

K+ sparring

It blocks the effect of aldosterone

Spirinolactone, eplenerone, amiloride, triamterene

Seat in K+ sparring

Spironolactone

Gynecomastia (breast enlargement) occurs due to this k+ sparring diuretic

Osmotic diuretic

uses osmosis effects

Mannitol

Only diuretic that crosses BBB

Pulmonary edema

WOF in mannitol in which causes crackles and pink frothy sputum

Crystallization

Mannitol IV only risk that causes IV blockage

Morning

Diuretics are taken in the

Weight

Best indicator for fluid status

Magnesium sulfate

This is a CNS depressant causing all VS and function down

Tocolytics, anticonvulsants, muscle relaxant, antiarrhytmias

4 function of Magsul (TAMA)

4-7 mg/dl

Therapeutic serum level of magsul

Absent deep tendon reflex

Earliest sign of toxicity of MagSul

Myasthenia Gravis, heart blocks, renal failure

Contraindicated to patients with

Calcium gluconate

Antidote of MagSuL

Rapid, short, intermediate, long, very long

Types of insulin

15-30 mins

Rapid acting onset

1 hr

Rapid acting peak

Rapid acting insulin

Insulin that is Highest risk for hypoglycemia

2-4 hrs

Intermediate acting onset

4-8hrs

Intermediate acting peak

Lisopo, Aspartame, Glulisine

Example of rapid acting (LAG)

30mins- 1hr

short onset

2-4 hrs

Short acting peak

Short acting/ regular insulin

Only insulin given IV

Intermediate acting insulin

Insulin that is never given IV

4-8 hrs

Long acting onset

8-16 hrs

Long acting peak

1hr

Very long acting onset

No peak

Very long acting peak

Very long acting insulin

Insulin that is lowest risk for hypoglycemia

Glargine (Lantus), Determir

example of very long acting insulin

Stress, surgery, sickness, steroid use

Doses of insulin may be increase due to

Rotate the sites

To avoid lipodystrophy

• at least 1 inch away from the previous

Room temp for 28 days

Storage of open insulin

Until expiration date

How many days to Storage of unopened in the ref

Until 28 days

How many days to Storage of unopened in the room temp

Clear to cloudy

Mixing insulin

• GET THAT RN! 🧑‍⚕

Cloudy - clear - clear - cloudy

Dispensing the drug itself from the vial to syringe steps

Oral Hypoglycemic Agents

only use for type 2 diabetes

• stimulates pancreas to release insulin → improve sensitivity of cells to insulin

24-48hrs

OHA should be stopped for how many hrs prior to administration of contrast media

B12 deficiency

Long term of OHA can cause