Ati Cardiovascular System Meds (Meds Affecting Urinary Output)

Front 1

high-ceiling loop diuretics

Back 1

proto: furosemide
others: ethacrynic acid (Edecrin)
bumetanide (Bumex)
torsemide (Demadex)

Front 2

high-ceiling loop diuretics MOA

Back 2

work in the ascending loop of Henle
blocks reabsorption of sodium and chloride and to prevent reabsorption of water
causes extensive diuresis even with severe renal impairment

Front 3

high-ceiling loop diuretics uses

Back 3

used when there is an emergent need for rapid mobilizations of fluid
pulmonary edema caused by heart failure
conditions not responsive to other diuretics, such as edema caused by liver, cardiac, or kidney disease, or hypertension
used to treat hypercalcemia related to kidney stone formation

Front 4

high-ceiling loop diuretic adverse

Back 4

dehydration, hypernatremia, hypochloremia
hypotension
ototoxicity
hypokalemia
hyperglycemia, hyperuricemia, decrease in calcium and magnesium levels

Front 5

high-ceiling loop diuretic contraindications

Back 5

pregnancy
diabetes or gout

Front 6

high-ceiling loop diuretics interactions

Back 6

digoxin (Lanoxin) toxicity can occur in the presence of hypokalemia
concurrent use of antihypertensives can have additive hypotensive effect
lithium carbonate serum levels can increase which may lead to toxicity if hyponatremia occurs due to the loop diuretic
NSAIDS increase blood flow to kidney which reduces diuretic effect

Front 7

high-ceiling loop diuretic considerations

Back 7

avoid adminstering late in the day to prevent nocturia
normal dosing time is 0800 and 1400
administer furosemide orally, IV bolus dose, or continuous IV infusion
Infuse IV doses at 20mg/min or slower to avoid abrupt hypotension and hypovolemia
monitor potassium, eat foods high in potassium
monitor magnesium levels, blood glucose levels

Front 8

high-ceiling loop diuretic effectiveness

Back 8

decrease in pulmonary or peripheral edema
weight loss
decrease in BP
increase in urine output

Front 9

thiazide diuretics

Back 9

Proto: hydrochlorothiazide
others: chlorothiazide (Diuril)
methyclothiazide (Enduron)
thiazide-type diuretics:
indapamide (Lozide, Lozil)
chlorthalidone (Hygroton)
metolazone (Zaroxolyn)

Front 10

thiazide diuretic MOA

Back 10

work in the early distal convuluted tubule
blocks reabsorption of sodium and chloride, and prevents the reabsorption of water at this site
promotes diuresis when renal function is not impaired

Front 11

thiazide diuretic use

Back 11

often medication of first choice for essential hypertension
edema of mild-to-moderate heart failure and liver and kidney disease
often used in combination with antihypertensive agents for blood pressure control

Front 12

thiazide diuretic adverse

Back 12

dehydration
hypokalemia (< 3.5 mEq/l)
hyperglycemia

Front 13

thiazide diuretic contraindications

Back 13

pregnancy, lactation, breastfeeding

Front 14

thiazide diuretics interactions

Back 14

same as loop-diuretic meds
cause no risk of hearing loss and can be combined with ototoxic drugs

Front 15

thiazide diuretic considerations

Back 15

monitor potassium levels
take meds first thing in the morning
if twice daily is prescribed- make sure to give last dose no later than 1400 to prevent nocturia
diet high in potassium and plenty of fluids
take with or after meals if GI upset occurs
alternate-day dosing can decrease electrolyte imbalances

Front 16

thiazide diuretic effectiveness

Back 16

decrease in BP
decrease in edema
Increase in urine output

Front 17

potassium-sparing diuretics

Back 17

sprionolactone (Aldactone)
other meds: triamterene (Dyrentium)
amiloride (Midamor)

Front 18

potassium-sparing diuretics MOA

Back 18

block the action of aldosterone which results in potassium retention and the secretion of sodium and water

Front 19

potassium-sparing diuretics uses

Back 19

combined with other loop diuretics for potassium sparing effects
administered for heart failure
therapeutic effects may take 12-8 hours

Front 20

postassium-sparing diuretic adverse

Back 20

hyperkalemia (>5.0 mEq/l)- discontinue meds restrict potassium, administer insulin injections to drive potassium back into the cell
should not be administered with spirolactone
caution with angiotensin-converting enzyme, angiotensin receptor blockers, and direct renin inhibtors because they may cause elevated potassium levels
Endocrine effects

Front 21

potassium-sparing diuretics contraindications

Back 21

hyperkalemia
severe kidney failure and anuria

Front 22

potassium-sparing diuretics interactions

Back 22

concurrent use of ACE inhibitors increases risk of hyperkalemia
concurrent use of potassium supplements increase the risk of hyperkalemia

Front 23

potassium-sparing diuretic considerations

Back 23

avoid salt substitutes that contain potassium
monitor BP and weight
triameterine may turn urine a bluish color
monitor potassium levels

Front 24

potassium-sparing diuretic effectiveness

Back 24

weight loss, maintenance of normal potassium levels, decrease in blood pressure and edema

Front 25

osmotic diuretics

Back 25

mannitol (Osmitrol)

Front 26

osmotic diuretics MOA

Back 26

reduce intracranial pressure and intraocular pressure by raising serum osmolarity and drawing fluid back into the vascular and extravascular space

Front 27

osmotic diuretics uses

Back 27

prevent kidney failure in specific situations such as hypovolemic shock and severe hypotension, because mannitol is not reabsorbed and remains in the nephron, drawing off water, thus preserving urine flow and preventing kidney failure
decreases intracranial pressure caused by cerebral edema by drawing off fluid form the brain into the bloodstream
decreases IOP
promote sodium retention and water excretion in clients who have hyponatremia and fluid volume excess
administered for the oliguria phase of acute kidney injury

Front 28

osmotic diuretic adverse

Back 28

heart failure, pulmonary edema, kidney failure, fluid and electrolyte imbalances

Front 29

osmotic diuretic contraindications

Back 29

heart failure

Front 30

osmotic diuretic interactions

Back 30

lithium excretion through the kidneys is increased (monitor lithium levels)

Front 31

osmotic diuretic considerations

Back 31

administer mannitol through continuous IV infusion
monitor for signs of dehydration, acute kidney injury, and edema

Front 32

osmotic diuretic effectiveness

Back 32

urine output of at least 30 mL/hour
serum creatinine between 0.6 to 1.2 mg/dL for men and 0.5-1.1 mg/dL for women
BUN levels between 10-20 mg/dL
decrease in intracranial pressure
decrease in intraocular pressure