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pharm exam 3 NUR 2060 (1)
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pharm exam 3 NUR 2060what are the medication classes for hypertension? - ANS--diuretics
-angiotensin converting enzyme (ACE) inhibitors
-angiotensin receptor blockers (ARBS)
-beta blockers
-calcium channel blockers
-centrally or peripherally acting sympathetic nervous system inhibitors
-peripheral vasodilators
what are diuretics - ANS-medications that act on kidneys to increase diuresis (urine output)
-treat hypertension, edema (HF and pulmonary edema), renal diseases (nephrotic syndrome),
hepatic diseases (cirrhosis- kidney failure)
-produce diuresis via decreasing reabsorption of sodium and water in the kidney tubules
-side effects: hypovolemia, acid base disturbances, electrolyte imbalances (K, Mg, Na, Cl)
T/F: the higher the diuretic works on the nephron, the more impact it will have on the body -
ANS-True
where in the nephron do diuretics work? - ANS--proximal tubule: osmotic diuretic
-thick ascending loop of henle: loop diuretics
-early distal tubule: thiazide diuretics
-late distal tubule: potassium sparing diuretics
loop diuretics work by - ANS--inhibiting sodium reabsorption in the Loop of Henle
-temporary increase in renal blood flow without increase in GFR
-work best of all diuretics in pt w urine output less than 30ml/hr (kidney failure, forms of sepsis)
-very strong, used for rapid diuresis
-greatest potential volume of diuresis
uses of loop diuretics - ANS--heart failure
-hepatic disease
-renal disease
-pulmonary edema
-hypertension refractory to thiazides
-ascites
-oliguria (low urine output)
furosemide (Lasix) is a - ANS-loop diuretic
-push SLOW, could cause hearing loss
, -ADRs: hyponatremia, hypochloremia, dehydration which can produce thromosis and embolism,
hypotension, hypokalemia (esp for patients taking digoxin for HF), ototoxicity (push no faster
than 20-40mg/min), dont take while pregnant or breastfeeding, caution in elderly
loop diuretic side effects - ANS--ototoxicity
-hypokalemia
-dehydration
-allergy
-nephritis (inflammation of the kidneys)
-gout
-ADRs greater with rapid IV or IVP administration (push slowly)
-take in morning bc will have to pee a lot
hypokalemia - ANS-symptoms: alkalosis, shallow respirations, irritability, confusion, drowsiness,
weakness, fatigue, arrhythmias- tachycardia, irregular rhythm and/or bradycardia, lethargy,
thready pulse, decrease intestinal motility- nausea, vomiting, ileus
-replace with K+, 10mEq as IVPB in 50cc of D5W over one hour
-do not push potassium- death
-replace moderate loss w oral dose
hyperkalemia - ANS-symptoms: muscle twitches-> cramps-> paresthesia (numbness/tingling),
irritability and anxiety, decreased BP, EKG changes, dysrhythmias- irregular rhythm, abdominal
cramping, diarrhea
-remove with insulin and glucose infusion in emergency, can IV push
-excess can be removed via sodium polystyrene sulfonate (Kayexalate)
-low potassium diet if only mildly elevated
How do thiazide diuretics work? - ANS--increase excretion of sodium chloride, water, and
potassium
-act on distal tubule- inhibit Na absorption
-antihypertensive- decrease peripheral vascular resistance
what are thiazide diuretics used for? - ANS--hypertension
-heart failure
-edema of early renal disease
-cirrhosis
-works best if urine output is normal/ at least >30cc/hr
-takes one month to see full effect
-increases effectiveness of other htn meds by 30-50%
ADRs of thiazide diuretics - ANS-- electrolyte disturbances- K, Mg, Na, Cl
-increase fasting blood glucose levels
-elevated BUN
-hyperuricemia (can lead to gout)
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