Review notes for Test 3pharm (1)summer PDF

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Review notes for Test 3

Chp. 51 

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Diuretics are used for 2 main purposes: o Decrease hypertension (lower bp) o Decrease edema (peripheral and pulmonary) in heart failure and renal or liver disorders Diuretics are used either alone or in combination to decrease bp Have a antihypertensive effect- they promote sodium and water loss by blocking sodium and chloride reabsorption Diuretics make you urinate by inhibiting sodium and water reabsorption from the kidney tubules Potassium wasting: diuretics that promote potassium excretion Potassium sparing: diuretics that promote potassium retention Potassium level is 3.5-5.2 o Potassium is good for heart and muscles o Patient will complain of problems with the heart or muscle cramps. o Adverse effects: electrolyte changes  Hypokalemia: sx and symptoms: weakness, muscle cramps, arrhythmias  Anything with “toes” is good for potassium diet.  If used for a prolonged time frame: blood sugar can increase Loop : high ceiling: cause greater diuresis- diuretic that deals with potassium

Loop diuretics     

Inhibits sodium, chloride and water reabsorption in the proximal portion of the ascending loop of Henle Drugs of choice when rapid and extensive diuresis needed Affect blood sugar and increase uric acid levels Often called high-ceiling diuretic or potassium-wasting diuretic May cause ototoxicity, hypokalemia, and hypocalcemia

Thiazide, loop, and potassium sparing diuretics are most frequently prescribed for hypertension and for edema associated with heart failure o

All other diuretics are potassium wasting

Thiazides and Thiazide-Like Diuretics     

Act on the distal convoluted renal tubule to promote sodium, chloride, and water excretion Used to treat HTN and peripheral edema Not effective for immediate diuresis and should not be used to promote fluid loss in patients with severe renal dysfunction Used primarily for patients with normal renal function Thiazides cause a loss of sodium, potassium, and magnesium but promote calcium reabsorption o Hypercalcemia may occur

They affect glucose tolerance so hyperglycemia can also occur- be cautious with diabetic patients Should be administered in the morning to avoid nocturia Side Effects and Adverse Reactions o Electrolyte imbalances (hypokalemia, hypercalcemia, hypomagnesemia, and bicarbonate loss) o Hyperglycemia o Hyperuricemia (elevated serum uric acid level) o Hyperlipidemia o Orthostatic hypotension o Client experiences no ototoxicity o Other side effects include: dizziness, headache, N/V, constipation, urticaria, or hives and blood dyscrasias o Be cautious when giving medication to patients who are taking digoxin o

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Furosemide (Lasix) : ototoxic   

It will cause irreversible hearing loss if you give the medication too fast IV Only given 10-20 mg per minute by IV. Should never be combined with another loop diuretic

Potassium-sparing (holds on to potassium): Aldactone, triamterene  

Do not give foods high in potassium because the medication holds on to it. LEAK o Low Sodium o Elevated T waves from increased potassium o Agranulocytosis with triamterene o K+ level must be monitored

Adverse effects: hyperkalemia: lethargy, confusion, muscle cramps, arrhythmias, hirsutism-hairy , gynecomastia-breasts in males, deepening of voice, irregular menses ** need to know foods rich in potassium: page 866 Take diuretic early ? Diuretics make the patient have urinary frequency during the day and sleep at night. Ready access to bathroom. Call bell needs to be within reach. ?? assess fluid retention- make the patient weigh themselves the same time every day with no clothes on. If ever in doubt about the medication, hold and call physician before giving the medication.

DIURETIC Diet- Increase K+ for all except Aldactone 

Clients taking potassium-sparing diuretics should not eat a diet rich in potassium

Intake & output, daily weigh 

There should be an increase in the urine output

Undesirable effects: fluid and electrolyte imbalance    

Hypovolemia-  HR with weak pulse,  respirations,  BP,  output Hypokalemia- abnormal EKG, orthostatic hypotension, flaccid paralysis, and weakness Hyperkalemia- nausea, diarrhea, abnormal EKG, confusion, muscle weakness, tingling in the extremities, paresthesia, dyspnea, and fatigue Hyponatremia- lethargy, disorientation, muscle tenseness, seizures, coma (therapeutic 135-145)

Review HR, BP, and electrolytes  

To prevent potential hypovolemia If client is taking digoxin, evaluate for signs of hypokalemia due to risk of digoxin toxicity

ELDERLY- careful 

Evaluate adequate renal function by checking the creatinine clearance in the elderly (not important)

Take with or after meals and in AM   

Instruct patient to take with or after meals if GI distress occurs4 N/V may be a result of electrolyte disturbance Administering the medication early in the day will help avoid nocturia

Increase risk of orthostatic hypotension; move slowly Cancel alcohol 

Alcohol may decrease the blood pressure too low

??? When providing care to a pt who is receiving a loop diuretic, the nurse would determine the need to regularly monitor which of the following? a. Sodium b. Bone marrow function c. Calcium d. Potassium

??? The nurse would instruct a pt receiving a loop diuretic to report: a. Yellow vision b. Weight loss of 1 pound/day c. Muscle cramping d. Increased urination ??? Routine nursing care of a client receiving a diuretic would include which of the following? Select all that apply. a. b. c. d. e. f.

Daily weighing Tight fluid restrictions Periodic electrolyte evaluations Monitoring of urine output Regular intraocular pressure testing Teaching the pt to report muscle cramping

Chp. 52 Symptoms of UTI   

Urgency, frequency, hesitancy Women are more frequent to get UTI due to shorter urethra. Sx: burning, dysuria, urgency, confusion with elderly, blood in urine, suprapubic pain

Two categories: -

Upper UTI = pyelonephritis Lower UTI = cystitis, urethritis, or prostatitis

Symptoms of pyelonephritis (kidney infection)

Back pain (CVA tenderness) and fever

*** C &S done BEFORE starting antibiotics , then may start broad spectrum until results return 

Start with broad spectrum abx then to narrow spectrum

Teaching points   

Pee after having sex Drink plenty of water Wipe from front to back

Urinary tract antispasmodics: when bladder does not have spasms. Symptoms of urinary tract inflammation: cystitis, nocturia, urgency, dysuria 

Simple UTI is a lower bladder infection

::: anticholinergic drugs

***know how to prevent UTI, symptoms of UTI, difference between pyelonephritis and UTI Examples: toviaz, Ditropan, Detrol, urispas Gotta go, gotta go Need IOP monitoring ; encourage fluids (maintain flow and prevent stasis) Urinary tract analgesics Example: phenazopyridine (azo, Pyridium) (dye) Topical anesthetic effect on mucosa ***turns urine orange (may stain fabric) educate patient 

potential liver toxicity – will cause you to turn jaundice.

GUSH GI disturbances Urine turns yellow orange Sclera and skin orange Hemolytic anemia

Benign Prostatic Hypertrophy-enlarged prostate      

when the prostate is enlarged it squeezes the urethra which causes either urinary frequency or retention if given a drug to help decrease the size of the prostate will cause the patient to either have orthostatic hypotension- risk for falls Common problem; increases with age PSA level is...