Term
| Example of a loop diuretic. |
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Definition
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Term
| Indication for loop diuretic. |
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Definition
| Pulmonary edema associated with CHF; HTN or edema of hepatic, cardiac or renal origin- not responsive to other diuretics; Renal impairment b/c GFR is irrelevant to drug's ability to work. |
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Term
| Mechanism of action for loop diuretics. |
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Definition
Acts in the loop of henle to block reabsorbtion of Na and Cl, preventing reabsorption of water.
Most effective diuretic available. |
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Term
| Contraindications for using loop diuretics. |
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Definition
| Anuria (kidney can't make urine)
Caution in pts w/CV disease, renal impairment, DM, hx of gout, pts who are pregnant or taking digoxin, lithium, ototoxic drugs, NSAIDs, or antihypertensives. |
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Term
| Serious Adverse Effects of loop diuretics. |
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Definition
| Electrolyte imbalance- hypokalemia and hyponatremia/ hypochloremia (leading to dehydration); hypotension (due to less volume and relaxation of venuoles), Ototoxicity (hearing impairment) |
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Term
| Common Adverse Effects for loop diuretics. |
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Definition
| Dry mouth, thirst, oliguria (lack of urine output) |
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Term
| Preadministration assessment for loop diuretics. |
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Definition
| What does fluid balance look like? I/O, daily weights, edema, s/s of dehydration and electrolyte imbalance. Baselines for wt, BP, HR, Resp, electrolytes, and lung sounds. |
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Term
| Monitoring for loop diuretics. |
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Definition
| Labs for Na, K, and Cl; renal function, drug levels, glucose readings, BP, and pulse. Is the drug working, weights, fluid output > fluid input, side effects? |
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Term
| Patient education for loop diuretics. |
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Definition
| Eat foods high in potassium (bananas, OJ); or take supplements; make sure to drink enough water (8-10 glasses) and dose early in the day to minimize nocturia. Teach pt to monitor BP, s/s of postural hypotension, hypokalemia, ototoxicity, gouty attack- notify PCP of any problems. Diabetic pts should be careful w/ monitoring of their sugars. Bi-weekly wts, don't X2 dose, use sunscreen. |
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Term
| Mechanism of action for Thiazide diuretics. |
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Definition
| Acts in distal convoluted tubule to block reabsorption of Na and Cl, preventing reabsorption of water. Ability depends on adequate kidney function. |
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Term
| Example of Thiazide Diuretic. |
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Definition
| Hydrochlorothiazide (HCTZ) |
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Term
| Indications for Thiazide Diuretics. |
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Definition
| HTN; Edema associated w/mild to moderate heart failure or hepatic/renal failure. |
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Term
| Contraindications for Thiazide Diuretics. |
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Definition
Renal impairment, Anuria (kidney can't make urine), allergy to sulfonamides.
Caution w/pts that have CV disease, renal impairment, DM, hx of gout, pts taking digoxin, lithium, or antihypertensives, and generally avoid pts who are pregnant. |
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Term
| Serious Adverse Effects for Thiazide Diuretics. |
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Definition
| Electrolyte imbalance- hypokalemia and hyponatremia/ hypochloremia (resulting in dehydration); effects on fetal growth during pregnancy. |
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Term
| Preadministration assessment for Thiazide Diuretics. |
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Definition
| What does fluid balance look like? I/O, edema, daily wts, s/s of dehydration and electrolyte imbalance. Baselines for wt, BP, HR, Resp, and electrolyte values (K, Na, Cl). |
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Term
| Monitoring for Thiazide Diuretics. |
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Definition
| Labs for Na, K, and Cl; renal function, drug levels, glucose readings, BP, and pulse. Is the drug working, weights, fluid output > fluid input, side effects? Can increase cholesterol leves, so should check lipid profile. |
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Term
| Patient education for Thiazide Diuretics. |
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Definition
| Eat foods high in potassium (bananas, OJ); or take supplements; make sure to drink enough water (8-10 glasses) and dose early in the day to minimize nocturia. Teach pt to monitor BP, s/s of postural hypotension, hypokalemia, ototoxicity, gouty attack- notify PCP of any problems. Diabetic pts should be careful w/ monitoring of their sugars. Bi-weekly wts, don't X2 dose, use sunscreen. |
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Term
| Example of Potassium-sparing diuretics. |
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Definition
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Term
| Mechanism of action for potassium-sparing diuretics. |
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Definition
| Blocks action of aldosterone in distal nephron (increases urine production, decreases K excreation, and increases Na excreation) |
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Term
| Indications for potassium-sparing diuretics. |
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Definition
| HTN, edema; Heart failure- reduces mortality and hospital admission due to protective effects. |
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Term
| Contraindications for potassium-sparing diuretics. |
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Definition
Anuria (kidney can't make urine); Hyperkalemia and pts taking K suplements; acute renal insufficiency/ significant renal excretory function impairment.
Caution in pts taking ACE inhibitors, angiotensin receptor blockers, and direct rennin inhibitors. |
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Term
| Serious adverse effects for potassium-sparing diuretics. |
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Definition
| Electrolyte imbalance- hyperkalemia (causing dysrhythmias), endocrine effects |
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Term
| Preadministration assessment for potassium-sparing diuretics. |
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Definition
| What does fluid balance look like? I/O, edema, daily wts, s/s of dehydration and electrolyte imbalance. Baselines for wt, BP, HR, Resp, and electrolyte values (K, Na, Cl). |
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Term
| Monitoring for potassium-sparing diuretics. |
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Definition
| Labs for Na, K, and Cl; renal function, drug levels, glucose readings, BP, and pulse. Is the drug working, weights, fluid output > fluid input, side effects? |
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Term
| Patient education for potassium-sparing diuretics. |
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Definition
Need to watch K intake; make sure to drink enough water (8-10 glasses); take w/meals if it causes GI upset. May cause menstrual irregularities/ impotence due to endocrine effects. Bi-weekly weights, don't 2X dose, use sunscreen.
Often used in combo w/a thiazide or loop diuretic b/c counteracts K loss. |
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Term
| Examples of Osmotic Diuretics. |
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Definition
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Term
| Mechanism of action for osmotic diuretics. |
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Definition
| Increased osmotic force w/in lumen of nephron inhibiting passive reabsorbtion of water; mannitol can't be reabsorbed, takes water w/it |
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Term
| Indications for osmotic diuretics. |
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Definition
| Increased intracranial pressure; increased intraoccular pressure; and to prevent renal failure |
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Term
| Contraindications for osmotic diuretics. |
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Definition
| Anuria (kidney can't make urine); severe dehydration; heart failure; pulmonary edema/congestion; intracranial bleeding; renal damage |
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Term
| Serious adverse effects for osmotic diuretics. |
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Definition
| Edema, CHF, hypotension, renal failure. |
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Term
| Common adverse effects for osmotic diuretics. |
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Definition
| Headache, N/V, fluid and electrolyte imbalance. |
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Term
| Preadministration assessment for osmotic diuretics. |
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Definition
| What does fluid balance look like? I/O, edema, daily wts, s/s of dehydration and electrolyte imbalance. Baselines for wt, BP, HR, Resp, and electrolyte values (K, Na, Cl). |
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Term
| Monitoring for osmotic diuretic. |
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Definition
| Labs for Na, K, and Cl; renal function, drug levels, and glucose levels. Is the drug working, weights, fluid output > fluid input, side effects? |
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Term
| Patient education for osmotic diuretics. |
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Definition
| Make sure to drink enough water (8-10 glasses). Bi-weekly weights; don't X2 dose; be careful getting up (postural hypotension); use sunscreen. |
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Term
| Example of an Anti-diarrheal. |
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Definition
| Diphenoxylate HCl w/ Atropine. |
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Term
| Mechanism of action for anti-diarrheal. |
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Definition
| Acts on smooth muscle of intestine to slow motility and prolong transit time, allowing for the reabsorption of fluid. |
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Term
| Indications for anti-diarrheal. |
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Definition
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Term
| Contraindications for antidiarrheal. |
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Definition
| Diarrhea associated w/organisms that penetrate intestinal mucosa; pseudo-membranous enterocolitis. |
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Term
| Serious adverse effects for anti-diarrheal. |
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Definition
| Atropine overdose and toxic megacolon. |
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Term
| Common adverse effects for anti-diarrheal. |
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Definition
| drowsiness, dizziness, and dry mouth. |
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Term
| Monitoring for anti-diarrheal. |
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Definition
| Decrease the dose when diarrhea diminishes; monitor for signs of atropine overdose and toxic megacolon. |
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Term
| Patient education for anti-diarrheals. |
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Definition
| Do not exceed prescribed dose. |
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Term
| Examples of bulk forming laxatives. |
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Definition
Methylcellulose
Like fiber mixes |
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Term
| Mecahnism of action for bulk forming laxatives. |
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Definition
| Nondigestible; absorbs water and swells to soften and increase fecal mass (like dietary fiber); fecal mass swelling promotes peristalsis; works in smooth intestines and colon |
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Term
| Contraindications for bulk forming laxatives. |
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Definition
| Acute abdominal pain, nausea, cramps (symptoms of possible fecal impaction, bowel obstruction, appendicitis, regional enteritis, diverticulitis, or ulcerative colitis). |
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Term
| Serious adverse effects for bulk forming laxatives. |
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Definition
| Esophageal obstruction (if not given with sufficient fluid); intestinal obstruction or impaction; avoid if intestinal lumen is narrowed. |
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Term
| Common adverse effects for bulk forming laxatives. |
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Definition
| Overactive GI activity (too watery of a stool). |
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Term
| Patient education for bulk forming laxatives. |
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Definition
| Educate on good bowel habits (consistant timing, etc), importance of exercise, fluids, and fiber in the diet. Also that laxatives should only be used when absolutely necessary, at lowest dose possible, for as brief as possible. Short term use only! Works in 1-3 days. |
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Term
| Example of a Surfactant laxative. |
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Definition
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Term
| Mechanism of action for surfactant laxative. |
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Definition
| Alters BM consistancy by allowing fluid to penetrate fecal material; also causes secretion of electrolytes and water into intestine; works in smooth intestine and colon. |
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Term
| Indications for surfactant laxative. |
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Definition
| Often used to soften stool in conditions where passing hard stool and straining would be contraindicated. |
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Term
| Contraindications for surfactant laxatives. |
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Definition
| Acute abdominal pain- possible fecal impaction, bowel obstruction. |
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Term
| Common adverse effects of surfactant laxatives. |
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Definition
| GI (nausea, cramping), overactive GI activity (watery stool) |
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Term
| Patient education for surfactant laxatives. |
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Definition
| Educate on good bowel habits (consistant timing, etc), importance of exercise, fluids, and fiber in the diet. Also that laxatives should only be used when absolutely necessary, at lowest dose possible, for as brief as possible. Short term use only! Requires several days to work. |
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Term
| Examples of stimulant laxatives. |
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Definition
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Term
| Mechanism of action for stimulant laxatives. |
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Definition
| Stimulates peristalsis and softens feces by increasing amount of electrolytes and water in intestinal lumen; works in smooth intestine OR colon (depending on drug used) |
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Term
| Indications for stimulant laxatives. |
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Definition
| Opiod induced constipation; constipation resulting from slow intestinal transit; Oral: 6-12 hrs, Rectal: 15-60 mins |
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Term
| Contraindications for stimulant laxatives. |
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Definition
| Acute abdominal pain- possible fecal impaction, bowel obstruction |
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Term
| Serious adverse effects for stimulant laxatives. |
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Definition
| Atony of colon- the colon does not want to work w/out it |
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Term
| Common adverse effects for stimulant laxatives. |
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Definition
| Abdominal discomfort (widely abused); overactive GI tract (stool too watery) |
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Term
| Patient education for stimulant laxatives. |
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Definition
| Educate on good bowel habits (consistant timing, etc), importance of exercise, fluids, and fiber in the diet. Also that laxatives should only be used when absolutely necessary, at lowest dose possible, for as brief as possible. Short term use only, do not abuse! Don't take bisacodyl w/in 1hr of ingesting milk or antacids. Senna can cause urine to turn yellowish-brown or pink. Castor oil acts rapidly (don't administer at bedtime) and is very powerful, so not for routine constipation. |
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Term
| Example of osmotic laxative. |
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Definition
Magnesium hydroxide
Like milk of magnesia. |
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Term
| Mechanism of action for osmotic laxatives. |
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Definition
| Draw water into the intestinal lumen by osmotic pressure; fecal swelling increases peristalsis; works in smooth intestine and colon. |
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Term
| Indications for osmotic laxative. |
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Definition
| Low dose is for relief of constipation (works in 6-12 hrs). High dose is for an evacuation of the bowels (happens in 2-3 hrs). |
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Term
| Contraindications for osmotic laxatives. |
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Definition
Acute abdominal pain- possible fecal impaction, bowel obstruction.
Mg salts- pts w/renal dysfunction
Na salts- pts w/heart failure, HTN, edema, and caution w/kidney disease |
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Term
| Serious adverse effects for osmotic laxatives. |
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Definition
Dehydration w/all of them.
Mg salts: toxic mg levels w/renal failure. Na salts: fluid retention, renal failure in pts w/kidney disease or those taking diuretics, ACE, or ARBs. |
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Term
| Common adverse effects for osmotic laxatives. |
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Definition
| Overactive GI activity (too watery of stools). |
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Term
| Patient education for osmotic laxatives. |
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Definition
| Educate pts on good bowel habits (consistent timing, etc). Importance of exercise, fluids, and fiber in the diet. Also that laxatives should only be used when absolutely necessary, at lowest dose possible, for as brief as possible. Short term use only! Increase fluid intake during treatment. |
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