NUR 354 Exam 2 | Questions with 100% Correct Answers

NUR 354 Exam 2 | Questions with 100% Correct Answers What drug class do furosemide and bumetanide fall under? loop diuretics what is the pharmacological action of loop diuretics? - block reabsorption of sodium, chloride, and water in the loop of Henle Which diuretic class still works well in kidney impairment? loop diuretics What are the therapeutic uses associated with loop diuretics? - reduce edema from HF, cirrhosis, and renal failure - can be used to temporarily treat hypertension from FVE What are the drug interactions associated with loop diuretics? - hypokalemia risk: may cause dysrhythmias with digoxin and cardiac glycosides (heart failure meds) - caution with meds that are nephrotoxic or ototoxic like opioids and amino-glycoside antibiotics - may counteract insulin and cause hyperglycemia due to increased blood concentration What are the food interactions associated with loop diuretics? - hawthorn= hypotension - ginseng and high sodium reduce effectiveness What side effects are associated with loop diuretics? - hypokalemia and other electrolyte imbalances - dehydration - hypotension - hypovolemia What adverse effects are associated with loop diuretics? - ototoxicity: tinitus, vertigo, nausea - hyperglycemia - hyperuricemia - increased LDL and decreased HDL What are some nursing interventions for loop diuretics? - obtain baseline data: vitals, i's&o's, amount and placement of edema, lung sounds, skin turgor, mucus membrane assessment - daily weights at same time each day - monitor electrolyte levels - monitor BP and HR/pulses before administration What are some safety considerations for loop diuretics? tell provider if any of these symptoms develop: dry mouth, increased thirst, muscle cramps, n/v, symptoms of orthostatic hypotension such as dizziness, lightheadedness, and syncope may occur What should you educate patients on if they are receiving loop diuretics? - change positions slowly - tell provider if signs of dehydration or electrolyte imbalance occur How should you evaluate for loop diuretic effectiveness? daily weights, i's&o's, electrolyte levels, kidney function monitoring (serum creatinine and serum BUN) What drug class is hydrochlorothiazide in? thiazide diuretic What is the pharmacological action of thiazide diuretics? blocks sodium, chloride, and water reabsorption in the kidney tubule which encourages potassium and water excretion What are the therapeutic uses of thiazide diuretics? - first choice for treating HTN quickly - edema from HF, liver and kidney disease - reduces urine production in diabetes insipidus - good for osteoporosis because it promotes calcium reabsorption True or false: thiazide diuretics are equally as effective as loop diuretics false: thiazide diuretics are less effective than loop diuretics What are the drug interactions associated with thiazide diuretics? - use w/ other HTN meds will add to effects on BP - may reduce efficacy of anticoagulants and insulin - use with NSAIDs increases risk for nephrotoxicity - hypokalemia= high risk for digoxin toxicity - carbamazepine and thiazide diuretics increase each-other's toxicity What are the food interactions associated with thiazide diuretics? - ginko biloba may cause paradoxical interaction and cause HTN - hawthorn may cause hypotension when used with thiazide diuretics What are the side effects associated with thiazide diuretics? - hypokalemia and hyponatremia along with other electrolyte imbalances - increased risk for gout attacks - dehydration What are the adverse effects associated with thiazide diuretics? - pregnancy: decreased placental perfusion - NOT SAFE FOR USE WITH RENAL IMPAIRMENT What are some nursing interventions appropriate for thiazide diuretic therapy? - notify provider of prolonged signs of dehydration and electrolyte imbalance - alternate day dosing can help with electrolyte imbalance - give with food or milk to reduce GI upset - administer early in day - i's&o's + daily weights What is some patient education we can provide for thiazide therapy? - record intermittent therapy on calendar - take med early in day with a meal or milk - change positions slowly, no heavy machinery or dangerous activities while dizzy - report weight change of more than 3 lbs in one day, edema on lower extremities, bleeding/bruising, dizziness, trembling, numbness, fatigue, or myalgia what drug class is chlorthalidone in? thiazide LIKE diuretics what is the mechanism of action of thiazide like diuretics? blocking sodium reabsorption at the distal convoluted tubule What is the therapeutic use of thiazide like diuretics? used alone or in combination with other drugs to control HTN What are the food interactions associated with thiazide like diuretics? grapefruit juice may increase effects of the drug and lead to severely low BP what are some side effects and adverse effects of thiazide like diuretics? hypotension electrolyte imbalances including hypercalcemia thrombocytopenia symptoms of dehydration What are some safety considerations for thiazide like diuretics? - gout: may increase risk for gout flare what is the drug class of spironolactone? potassium sparing diuretic what is the mechanism of action of spironolactone? - aldosterone antagonist; works on distal renal tubules (aldosterone is responsible for keeping sodium in the body and releasing potassium) What are the therapeutic uses of spironolactone? - combo with other drugs to treat HTN and edema - HF what are some drug interactions associated with spironolactone? - aspirin, other salicylates, potassium supplements, ACE inhibitors, and ARB's may increase potassium levels= hyperkalemia and/or toxicity - use with digoxin may cancel digoxin effects - use with other antihypertensives= hypotension what food interaction is known to exist with spironolactone? hawthorn may cause hypotension What are the side effects associated with spironolactone? hyperkalemia men: deepening of voice, impotence women: menstrual irregularity drowsiness metabolic acidosis What are some safety considerations for spironolactone? - cannot be given to patients with kidney impairment or anuria - not safe for use with other potassium sparing drugs (ACE inhibitors, ARB's, or direct renin inhibitors) - no salt substitutes! what drug class does mannitol fall into? osmotic diuretics what is the mechanism of action of osmotic diuretics? - inhibit water reabsorption in the proximal convoluted tubule and thin descending loop of henle and collecting duct - raise serum osmolality (concentration) and draws fluid into vascular and extravascular space What are the therapeutic uses for osmotic diuretics? used to - prevent renal failure with hypovolemic shock by preserving urine flow - decreases ICP and IOP - promoted serum retention and water excretion with hyponatremia what is CKD? chronic kidney disease - excess fluid and waste from the blood remain in the body and cause other issues like heart disease and stroke what is renal dosing? To avoid harm when drug clearance is significantly decreased, the dose of renally cleared drugs should usually be reduced in patients with renal disease. What is the effect of nitrates on the blood vessels? vasodilation of arteries, veins, and coronary arteries Why do we use nitrates in coronary artery disease? reduces heart workload and lowers the myocardial oxygen demand; overall reducing work done by the heart what is the short term and long term effects of organic nitrates? - short term: terminate acute angina episode associated with coronary artery disease - long term: decrease severity and frequency of episodes what is the drug class of nitroglycerine? organic nitrates What are the administration routes and special considerations of nitroglycerine? - sublingual: peak plasma level in 2-4 mins - PO, transmucosal, and topical: large first pass effects; wear gloves with topical - IV: use UV protectant glass bottle and special tubing because plastic absorbs the med and UV rays degrade it - extended release PO and transdermal: only used for prophylaxis due to slow onset; take patch off at night what are the adverse effects/safety considerations associated with nitroglycerine? - headache due to dilation of cerebral vessels - reflex tachycardia - orthostatic hypotension - tolerance - caution with other HTN meds - NO VIAGRA/SILDENAFIL!!! how can we avoid a tolerance to nitroglycerin? start with the lowest dose, avoid foods containing nitrates, remove transdermal patch at bedtime what are the other nitrate drugs and the differences between them? - isosorbide dinitrate: rapid and long acting forms - isosorbide mononitrate: primarily long acting what drug class contains meds that end in "-lol"? beta-adrenergic blockers what is the mechanism of action of beta-adrenergic blockers? reduce workload by slowing HR and reducing contractility what is the therapeutic use of beta blockers? decrease HR, treat HF, HTN, angina, and MI, and occasionally migraines what are some side effects associated with beta blockers? fatigue/activity intollerance, insomnia, drowsiness, impotence, bradycardia, confusion abrupt cessation can cause rebound HTN, angina, and MI what are some nursing considerations for beta blockers? - check BP and HR before administering, during treatment, and after effects have taken effect - hold if HR is less than 60 bpm or if BP is low what is the mechanism of action of calcium channel blockers? inhibit calcium transport into myocardial cells which causes heart vessel vasodilation and decreased work load to the heart What is the therapeutic use of calcium channel blockers? lowers blood pressure by reducing force of heart contractions what are the adverse effects of calcium channel blockers? hypotension, bradycardia, heart failure, constipation, headache, dizziness, and edema what drugs are in the calcium channel blocker class? diltiazem and verapamil What drugs fall into the thrombolytic drug class? alteplase and reteplase (end in "-ase") what is the mechanism of action of thrombolytic drugs? acts by cleaving plasminogen which forms plasmin and then degrades the fibrin matrix of the thrombi what are the therapeutic uses of thombolytics? - dissolve clots obstructing coronary arteries - restore myocardial circulation in acute MI What are the safety considerations/adverse effects for thrombolytic drugs?