NR 508 Final Exam study guide

NR 508 Final Exam study guide Cardiovascular management: 1. Know Initial treatment choices for HTN AceI- sartans Arbs- ipine, verapamil & diltazem Thiazide- iaside, chlorthalidone, imdapamide, metolazone calcium channel blocker 2. Know first line treatment options for HTN for African Americans without renal impairment. Calcium channel blockers Thiazide 3. First line option for HTN for anyone with chronic kidney disease Ace inhibitors ARB’s Diuretics: 4. Types, Uses, Side effects Thiazides (HCTZ) Uses- HTN, CHF, edema, useful in decreases calcium stone formation Off label HCTZ- osteoporosis and diabetes AE- hypokalemia, hyperglycemia, arrhythmias, metabolic alkalosis, fatigue, postural Hypotension Loop diuretics (furosemide, torsemide, ethacrynic acid) *preferred diuretics for renal Impairment Uses- CFH, HTN, nephrotic syndrome, cirrhosis, pulmonary edema AE-hypocalcemia, hyponatremia, hypokalemia, ototoxicity Carbonic anhydrase inhibitors (acetazolamide) *weak diuretic Uses- edema, epilepsy, glaucoma, mountain sickeness AE- toxic epidermal necrolysis, agranulocytosis, aplastic anemia, thrombocytopenia, metabolic acidosis Potassium-sparing (spironolactone, eplerenone) Uses- CHF (in combo with thiazides or ACE and loop), HTN AE-gynomastia, n/v, erectile dysfuction, electrolyte imbalance, metabolic acidosis **postdiuretic sodium retention- It is important for pts to adhere to a low sodium diet. As drug concentrations fall, there is a period of positive sodium balance ** If a pt has a sulfa allergy= take ethacrynic acid 5. Preferred diuretic with renal impairment-  Loop diuretics because they retain efficacy even with moderate renal insufficiency: such as furosemide, buetanide, torsemide, ethacrynic acid.  Uses: Edematous states (HF, cirrhosis, pulmonary edema, nephrotic syndrome), hypercalcemia 6. Side effect of post diuretic sodium retention pg 374 As drug concentrations decrease, period of + Na balance, this is the post diuretic sodium retention If there is a high Na intake then Na lost with diuresis is offset.. diuretic resistance 7. Recognition that some diuretics are sulfa derivatives (carbonic anhydrase inhibitors, loop diuretics, thiazides, but NOT ethacrynic acid)  Loops- Examples: furosemide, bumetanide, torsemide, ethacrynic acid "The Loop FURiously BUMmed my TORSo like ACID" Common side effects: orthostatic hypotension, excessive diuresis, tinnitus, vertigo, hyperuricemia note all these are precursors to toxicity