Exam 2 study guide
For all medications we discussed know drug class, mode of action, uses, desired effects, side effects,
drug-drug interactions, nursing assessment and patient education with regard to the med and diet if
applicable
Diuretics – Uses, know how each class works, know what lab values you should monitor for each class
and what labs you expect to increase or decrease based on the medication they are taking.
Notes in class P. 325 Table
● Loop Diuretics: They are indicated for the treatment of HTN, heart failure, and disorders
characterized by accumulation of edema fluid.
○ Uses: To reduce edema associated with heart failure, hepatic cirrhosis, or CKD.
○ How it works: Act on the ascending limb on the nephron loop to block the reabsorption
of Na, Cl, and H2O. Excretion of K is increased.
○ Lab values to monitor: Potassium
○ In Class notes: Most effective diuretic (lasix specifically), works on the loop of Henle),
reduces Potassium (KNOW: Potassium 3.5-5.5), rids of Na (KNOW: NA 135-145) and
other electrolytes. Pt education, do not limit Na, do not stop abruptly. Take them on the
set schedule always. PO takes 20-30 mins onset. Check BP/urine output.
○ All end in IDE
○ P326 KNOW chart:
● Thiazide Diuretics:
○ Uses: Treatment of mild to moderate HTN, edema due to mild to moderate heart
failure, liver failure, CKD.
○ How it works: Act on early distal convoluted tubule (DCT) to block the reabsorption of
Na, Cl, and H2O. Excretion of K is increased. (gets rid of potassium)
○ Lab values to monitor: Na, K, Cl
○ In Class notes: *NEED TO KNOW* Drug interactions: anticoagulants, sulfonylureas, and
antidiabetic drugs, including insulin. Cholestyramine and colestipol decrease the
absorption of hydrochlorothiazide and reduce its effectiveness. Hydrochlo-rothiazide
increases the risk of nephrotoxicity from NSAIDs. Hypokalemia caused by
hydrochlorothiazide may increase digoxin toxicity. Carbamazepine should be used
with caution with hydrochlorothiazide because they may increase each other’s
toxicity.
● Potassium Sparing Diuretics: Also aldosterone antagonist. holds onto K+
○ Uses: Increases diuresis without affecting K.
○ How it works: Act on DCT (distal convoluted tube) and collect ducts to block the
reabsorption of Na and reduce secretion of K. Excretion of K is not increased.
○ Labs to value: Monitor for hyperkalemia.
○ In Class notes: Potassium goes up in labs
Think - How do you know the meds are working? Will know if they’re working if BP is coming down-it
will improve. output will be at least 30mL/hr.
,Please know normal lab values so you can recognize if they are low or high
●Na: 135-145
●K: 3.5-5
●Cl: 96-108
●LBUN: 7-20
●Cr: 0.7-1.4
Loop – Ex. Bumetanide (Bumex), Furosemide (Lasix)
● Bumetanide (Bumex)
○ Drug class: Loop Diuretic
○ Mode of action: Inhibits the reabsorption of Na and Cl from the loop of Henle
and distal renal tubule.
○ Uses: Edema due to heart failure, hepatic disease, or renal impairment.
○ Desired effects: Diuresis and subsequent mobilization of excess fluid.
○ Side effects: Hypokalemia, orthostatic hypotension, electrolyte depletion,
dehydration, hypotension, hyponatremia, hyperglycemia, coma.
○ Drug-drug interaction: Increased risk of hypotension with antihypertensives,
nitrates, and alcohol. Hypokalemia with other diuretics.
○ Nurse assessment: Assess fluid status, monitor BP.
○ Patient education: Change positions slowly to minimize orthostatic hypotension.
○ Lab values: Monitor electrolytes.
● Furosemide (lasix):
○ Drug class: Loop Diuretic.
○ Mode of action: Acts by preventing the reabsorption of Na in the nephron loop.
○ Uses: Treatment of acute heart failure and hypertension. Get rid of fluid from
liver failure (Ascites)
○ Desired effects: Quick relief from distressing symptoms. Less edema, decreased
BP
○ Side effects: Hypokalemia, possible dehydration and hypotension. ototoxicity,
hearing loss, syncopy
○ Drug-drug interaction: May cause dysrhythmias patients taking digoxin. Use
cautiously with aminoglycosides due to possible nephrotoxicity and ototoxicity.
May diminish hypoglycemic effects of insulin.
○ Nurse assessment: Assess serum potassium levels.
○ Patient education: Change positions slowly. reduce sodium in your diet. diet.
lifestyle modifications, increase fruits and veggies, no smoking or alcohol
○ Lab values: Blood glucose, BUN, serum amylase, cholesterol, triglycerides, and
serum electrolytes. Creatinine. Measure I&Os (30ml/hr or 0.5ml/kg/hr)
○ works within 5 minutes via IV, within 30-60 min via PO (peaks at 60-70) min.
○ Overdose: Give fluids-watch for increased output to see if intervention worked
K sparing diuretics - Spironolactone
, ● Spironolactone:
○ Drug class: K sparing diuretic. aldosterone antagonist
○ Mode of action: acts by inhibiting aldosterone, the hormone secreted by the
adrenal cortex responsible for increasing the renal reabsorption of Na+ in
exchange for K+, thus causing water retention.
○ Uses: To treat mild HTN. primary aldosteronism?
○ Desired effects: Reduce enema, reduce blood pressure.
○ Side effects: Hyperkalemia (muscle weakness, fatigue, bradycardia). In men, it
can cause gynecomastia, impotence, and decreased libido. Women may
experience menstrual irregularities, and breast tenderness.
○ Drug-drug interaction: Aspirin, salicylates, ACE inhibitors
○ Nurse assessment: Monitor I&Os. Periodic ECGs are recommended. monitor BP
○ Patient education: Take with food to increase absorption. Do not take with
Potassium
○ Lab values: potassium, sodium levels, BUN, creatinine
○class notes: do not take K+ with it. if K+ is high don’t give it.
○ Overdose: Fluids, vasopressors.
An ACE inhibitor in combination with spironolactone - gonna monitor CMP!
Thiazide diuretics - HCTZ, chlorothiazide All diuretics CHECK URIC ACIDS (Kidneys) so check
BUN/Creatinine! These are combined with other antihypertensive med (they are fabricated this way)
● HCTZ (hydrochlorothiazide):
○ Drug class: Thiazide diuretic.
○ Mode of action: Act on early DCT to block the reabsorption of Na, Cl, and H2O.
Excretion of K is increased.
○ Uses: Most prescribed diuretic for HTN, edema, Heart failure
○ Desired effects: Reduce HTN and edema.
○ Side effects: Electrolyte imbalances. May precipitate gout attacks due to
tendency to cause hyperuricemia.
○ Drug-drug interaction: Other antihypertensive drugs have synergistic effects.
May reduce the effectiveness of anticoagulants, sulfonylureas, and antidiabetic
drugs. Increases the risk of nephrotoxicity from NSAIDs, digoxin, other
hypertensives, antidiabetic meds, Cholestyramine, Carbamazapine
○ Nurse assessment: Assess BP, and bowel movement.
○ Patient education: Take in the morning to prevent nocturia.
○ Lab values: Serum glucose, cholesterol, bilirubin, triglycerides, calcium levels.
BUN, CREATININE. Na and K, Complete Metabolic Panel
● Chlorothiazide:,
○ Drug class: Thiazide diuretic.
○ Mode of action: Act on early DCT to block the reabsorption of Na, Cl, and H2O.
Excretion of K is increased.
○ Uses: Management of mild to moderate HTN.
○ Desired effects: Lower BP
○ Side effects: Hypotension, dizziness, lethargy, weakness.
For all medications we discussed know drug class, mode of action, uses, desired effects, side effects,
drug-drug interactions, nursing assessment and patient education with regard to the med and diet if
applicable
Diuretics – Uses, know how each class works, know what lab values you should monitor for each class
and what labs you expect to increase or decrease based on the medication they are taking.
Notes in class P. 325 Table
● Loop Diuretics: They are indicated for the treatment of HTN, heart failure, and disorders
characterized by accumulation of edema fluid.
○ Uses: To reduce edema associated with heart failure, hepatic cirrhosis, or CKD.
○ How it works: Act on the ascending limb on the nephron loop to block the reabsorption
of Na, Cl, and H2O. Excretion of K is increased.
○ Lab values to monitor: Potassium
○ In Class notes: Most effective diuretic (lasix specifically), works on the loop of Henle),
reduces Potassium (KNOW: Potassium 3.5-5.5), rids of Na (KNOW: NA 135-145) and
other electrolytes. Pt education, do not limit Na, do not stop abruptly. Take them on the
set schedule always. PO takes 20-30 mins onset. Check BP/urine output.
○ All end in IDE
○ P326 KNOW chart:
● Thiazide Diuretics:
○ Uses: Treatment of mild to moderate HTN, edema due to mild to moderate heart
failure, liver failure, CKD.
○ How it works: Act on early distal convoluted tubule (DCT) to block the reabsorption of
Na, Cl, and H2O. Excretion of K is increased. (gets rid of potassium)
○ Lab values to monitor: Na, K, Cl
○ In Class notes: *NEED TO KNOW* Drug interactions: anticoagulants, sulfonylureas, and
antidiabetic drugs, including insulin. Cholestyramine and colestipol decrease the
absorption of hydrochlorothiazide and reduce its effectiveness. Hydrochlo-rothiazide
increases the risk of nephrotoxicity from NSAIDs. Hypokalemia caused by
hydrochlorothiazide may increase digoxin toxicity. Carbamazepine should be used
with caution with hydrochlorothiazide because they may increase each other’s
toxicity.
● Potassium Sparing Diuretics: Also aldosterone antagonist. holds onto K+
○ Uses: Increases diuresis without affecting K.
○ How it works: Act on DCT (distal convoluted tube) and collect ducts to block the
reabsorption of Na and reduce secretion of K. Excretion of K is not increased.
○ Labs to value: Monitor for hyperkalemia.
○ In Class notes: Potassium goes up in labs
Think - How do you know the meds are working? Will know if they’re working if BP is coming down-it
will improve. output will be at least 30mL/hr.
,Please know normal lab values so you can recognize if they are low or high
●Na: 135-145
●K: 3.5-5
●Cl: 96-108
●LBUN: 7-20
●Cr: 0.7-1.4
Loop – Ex. Bumetanide (Bumex), Furosemide (Lasix)
● Bumetanide (Bumex)
○ Drug class: Loop Diuretic
○ Mode of action: Inhibits the reabsorption of Na and Cl from the loop of Henle
and distal renal tubule.
○ Uses: Edema due to heart failure, hepatic disease, or renal impairment.
○ Desired effects: Diuresis and subsequent mobilization of excess fluid.
○ Side effects: Hypokalemia, orthostatic hypotension, electrolyte depletion,
dehydration, hypotension, hyponatremia, hyperglycemia, coma.
○ Drug-drug interaction: Increased risk of hypotension with antihypertensives,
nitrates, and alcohol. Hypokalemia with other diuretics.
○ Nurse assessment: Assess fluid status, monitor BP.
○ Patient education: Change positions slowly to minimize orthostatic hypotension.
○ Lab values: Monitor electrolytes.
● Furosemide (lasix):
○ Drug class: Loop Diuretic.
○ Mode of action: Acts by preventing the reabsorption of Na in the nephron loop.
○ Uses: Treatment of acute heart failure and hypertension. Get rid of fluid from
liver failure (Ascites)
○ Desired effects: Quick relief from distressing symptoms. Less edema, decreased
BP
○ Side effects: Hypokalemia, possible dehydration and hypotension. ototoxicity,
hearing loss, syncopy
○ Drug-drug interaction: May cause dysrhythmias patients taking digoxin. Use
cautiously with aminoglycosides due to possible nephrotoxicity and ototoxicity.
May diminish hypoglycemic effects of insulin.
○ Nurse assessment: Assess serum potassium levels.
○ Patient education: Change positions slowly. reduce sodium in your diet. diet.
lifestyle modifications, increase fruits and veggies, no smoking or alcohol
○ Lab values: Blood glucose, BUN, serum amylase, cholesterol, triglycerides, and
serum electrolytes. Creatinine. Measure I&Os (30ml/hr or 0.5ml/kg/hr)
○ works within 5 minutes via IV, within 30-60 min via PO (peaks at 60-70) min.
○ Overdose: Give fluids-watch for increased output to see if intervention worked
K sparing diuretics - Spironolactone
, ● Spironolactone:
○ Drug class: K sparing diuretic. aldosterone antagonist
○ Mode of action: acts by inhibiting aldosterone, the hormone secreted by the
adrenal cortex responsible for increasing the renal reabsorption of Na+ in
exchange for K+, thus causing water retention.
○ Uses: To treat mild HTN. primary aldosteronism?
○ Desired effects: Reduce enema, reduce blood pressure.
○ Side effects: Hyperkalemia (muscle weakness, fatigue, bradycardia). In men, it
can cause gynecomastia, impotence, and decreased libido. Women may
experience menstrual irregularities, and breast tenderness.
○ Drug-drug interaction: Aspirin, salicylates, ACE inhibitors
○ Nurse assessment: Monitor I&Os. Periodic ECGs are recommended. monitor BP
○ Patient education: Take with food to increase absorption. Do not take with
Potassium
○ Lab values: potassium, sodium levels, BUN, creatinine
○class notes: do not take K+ with it. if K+ is high don’t give it.
○ Overdose: Fluids, vasopressors.
An ACE inhibitor in combination with spironolactone - gonna monitor CMP!
Thiazide diuretics - HCTZ, chlorothiazide All diuretics CHECK URIC ACIDS (Kidneys) so check
BUN/Creatinine! These are combined with other antihypertensive med (they are fabricated this way)
● HCTZ (hydrochlorothiazide):
○ Drug class: Thiazide diuretic.
○ Mode of action: Act on early DCT to block the reabsorption of Na, Cl, and H2O.
Excretion of K is increased.
○ Uses: Most prescribed diuretic for HTN, edema, Heart failure
○ Desired effects: Reduce HTN and edema.
○ Side effects: Electrolyte imbalances. May precipitate gout attacks due to
tendency to cause hyperuricemia.
○ Drug-drug interaction: Other antihypertensive drugs have synergistic effects.
May reduce the effectiveness of anticoagulants, sulfonylureas, and antidiabetic
drugs. Increases the risk of nephrotoxicity from NSAIDs, digoxin, other
hypertensives, antidiabetic meds, Cholestyramine, Carbamazapine
○ Nurse assessment: Assess BP, and bowel movement.
○ Patient education: Take in the morning to prevent nocturia.
○ Lab values: Serum glucose, cholesterol, bilirubin, triglycerides, calcium levels.
BUN, CREATININE. Na and K, Complete Metabolic Panel
● Chlorothiazide:,
○ Drug class: Thiazide diuretic.
○ Mode of action: Act on early DCT to block the reabsorption of Na, Cl, and H2O.
Excretion of K is increased.
○ Uses: Management of mild to moderate HTN.
○ Desired effects: Lower BP
○ Side effects: Hypotension, dizziness, lethargy, weakness.
