Pharmacology Exam Review

Furosemide - Loop Diuretic ACTIONS: inhibits reabsorption of sodium & water in the thick ascending Loop of Henle and the distal renal tubule, resulting in increased excretion of sodium, water, potassium, calcium and ...

Furosemide - Loop Diuretic ACTIONS: inhibits reabsorption of sodium & water in the thick ascending Loop of Henle and the distal renal tubule, resulting in increased excretion of sodium, water, potassium, calcium and magnesium. Also increases renal blood flow and decreases BP through vasodilation effects. USES: Heart failure, renal dysfunction, HTN, nephrotic syndrome, acute pulmonary and peripheral edema, hypercalcemia --Potent, fast acting protein binding drug --SE: hypokalemia, hypochloremia, hyperglycemia, metabolic alkalosis, GI disturbances, photosensitivity, dizziness, headache, weakness, rash, blurred vision, tingling/prickling sensation, and elevated uric acid levels --AR: orthostatic hypotension, hyperglycemia, gout, hearing loss, hypercholesterolemia --Life threatening: Renal failure, aplastic anemia, thrombocytopenia, agranulocytosis, Stevens-Johnson syndrome --Contraindication: presence of severe electrolyte imbalances, hypovolemia, anuria, hepatic coma, hypersensitivity to sulfonamides --Caution: HF, DM, hypotension, systemic lupus erythematosus, gout, nephrotoxicity, and patients with hearing impairment, acute MI, Geriatrics, BPH --Drug interactions: orthostatic hypotension with alcohol; ototoxicity with aminoglycosides; increased bleeding with anticoagulants; hypokalemia with steroids and amiodarone; digitalis toxicity and cardiac dysrhythmia with digoxin and hypokalemia; increased lithium toxicity; increased amphotericin B ototoxicity and nephrotoxicity; licorice may increase potassium loss; Hawthorn herbal may cause hypotension; ginseng may decrease diuretic action; and numerous serum electrolyte imbalances ASSESS/MONITOR: low BP, increased glucose, low K+/Mg++/Na+/Cl- labs NURSING: Assess orthostatic vitals; teach to sit up first before standing; never give drug until fluid status is known; assess BUN/CR prior to administration; teach to report dizziness, weight loss, tinnitus, N/V Hydrochlorothiazide (HCTZ) - Thiazide Diuretic ACTIONS: acts on the (DCT) distal convoluted renal tubule to promote sodium, water, potassium and chloride excretion and calcium reabsorption. Also decreasing cardiac output and preload, decreases edema, ascites on arterioles and causes vasodilation (thus decreasing BP). USES: Increase urine output, HTN, edema, HF, nephrotic syndrome and ascites --mildly potent, moderate protein binding with longer action onset than furosemide --take with K+ supplement. Potassium rich foods: bananas, oranges --SE: electrolyte imbalances, GI disturbances, photosensitivity, hyperglycemia, dizziness, headache, weakness, rash, blurred vision, tingling/prickling sensation, and elevated uric acid levels --AR: orthostatic hypotension, hyponatremia, gout --Life threatening: severe hypokalemia, aplastic anemia, hemolytic anemia, thrombocytopenia, agranulocytosis, renal failure, and Stevens-Johnson syndrome --Contraindication: renal failure, hypersensitivity --Caution: hepatic/renal dysfunction, DM, hypotension, systemic lupus erythematosus, gout, and electrolyte imbalance --Drug interactions: hypokalemia could cause toxicity with Digoxin; renal toxicity with aspirin, hypokalemia with steroids; decreased diuretic absorption and effects with NSAIDs, cholestyramine, and colestipol; hypercalcemia, hyperglycemia and increased uric acid levels. --Herbal interactions: Ginkgo may increase BP, Aloe & Licorice may increase potassium loss, and Hawthorn may cause hypotension