Chapter 28: Diuretic Drugs Flashcards
What are the 3 types of diuretic drugs?
- loop diuretics
- potassium-sparing diuretics
- thiazide and thiazide-like diuretics
Diuretics
drugs that accelerate the rate of urine formation via a variety of mechanisms.
Result of diuretics is
the removal of sodium and water from the body
Loop Diuretics include
furosemide, bumetanide, torsemide
Mechanism of Action: Loop Diuretics
blocks sodium reabsorption in the thick ascending loop of Henle
Loop Diuretics: Drug Effects
- Potent diuresis and subsequent loss of fluid
- Decreased fluid volume
- Potassium and sodium depletion
Loop Diuretics: Indications
- Edema associated with HF or hepatic or renal disease
- Hypertension
- Hypercalcemia (calcium excretion by kidneys)
- Congestive Heart Failure (from diastolic dysfunction)
Loop Diuretics: Adverse Affects to the CNS
- blurred vision
- dizziness
- headache
- tinnitus
Loop Diuretics: Adverse Affects to GI system
nausea, vomiting, diarrhea
Loop Diuretics: Adverse Affects to Integumentary System
stevens-johnson syndrome (torsemide)
Loop Diuretics: Adverse Affects to Hematologic
Agranulocytosis, neutropenia, thrombocytopenia
Loop Diuretics: Adverse Affects to Metabolic System
hypokalemia, hyperglycemia and hyperuricemia
Potassium-Sparing Diuretics
-amiloride
-spironolactone
-triamterene
aka aldosterone-inhibiting diuretics
Mechanism of Action: Potassium-Sparing Diuretics
blocks aldosterone action in the kidney
Potassium-Sparing Diuretics: Drug Effects
- Prevent potassium from being pumped into the tubule, thus preventing its secretion
- Competitively block aldosterone receptors and inhibit their action
Potassium-Sparing Diuretics: Indications
- spironolactone and triamterene:
- Hyperaldosteronism
- Hypertension
- Reversing potassium loss caused by potassium-losing drugs
- Certain cases of CHF
Potassium-Sparing Diuretics: Adverse Effects on CNS
dizziness, headache
Potassium-Sparing Diuretics: Adverse Effects on GI
cramps, nausea, vomiting, diarrhea
Potassium-Sparing Diuretics: Adverse Effects on other systems
urinary frequency, weakness, and hyperkalemia
Potassium-Sparing Diuretics: Adverse Effects due to spironolactone
gynecomastia, irregular menses
Thiazide diuretics include
- hydrochlorothiazide
- Chlorothiazide
Thiazide-like diuretics include
- metolazone
- chlorthalidone
- indapamide
Mechanism of Action: Thiazide and Thiazide-like Diuretics
Inhibit tubular resorption of sodium, chloride, and potassium ions
Thiazide and Thiazide-like Diuretics: Drug Effects
- Works primarily in the distal convoluted tubule
- Excretion of water, sodium, and chloride
- Lowered peripheral vascular resistance
Thiazide and Thiazide-like Diuretics: Indications
- Hypertension
- Edema
- Hypercalciuria
- Congestive Heart failure
- Ascites related to HF, hepatic cirrhosis
Thiazide and Thiazide-like Diuretics: Adverse Effects on CNS
dizziness, headache, blurred vision
Thiazide and Thiazide-like Diuretics: Adverse Effects on GI
anorexia, nausea, vomiting, diarrhea
Thiazide and Thiazide-like Diuretics: Adverse Effects on GU
impotence
Thiazide and Thiazide-like Diuretics: Adverse Effects on Hematologic
jaundice, leukopenia
Thiazide and Thiazide-like Diuretics: Adverse Effects on integumentary
urticaria, photosensitivity
Thiazide and Thiazide-like Diuretics: Adverse Effects on metabolic system
hyperglycemia, hyperuricemia, hyponatremia
Nursing Process: Assess
- perform thorough patient history and physical examination
- assess baseline fluid volume status, intake and output, serum electrolyte values, weight, and vital signs—especially postural BPs
- Assess for disorders that may contraindicate or necessitate cautious use of these drugs
During diuretic therapy, the nurse should
- instruct patients to take the medication in the morning if possible to avoid interference with sleep patterns
- monitor serum potassium levels during therapy
- monitor adverse effects
- monitor for therapeutic effects
What should the nurse teach the patient going through diuretic drug therapy?
- teach patients to maintain proper nutritional and fluid volume status
- to eat more potassium-rich foods when taking anything but the potassium-sparing drugs
Food high in potassium include
bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish, and legumes
Patients taking diuretics along with a digitalis preparation should
be taught to monitor for digitalis toxicity
Patients with diabetes mellitus who are taking thiazide and/or loop diuretics should
be told to monitor blood glucose and watch for elevated levels
Why should a nurse teach patients to change positions slowly and to rise slowly after sitting or lying down?
to prevent dizziness and fainting related to orthostatic hypotension
The nurse should encourage patients to
keep a log of their daily weight and remind them to return for follow-up visits and lab work.
Patients who have been ill with nausea, vomiting and/or diarrhea should
-notify their primary care provider because fluid and electrolyte balances can result.
Signs and symptoms of hypokalemia include
muscle weakness, constipation, irregular pulse rate, and overall feeling of lethargy
What should the nurse advise the patient to do if they are experiencing rapid heart rates or syncope (reflects hypotension or fluid loss)?
to notify their primary care provider immediately
Excessive consumption of licorice can lead to
additive hypokalemia in patients taking thiazides
What should the nurse monitor for in patients taking potassium-sparing diuretics?
hyperkalemia
Adverse Effects when taking Diuretics
Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alertness
When monitoring for therapeutic effects of diuretic therapy, the nurse should look at…
- Reduction of edema
- Reduction of fluid volume overload
- Improvement in manifestations of heart failure
- Reduction of hypertension
- Return to normal intraocular pressures
