Chapter 37: Diuretics Flashcards
K wasting diuretics
- Thiazide
chlorothiazide (Diuril)
hydrochlorothiazide (Microzide)
work in the distal tubule - Loop
furosemide (Lasix) -common inpatient med
bumetanide (Bumex) -common outpatient med (less SE and one time dosage)
Torsemide (Demadex)
work in the loop of henle
K sparing diuretics
Spironolactone (Aldactone)
Triamterene (Dyrenium)
Amiloride (Midamor)
work in the collecting tubule
weak diuretics
osmotic diuretics
mannitol
use for cerebral edema
work in the proximal tubule
Carbonic anhydrase inhibitors
used for glaucoma and alt. sickness. Do not promote urine excretion, promote loss of bicarb. Ex. Acetazolamide
work in proximal tubule
thiazide diuretic MOA
Inhibits distal tubule sodium and chloride reabsorption -> inhibits water reabsorption
thiazide diuretic use
Treats HTN and Peripheral Edema
thiazide diuretic SE
FVD (dehydration)
Orthostatic hypotension
Dizziness, fainting
Muscle cramps
Hypokalemia,
Hyponatremia
Hypomagnesemia
Hypercalcemia,
Hyperglycemia, Hyperuricemia, Hyperlipidemia
*keep in mind losing E and water
thiazide diuretic contraindications
Ineffective in someone who has low GFR. Need adequate kidney function to take thiazide.
loop diuretic MOA
Inhibits loop of Henle and proximal and distal tubule sodium and chloride reabsorption. Rapid Loss of Na, Cl, K, Mg, Ca, H20
LOH is very hypotonic and pulls lots of water and E and does not let it get reabsorbed
loop diuretic use
Edema, Pulmonary edema, HTN, CHF
Can be used in someone who has impaired renal function
Most effective -60x more potent than thiazide
loop diuretic admin
PO, IV
After PO admin diuresis should begin in 60 min and lasts about 6hr. Make sure they take these in the AM
loop diuretic SE
FVD
Hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia,
Orthostatic hypotension (med needs to be held or d/c)
Dysrhythmias (dt hypoK, esp. ventricular)
Ototoxicity (large doses, usually temp)
loop diuretic drug interactions
Digoxin* -r/o toxicity. Dig stays in blood longer with hypoK (inverse relationship)
Prescribing considerations for K wasting diuretics: therapeutic goal
tx of HTN and edema. Low dose: ~ 20mg/day. Start there and see how therapeutic it is.
Prescribing considerations for K wasting diuretics: baseline data
Weight VS, electrolytes
Administer in the AM
prescribing considerations for K wasting diuretics: identifying high risk patient
Use cautiously with CV patients , renal patients, DM, patients taking with Digoxin and other HTN meds (hypotension)
Prescribing considerations for K wasting diuretics: evaluating therapuetic effects
Pat should weigh themselves daily and evaluate for decreased edema. Monitor for S/S of hypokalemia
Minimizing Effects: Initiate with low doses, adjust doses carefully.
food sources of K
yogurt, bananas, spinach, acorn squash, fish, white bean,. oranges, tomatoes, avocados, mushrooms, dried apricots, baked potato
K sparing diuretics MOA
Blocks Aldosterone (mineralocorticoid) in distal tubule decreasing Na and water reabsorption and increasing K retention
K sparing diuretics use
Edema, HTN, diuretic induced hypokalemia, CHF
K sparing diuretics SE
FVD
Electrolyte abnormalities
Hyperkalemia*** (S&S)
Endocrine effects: Gynecomastia, Hirsutism, Menstrual irregularities, Impotence, Deepening of the voice
prescribing considerations for K sparing diuretics
Similar to K wasting EXCEPT:
Effects may take up to 48 hours
Tell pt to avoid foods high in potassium
Monitor SS of hyperkalemia and K level (no salt substitute)
