Diuretic Drugs Flashcards
Furosemide (Lasix)
Chemical Classification
Sulfonamide derivative
Furosemide (Lasix)
Functional Classification
Loop Diuretic
Furosemide (Lasix)
Mechanism of Action
Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle
Furosemide (Lasix)
Uses
Pulmonary edema; edema with CHF, hepatic disease, nephrotic syndrome, ascites, hypertension
Furosemide (Lasix)
Contraindications
Breastfeeding, infants, anuria, hypovolemia, electrolyte depletion
Furosemide (Lasix)
Side Effects
CNS: headache, fatigue, weakness, vertigo, paresthesias
CV: orthostatic hypotension, chest pain, ECG changes, CIRCULATORY COLLAPSE
EENT: loss of hearing, ear pain, tinnitus, blurred vision
ELECT: Hypokalemia, Hypochloremic Alkalosis, Hypomagnesemia, Hyperuricemia, Hypocalcemia, Hyponatremia, metabolic alkalosis
ENDO: Hyperglycemia
GI: Nausea, diarrhea, dry mouth, vomiting, anorexia, cramps, oral, gastric irritations, pancreatitis
GU: Polyuria, RENAL FAILURE, glycosuria
HEMA: THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, NEUTROPENIA, ANEMIA
INTEG: Rash, Pruritus, purpura, STEVENS-JOHNSON SYNDROME, sweating, photosensitivity, urticaria
MS: cramps, stiffness
Furosemide (Lasix)
Nursing Considerations
ASSESS:
- CHF: weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily
- HYPERTENSION: BP lying, standing; postural hypotension may occur
- Metabolic alkalosis: drowsiness, restlessness
- HYPOKALEMIA: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness
- Rashes, temp elevation daily
- Confusion, especially in geriatric patients; take safety precautions if needed
- HEARING, including tinnitus and hearing loss, when giving high doses for extended periods
- Rate, depth, rhythm of respiration, effect of exertion, lung sounds
- Electrolytes (potassium, sodium, chloride); include BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid
- Glucose in urine if patient diabetic
- Allergies to sulfonamides, thiazides
PERFORM/PROVIDE
-Increased fluid intake 2-3L/day unless contraindicated
Furosemide (Lasix)
Overdose Treatment
Lavage if taken orally; monitor electrolytes; administer dextrose in saline; monitor hydration, CV, renal status
Hydrochlorothiazide
Functional Classification
Thiazide diuretic, antihypertensive
Hydrochlorothiazide
Chemical Classification
Sulfonamide derivative
Hydrochlorothiazide
Mechanism of Action
Acts on distal tubule and ascending limb of loop of Henle by increasing excretion of water, sodium, chloride, potassium
Hydrochlorothiazide
Uses
Edema, hypertension, diuresis, CHF; edema in corticosteroid, estrogen, NSAIDs; idiopathic lower extremity edema therapy
Hydrochlorothiazide
Contraindications
Hypersensitivity to thiazides or sulfonamides, anuria, renal decompensation, hypomagnesemia
Hydrochlorothiazide
Side Effects
CNS: drowsiness, paresthesia, depression, headache, Dizziness, Fatigue, Weakness, fever
CV: irregular pulse, orthostatic hypotension, palpitations, volume depletion, allergic myocarditis
EENT: blurred vision
ELECT: Hypokalemia, hypercalcemia, hyponatremia, hypochloremia, hypomagnesemia
GI: Nausea, Vomiting, Anorexia, constipation, diarrhea, cramps, pancreatitis, GI irritation, HEPATITIS
GU: Urinary Frequency, polyuria, UREMIA, GLUCOSURIA, hyperuricemia
HEMA: APLASTIC ANEMIA, HEMOLYTIC ANEMIA, LEUKOPENIA, AGRANULOCYTOSIS, THROMBOCYTOPENIA, NEUTROPENIA
INTEG: Rash, urticaria, purpura, photosensitivity, alopecia, erythema multiforme
META: Hyperglycemia, Hyperuricemia, increased creatinine, BUN
Hydrochlorothiazide
Nursing Considerations
ASSESS:
- Weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily
- Rate, depth, rhythm of respiration, effect of exertion
- BP lying, standing; postural hypotension may occur
- Blood studies: BUN, blood glucose, CC, serum creatinine, blood pH, ABGs, uric acid, electrolytes
- SIGNS OF METABOLIC ALKALOSIS: drowsiness, restlessness
- SIGNS OF HYPOKALEMIA: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness, dehydration
- Confusion, especially in geriatric patients; take safety precautions if needed
Hydrochlorothiazide
Overdose Treatment
Lavage if taken orally; monitor electrolytes; administer dextrose in saline; monitor hydration, CV, renal status
Mannitol
Functional Classification
Diuretic, osmotic
Mannitol
Chemical Classification
Hexahydric Alcohol
Mannitol
Mechanism of Action
Acts by increasing osmolarity of glomerular filtrate, which inhibits reabsorption of water and electrolytes and increases urinary output
Mannitol
Uses
Edema; promotion of systemic diuresis in cerebral edema; decreased in intraocular/intracranial pressure; improved renal function in acute renal failure, chemical poisoning
Mannitol
Contraindications
Active intracranial bleeding, hypersensitivity, anuria, severe pulmonary congestion, edema, severe dehydration, progressive heart, renal failure
Mannitol
Side Effects
CNS: dizziness, headache, SEIZURES, REBOUND INCREASED ICP, confusion
CV: edema, thrombophlebitis, hypo/hypertension, TACHYCARDIA, angina-like chest pains, fever, chills, CHF, CIRCULATORY OVERLOAD
EENT: loss of hearing, blurred vision, nasal congestion, decreased intraocular pressure
ELECT: fluid, electrolyte imbalances, Acidosis, electrolyte loss, dehydration, hypo/hyperkelemia
GI: Nausea, Vomiting, dry mouth, diarrhea
GU: marked diuresis, urinary retention, thirst
RESP: pulmonary congestion
Mannitol
Nursing Considerations
ASSESS:
- Weight, I&O daily to determine fluid loss; effect of product may be increased if used daily; output every hour prn
- Rate, depth, rhythm of respiration, effect of exertion
- BP lying, standing; postural hypotension may occur
- Electrolytes: potassium, sodium, chloride; include BUN, CBC, serum creatinine, blood pH, ABGs, CVP, PAP
- METABOLIC ACIDOSIS: drowsiness, restlessness
- HYPOKALEMIA: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness, or hyperkalemia
- rashes, temp daily
- confusion, especially in geriatric patients; take safety precautions if needed
- Hydration including skin turgor, thirst, dry mucous membranes
- Blurred vision, pain in eyes before, during treatment (INCREASED INTRAOCULAR PRESSURE); neurologic checks, intracranial pressure during treatment (INCREASED INTRACRANIAL PRESSURE)
Mannitol
Overdose treatment
Discontinue inf; correct fluid, electrolyte imbalances; hemodialysis, monitor hydration, CV status, renal function
Spironolactone (Aldactone)
Functional Classification
Potassium-Sparing Diuretic
Spironolactone (Aldactone)
Chemical Classification
Aldosterone Antagonist
Spironolactone (Aldactone)
Mechanism of Action
Completes with aldosterone at receptor sites in distal tubule, thereby resulting in the excretion of sodium chloride and water and the retention of potassium and phosphate
Spironolactone (Aldactone)
Uses
edema of CHF, hypertension, diuretic-induced hypokalemia, primary hyperaldosteronism (diagnosis, short-term treatment, long-term treatment), edema of nephrotic syndrome, cirrhosis of liver with ascites
Spironolactone (Aldactone)
Contraindications
Pregnancy (D), hypersensitivity, anuria, severe renal disease, hyperkalemia
Spironolactone (Aldactone)
Side Effects
CNS: Headache, confusion, drowsiness, lethargy, ataxia,
ELECT: hyperchloremic metabolic acidosis, HYPERKALEMIA, hyponatremia
ENDO: impotence, gynecomastia, irregular menses, amenorrhea, postmenopausal bleeding, hirsutism, deepening voice, breast pain
GI: Diarrhea, cramps, BLEEDING, gastritis, Vomiting, anorexia, nausea, HEPATOCELLULAR TOXICITY
HEMA: AGRANULOCYTOSIS
INTEG: Rash, Pruritus, urticaria
Spironolactone (Aldactone)
Nursing Considerations
ASSESS:
- HYPOKALEMIA: polyuria, polydipsia; dysrhythmias, including a u wave on ECG
- HYPERKALEMIA: weakness, fatigue, dyspnea, dysrhythmias, confusion, fatigue
- Electrolytes: sodium, chloride, potassium, BUN, serum creatinine, ABGs, CBC
- Weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily; ECG periodically with long-term therapy
- Signs of metabolic acidosis: drowsiness, restlessness
- Rashes,temp daily
- Confusion, especially in geriatric patients; take safety precautions if needed
- Hydration: skin turgor, thirst, dry mucous membranes
Spironolactone (Aldactone)
Overdose Treatment
Lavage if taken orally; monitor electrolytes, administer IV fluids, monitor hydration, renal, CV status
