Diuretic Medications, Fluids, and Electrolytes Flashcards
What are Diuretic medications mainly used for?
- Also list additional uses.
Diuretic medications are used for maintenance of blood pressure, usually in cases of hypertension.
These medications are also used in treatment of heart failure (HF) and renal failure.
*Used for renal failure as long as failure is not too progressed (there are stages).
Why are the kidneys critical for day-to-day functioning of the body, i.e. what do they do?
The kidneys filter toxic waste products and conserve essential substances, such as water and electrolytes.
What substance does water always follow?
Sodium (Na+)!
What do diuretic drugs generally do, i.e. how do they produce therapeutic results?
- They accelerate the rate of urine formation
- They remove sodium (Na) and, therefore, water
This will, hopefully, result in the decrease of BP in those with hypertension.
How much of total sodium (Na) is absorbed at the following points in the nephron:
- Loop of Henle
- Proximal convoluted tubule
- Distal convoluted tubule
Why is this important to consider in regards to diuretic medications?
Loop of Henle = 25% or 1/4 of total sodium (Na)
Proximal convoluted tubule = majority of sodium; greater than the Loop of Henle
Distal convoluted tubule = small percentage of remaining sodium
This is important to consider in regards to diuretic medications because diuretics are classified based on where they act in the nephron (some medications will target areas of higher reabsorption while others won’t.
List the 4 types of Diuretic Drugs (Remember acronym you made up).
T = Thiazide and thiazide-like diuretics
L = Loop diuretics
P = Potassium-sparing diuretics
O = Osmotic diuretics
“The Loose P** Opens.”
Hydrochlorothiazide
- Class?
- MOA? (location of action, what it inhibits/stimulates, etc.)
- Prescribed for?
- Side effects?
- Nursing considerations? (monitor/check, important teaching points, etc.)
*How does this medication treat HF (when used for that)?
Class: Thiazide diuretic
MOA:
- Distal convoluted tubule
- Inhibits reabsorption of sodium (Na), chloride (Cl), potassium (K), and water, so more will be excreted in the urine
- Helps dilate small blood vessels, decreasing peripheral vascular resistance (additional mechanism to decrease BP)
Prescribed for:
- Hypertension
- Swelling d/t fluid build up
Side effects:
- Hypokalemia (low potassium)
- Hyponatremia (low sodium)
- Decreased libido
- Dizziness (especially in the beginning)
- Dehydration
Nursing considerations:
- Check BP (could be too low to give medication safely)
- Monitor labs; sodium (Na)/potassium (K) levels (too high sodium can effect the heart’s electrical action; too high potassium can affect neurology)
- Decreased libido (could affect pts willingness to take medication)
- Dizziness (teach pt to stand/change positions slowly; take medication in the morning or afternoon when pt can see in case they need to go to the bathroom) *Fall risk
*Treats HF by:
1. Decreasing after-load i.e., resistance the heart has to pump against by dilating blood vessels
2. Decreases pre-load i.e., amount of blood going to the heart/amount of blood the heart has to pump
Chlorothiazide
- Class?
- MOA? (location of action, what it inhibits/stimulates, etc.)
- Prescribed for?
- Side effects?
- Nursing considerations? (monitor/check, important teaching points, etc.)
*How does this medication treat HF (when used for that)?
Class: Thiazide Diuretic
MOA:
- Distal convoluted tubule
- Inhibits reabsorption of sodium (Na), chloride (Cl), potassium (K), and water, so more will be excreted in the urine
- Helps dilate small blood vessels, decreasing peripheral vascular resistance (additional mechanism to decrease BP)
Prescribed for:
- Hypertension
- Swelling d/t fluid build up
Side effects:
- Hypokalemia (low potassium)
- Hyponatremia (low sodium)
- Decreased libido
- Dizziness (especially in the beginning)
Nursing considerations:
- Check BP (could be too low to give medication safely)
- Monitor labs; sodium (Na)/potassium (K) levels (too high sodium can effect the heart’s electrical action; too high potassium can affect neurology)
- Decreased libido (could affect pts willingness to take medication)
- Dizziness (teach pt to stand/change positions slowly; take medication in the morning or afternoon when pt can see in case they need to go to the bathroom) *Fall risk
*Treats HF by:
1. Decreasing after-load i.e., resistance the heart has to pump against by dilating blood vessels
2. Decreases pre-load i.e., amount of blood going to the heart/amount of blood the heart has to pump
Metolazone
- Class?
- MOA? (location of action, what it inhibits/stimulates, etc.)
- Prescribed for?
- Side effects?
- Nursing considerations? (monitor/check, important teaching points, etc.)
Class: Thiazide-Like Diuretic
MOA:
- Distal convoluted tubule
- Inhibits reabsorption of sodium (Na), chloride (Cl), potassium (K), and water, so more will be excreted in the urine
- Helps dilate small blood vessels, decreasing peripheral vascular resistance (additional mechanism to decrease BP)
Prescribed for:
- Hypertension
- Swelling d/t fluid build up
Side effects:
- Hypokalemia (low potassium)
- Hyponatremia (low sodium)
- Decreased libido
- Dizziness (especially in the beginning)
Nursing considerations:
- Check BP (could be too low to give medication safely)
- Monitor labs; sodium (Na)/potassium (K) levels (too high sodium can effect the heart’s electrical action; too high potassium can affect neurology)
- Decreased libido (could affect pts willingness to take medication)
- Dizziness (teach pt to stand/change positions slowly; take medication in the morning or afternoon when pt can see in case they need to go to the bathroom) *Fall risk
Furosemide (Lasix)
- Class?
- MOA (location where it acts, what it inhibits/aids in, etc.)
- Prescribed for?
- Side effects?
- Nursing considerations (what to monitor/perform, pt education, etc.)
- Medication interactions?
*How does this medication treat HF (when used for that)?
Class: Loop Diuretic
*VERY potent diuretic when given IV
- given when you need results QUICKLY
MOA:
- Works in the Loop of Henle
- Inhibits sodium (Na), chloride (Cl), potassium (K), and water from being reabsorbed, causing more to be excreted in the urine
- helps dilate small blood vessels to decrease vascular resistance (additional mechanism to lower BP)
Prescribed for:
- Hypertension
- Edema
- Heart failure
- Kidney failure
Side effects:
- Hypokalemia (potassium wasting)
- Hypovolemia (pull off too much fluid volume)
- Dizziness
- Tinnitus (ear ringing)
Nursing considerations:
- Monitor labs (Na, K, Cl values)
- Timing of doses (want to take in morning d/t dizziness)
- Perform good respiratory assessments (is fluid being drawn off how it’s supposed to be?)
Medication interactions:
- Possibility of cross-reaction to Sulfonamides (antibiotic)
*Treats HF by:
1. Decreasing after-load i.e., decreasing resistance the heart has to pump against by dilating blood vessels
2. Decreases after-load i.e., decreasing blood volume returning to the heart/what the blood has to pump
Torsemide
- Class?
- MOA (location where it acts, what it inhibits/aids in, etc.)
- Prescribed for?
- Side effects?
- Nursing considerations (what to monitor/perform, pt education, etc.)*
- Medication interactions?
*How does this medication treat HF (when used for that)?
Class: Loop diuretic
*VERY potent diuretic when given IV
- given when you need results QUICKLY
MOA:
- Works in the Loop of Henle
- Inhibits sodium (Na), chloride (Cl), potassium (K), and water from being reabsorbed, causing more to be excreted in the urine
- helps dilate small blood vessels to decrease vascular resistance (additional mechanism to lower BP)
Prescribed for:
- Hypertension
- Edema
- Heart failure
- Kidney failure
Side effects:
- Hypokalemia (potassium wasting)
- Hypovolemia (pull off too much fluid volume)
- Dizziness
- Tinnitus (ear ringing)
Nursing considerations:
- Monitor labs (Na, K, Cl values)
- Monitor CBC or Complete blood count (WBC count & platelet count) *specific to Torsemide
- Timing of doses (want to take in morning d/t dizziness)
- Perform good respiratory assessments (is fluid being drawn off how it’s supposed to be?)
Medication interactions:
- Possibility of cross-reaction to Sulfonamides (antibiotic)
*Treats HF by:
1. Decreasing after-load i.e., decreasing resistance the heart has to pump against by dilating blood vessels
2. Decreases after-load i.e., decreasing blood volume returning to the heart/what the blood has to pump
Spironolactone
- Class?
- MOA?
- Prescribed for?
- Side effects?
- Nursing considerations?
- Medication interactions?
Class: Potassium-sparing diuretic
MOA:
- Works in the collecting ducts and distal convoluted tubule
- Spares potassium, so potassium is reabsorbed and more sodium is excreted in the urine
- Binds to the aldosterone receptor, preventing sodium from being reabsorbed into the bloodstream, so more is excreted in the urine
Prescribed for:
- Protective purposes of the heart
Side effects:
- Hyperkalemia (usually when pt is taking other medications that heighten potassium or when pt has kidney failure d/t not excreting as much potassium as they should be)
- Gynecomastia or enlarged breast tissue in male patients (d/t effecting aldosterone hormone)
- Amenorrhea or irregular menses/stopped period/postmenopausal bleeding (women also have testosterone levels that are important for function)
Nursing considerations:
- Monitor BP
- Monitor labs (potassium levels)
- Pregnancy category C (animal studies, but no studies in humans; look at risk-to-benefits d/t possible alterations to male fetus sex development)
Medication interactions:
- Lithium (can make lithium levels too high/toxic)
- Potassium supplements (cause potassium levels to be too high)
Amiloride
- Class?
- MOA?
- Prescribed for?
- Side effects?
- Nursing considerations?
- Medication interactions?
Class: Potassium-sparing diuretic
MOA:
- Works in the collecting ducts and distal convoluted tubule
- Spares potassium, so potassium is reabsorbed and more sodium is excreted in the urine
- Binds to the aldosterone receptor, preventing sodium from being reabsorbed into the bloodstream, so more is excreted in the urine
Prescribed for:
- Protective purposes of the heart
Side effects:
- Hyperkalemia (usually when pt is taking other medications that heighten potassium or when pt has kidney failure d/t not excreting as much potassium as they should be)
- Gynecomastia or enlarged breast tissue in male patients (d/t effecting aldosterone hormone)
- Amenorrhea or irregular menses/stopped period/postmenopausal bleeding (women also have testosterone levels that are important for function)
Nursing considerations:
- Monitor BP
- Monitor labs (potassium levels)
- Pregnancy category C (animal studies, but no studies in humans; look at risk-to-benefits d/t possible alterations to male fetus sex development)
Medication interactions:
- Lithium (can make lithium levels too high/toxic)
- Potassium supplements (cause potassium levels to be too high)
Mannitol (Osmitrol)
- Class?
- MOA?
- Prescribed for?
- Side effects?
- Nursing considerations?
Class:
- Osmotic diuretic
MOA:
- Works in the proximal convoluted tubule
- Removes water extremely quickly
Prescribed for:
*Critical care situations
- Swelling in the brain/intercranial pressure
- To get rid of toxic substances faster
- Sometimes used to dilate blood vessels r/t kidney (non-emergent), but not often
Side effects:
- Convulsions
- Thrombophlebitis
- Pulmonary congestion
Nursing considerations:
- Perform frequent cardiac assessments d/t electrical activity
- Draw & monitor frequent labs (renal function)
- Frequent neuro checks d/t swelling in the brain
- Monitor IV site
- Given IV through a filter d/t crystallization
*Would likely be one-on-one with patient d/t severity of the situation
What does the term “Crystalloids” refer to?
- what do they contain?
- what don’t they contain?
It’s a fancy term for IV fluids. We given water and sodium to maintain fluid and electrolyte balance in the body.
- don’t contain proteins
When will you utilize IV fluids in practice?
- What are general nursing considerations to think about?
When someone has a fluid or electrolyte disturbances, as well as if someone needs more fluids.
- Profuse vomiting
- Abnormal electrolyte levels in labs
Nursing considerations:
- Know the pts kidney function
- Know the pts heart function
- Review lab values of electrolytes
- Know and check the ordered rate for the IV
- Monitor the IV site for infiltration & that it is functioning as it should be (someone in heart failure should not be given a really high rate of electrolytes)
0.9% Sodium Chloride (Normal Saline) (NS)
- Type of solution?
- What does it do?
- Name one example of when it is used and why?
- Isotonic solution (same solute conc. inside & outside the cells)
- Keeps fluid and electrolyte balance steady/equal (i.e. no movement inside or outside of the cell; blood cells look “normal”)
Example: Used in blood transfusions to dilute the blood and keep cells from rupturing.
Lactated Ringers (LR)
- Type of solution?
- What does it do?
- Isotonic solution
- Keeps everything steady/normal; no movement of fluid inside cell or outside of cell
Dextrose 5% in water
- Type of solution?
- What does it do?*
- Isotonic solution
- Keeps everything steady/normal; no movement of fluid inside cell or outside cell
- Might also be given if someone needs carbohydrates/calories d/t low blood sugar
0.45% Normal saline (“Half normal saline”)
- Type of solution? What does it do to cells?
- Used for?
- Nursing considerations?
- Hypotonic solution (water and sodium are drawn into cells and cells swell)
- Used for dehydration
Nursing considerations:
- Slow infusion rate (do not want to correct too quickly and risk the possibility of cells swelling and bursting)
- Know/monitor sodium levels (Normal = 136-145)
3% Normal Saline
- Type of solution?
- Used for?
- Nursing considerations? (Check/monitor, be aware of, etc.)
- What’s crucial to remember about this IV fluid compared to others?
- Hypertonic solution (draws sodium and water out of cells, causing them to shrink)
Used for:
- REALLY low blood sugar
- Low sodium (hyponatremia)
Nursing considerations:
- Be sure/check infusion rate
- Be sure you have an order to be giving this medication (high alert medication)
- Be aware of osmotic demyelination syndrome (leads to problems in the brain stem r/t giving medication too quickly or giving too much)
- Monitor/check sodium (Na) level (Normal = 136-145)
5% Normal Saline
- Type of solution?
- Used for?
- Nursing considerations? (Check/monitor, be aware of, etc.)
- What’s crucial to remember about this IV fluid compared to others?
- Hypertonic solution (draws sodium and water out of cells, causing them to shrink)
Used for:
- REALLY low blood sugar
- Low sodium (hyponatremia)
Nursing considerations:
- Be sure/check infusion rate
- Be sure you have an order to be giving this medication (high alert medication)
- Be aware of osmotic demyelination syndrome (leads to problems in the brain stem r/t giving medication too quickly or giving too much)
- Monitor/check sodium (Na) level (Normal = 136-145)
Dextrose 10% in water
- Type of solution?
- Used for?
- Nursing considerations? (Check/monitor, be aware of, etc.)
- What’s crucial to remember about this IV fluid compared to others?
- Hypertonic solution (draws sodium and water out of cells, causing them to shrink)
Used for:
- REALLY low blood sugar
- Low sodium (hyponatremia)
Nursing considerations:
- Be sure/check infusion rate
- Be sure you have an order to be giving this medication (high alert medication)
- Be aware of osmotic demyelination syndrome (leads to problems in the brain stem r/t giving medication too quickly or giving too much)
- Monitor/check sodium (Na) level (Normal = 136-145)
