Diuretics

Question 1

Diuretics Side Effects

Answer 1

• Prevent renal reabsorption of fluid –> diuresis &
  natriuresis –> decreased IV volume
• “Diuretic contraction”: increased concentration of blood
  content that are not excreted in urine
• Blood cells, glucose, uric acids, lipids all increased

Electrolyte imbalance:
- Low K, Mg, Na, Bicarb
- Hypokalemia, hypomagnesemia, hyponatremia,
metabolic acidosis
- High Ca, BG, uric acid, LDL
- Hyperglycemia, hyperuricemia, hyperlipidemia

• Decreased BP –> orthostatic hypotension, dizziness,
  syncope, fall
• Poor renal perfusion –> AKI
• Tachycardia (reflex tachycardia)
• Hypovolemia
• Assess daily weight
• Assess edema (0-4+)

Question 2

Diuretic Nursing

Answer 2

• Assess ability to use the urinal/BSC in 30 minutes after
  taking
• Adherence
• Build rapport to understand the root cause of non-
  adherence
• Avoid taking potassium supplement while skipping the
  diuretic dose
• Hyperkalemia & fluid overload
• Take diuretics earlier in the day rather than close to
  bedtime
• Keep a long of BP & daily weight

Question 3

Thiazide & Thiazide-Like Diuretics

Answer 3

-Diuretic

Thiazides: 
- Chlorothiazide (PO, IV)
- Hydrochlorothiazide= HCTZ  (PO)
Thiazide-Like
- Metolazone; give it an hour before Loop --> makes Loops work better 

Indication:
- Hypertension

Contraindications:

• Hypovolemia
• Pregnancy
• Lactation
• Anuria (oliguria)
• Oldest and cheapest; many brands

Question 4

Loop Diuretics

Answer 4

• Furosemide, bumetanide
• Strongest diuretics (high ceiling)

Renal vasodilator
- All diuretics cause AKI due to loss of blood
volume/lower BP (lower renal perfusion)
- All diuretics should be avoided in AKI, but if we must
use diuretics, Loop diuretics are the safest
- The only diuretic that may be used in CKD

Indication:
- Hypertension

Contraindications:

• Hypovolemia
• Pregnancy
• Lactation
• Anuria (oliguria)
• Medication Administration: IV, PO, IM

Nursing Interventions (monitoring):
- Dilute & very slowly IVP to avoid tinnitus
  ototoxicity

Question 5

K-Sparing Diuretics

Answer 5

Drug:
- Spironolactone (PO)

• Diuretic, Aldosterone Receptor Blocker
• Weakest diuretics

Mechanism of Action:
- Blocks the action of aldosterone –> K retention, water, Na, bicarb excretion

Indication:
- Hypertension

Secondary Indication:
- With other diuretics to balance potassium
- Treatment of post-adolescent acne (MOA: anti-
adrenergic effect)

Contraindication:

• Hypovolemia
• Pregnancy
• Lactation
• Anuria (oliguria)

Adverse effects

• Anti-androgenic effect
• Male: impotence, gynecomastia
• Female: deepened voice, irregular menstrual cycles

Nursing Interventions (monitoring):
- Monitor increased K
- Place on heart monitor (dysrhythmia)
- Bradycardia/cardiac arrest, peaked T (cardiac monitor)
- Monitor for paresthesia, abd/muscle cramps,
weakness, fatigue

Patient Education:

• Diet: Avoid high potassium foods
• Ex: Oranges, grapefruit, potatoes, bananas, dried fruits

Interactions:
- Avoid with ACEi and ARB