Diuretics

Question 1

Hydrochlorothiazide

Answer 1

Edema caused
by HF, liver or
renal disease;
First line for
HTN
Adverse: Dizziness,
vertigo, orthostatic
hypotension, polyuria,
nocturia
↓ K
(muscle cramps,
weakness,
arrhythmias)
GI upset, dry
mouth,
-Risk of digoxin
toxicity (if on digoxin)
due to potential
changes in K+ levels;
Cross allergy with
sulfonamides is
considered mild

Question 2

Furosemide/Bumetadine

Answer 2

Edema
related to heart
failure (HF)
HTN - ↓ BP
Adverse:Dizziness,
vertigo
orthostatic
hypotension
↓ K
↑ glycosuria (long
term use),
↑ liver enzymes
and BUN
polyuria
anorexia, N &V,
Stevens-Johnson
Syndrome
ototoxicity
-Cross allergy with
sulfonamides and
thiazides
NSAIDS ↓
effectiveness of
diuretic
Avoid with ETOH
tolerance
Caution: severe liver
disease,
Digoxin toxicity risk
(K+ depleting effect
of diuretic) if on
Digoxin
Geriatric: increased
fall risk

Question 3

Spironolactone

Answer 3

Management of
primary
hyperaldosteron
ism
Edema
associated with
CHF, cirrhosis, &
nephrotic
syndrome.
Essential HTN
Treatment of
Hypokalemia
Adverse: Dizziness,
headache
Arrhythmias
GI upset
Electrolytes:
hyperkalemia,
hyponatremia,
metabolic acidosis.
Hormonal:
Gynecomastia (in
men), erectile
dysfunction;
breast tenderness,
irregular menses,
deepening of the
voice, ↑ hair
growth (in women).
Derm: Stevens-
Johnson Syndrome
Blood:
Agranulocytosis
-Always assess K+
Level (3.5 – 5 mEq/L)
and BP prior to
administering.
Monitor ECG for
signs of
hyperkalemia (tented
T waves).
Teaching: avoid salt
substitutes and high
K+ foods.

Question 4

Mannitol

Answer 4

Acute oliguric
renal failure
↑intracranial
pressure
↑ intraocular
pressure
Adverse: confusion
Blurred
vision
transient
volume expansion
dehydration,
↑ or ↓ K+ or Na+,
Local: irritation at
IV site /
extravasation
-Contraindicated in:
active intracranial
bleeding
Monitor serum
electrolytes, renal
function;
Only given IV;
Filtered, and
Must Warm if you
see crystals