Diuretics Flashcards
Diuretics MOA
accelerate the rate of urine formation
types of Diuretics
Carbonic anhydrase inhibitors (CAIs)
Loop diuretics
Osmotics
Potassium-sparing diuretics
Thiazide and thiazide-like diuretics
CAI Indications
- long term management of OA glaucoma
- lower intraocular pressure befor eye surgery (when used with miotics)
also useful for
- edema (brain)
- high altitude sickness (high pressure in brain)
CAI contraindications
Acetazolamide drug class
Carbonic Anhydrase Inhibitor
(Diuretic)
Furosemide (Lasix) drug class
Loop diuretic
Torsemide drug class
Loop diuretic
Bumetanide drug class
Loop diuretic
Mannitol drug class
Osmotic diuretic
Spironolactone drug class
Potassium sparing diuretic
Chlorothiazide drug class
Thiazide/Thiazide like diuretic
Hydrochlororthiazide (HCTZ) drug class
Thiazide/Thiazde like diuretic
CAIs MOA
- Inhibit carbonic anhydrase which allows the exchange of H+ ions with sodium and water
- Less water is absorbed
- Urine volume increased
Osmotic diuretics MOA
- Increase pressure
- water enters tubules from tissue
- minimal effect on Na
- vasodilation
K sparing diuretics MOA (two kinds)
- inhibit Na/K channel pump that pulls K into the nephron
- more K stays in the blood
- more Na is excreted
- more water is excreted
OR - inhibit aldosterone that triggers Na/K exchange
- more K stays in the blood
- more Na is excreted
- more water is excreted
Thiazide MOA
- Inhibit reabsorption of Na and Cl
- manage hypertension
Loop diuretics MOA
- cause Na, Cl, water, and K excretions
- decreases preload
Loop diuretics indications
- Edema d/t HF, cirrhosis
- Hypertension
- To excrete Ca
Loop diuretics contraindications
- Hepatic coma
- Electrolyte imbalance
Loop Diuretics AE
hypokalemia
hyperglycemia
SJS
neutropenia (and other deficiencies of the blood)
hyperuricemia
Loop diuretics toxicity
- electrolyte loss/dehydration leading to CV collapse
- Neuro/nephrotoxic risk
- Increase blood uric acid and glucose levels
Loop diuretics interactions
- Thiazide (metolazone): causing nephron blockage
- NSAIDS: reduce loop’s ability to decrease vascular resistance
Loop diuretics Nursing Implications
- caution with elderly
- monitor for skin rx
- BP, ortho hypotn
- Hypokalemia
Erythema multiforme
S/S of hypokalemia
Anorexia
Nausea
Lethargy
Muscle weakness
Confusion
Hypotension
Erythema multiforme
- hypersensitivity rx
- triggered by infx (herpes)
- target lesion
- sometimes affects mucous membrane
- acute
Osmotic diuretics indications
- prevent kidney damage during acute KF
- high ICP and cerebral edema
- closed angle glaucoma
Loop diuretics AE
convulsions
thromboplebitis
pulmonary congestion
Mannitol Indications
swelling (eye and brain)
kidney failure
Mannitol Nursing Implications
can crystallize (discard)
filter in IV line
Potassium Sparing Diuretics Nursing Implications
monitor for K level >5.1
interacts with lithium, K supplements,
Thiazides and Thiazide-like contraindications
creatine clearance <30-50mL/min
Hydrochlorothiazide (HCTZ) Nursing implications
monitor BUN, creatine, K, glucose, dehydration and electrolytes
do a thorough history and physical
Carbonic Anhydrase Inhibitor (CAI) Nursing implications
monitor for digoxin toxicity if using together
monitor electrolyte levels
Normal serum potassium range
3.5-5.0mEq/L
