Diuretics Flashcards
AcetaZOLAMIDE (Diamox, Diamox Sequels)
Type: Carbonic anhydrase inhibitor, Diuretic
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MOA:
Inhibits hydrogen ion excretion in the renal tubules, increasing sodium, potassium, bicarbonate, and water excertion and producing alkaline diuresis
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Indications: Acute Mountain Sickness (treatment and prophylaxis) | Prevention of HACE (High-altitude cerebral edema)
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Contraindications: Hypersensitivity to acetaZOLAMIDE or sulfa | Known hypokalemia or hyponatremia | Renal or liver dysfunction | Should not be used for the treatment of HAPE (high-altitude pulmonary edema)
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Adverse Reactions: Fluid and electrolyte imbalance | Metabolic acidosis | Seizures | N/V | Anorexia | Orthostatic hypotension
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Drug Interactions: Increased risk of severe acidosis and CNS toxicity with high-dose aspirin | Use caution with diuretics and anticonvulsants | May potentiate the effects of hypoglycemics | Increased risk of renal calculus formation with sodium bicarbonate administration
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Dosages:
Adult.
Tx of Acute Mountain Sickness: 250mg orally every 12 hours is recommended
Paediatric.
Tx of Acute Mountain Sickness: 2.5mg/kg orally every 12 hours (max dose 250mg/dose) is recommended
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Duration: Onset: 1 to 1.5 hours | Peak effect: 2 to 4 hours | Duration: 4 to 12 hours
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Special Conditions: Pregnancy safety: Category C
Bumetanide (Bumex)
Type: Loop dieuretic
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MOA:
A potent loop diuretic with a rapid onset and short duration of action | Inhibits the reabsorption of sodium and chloride in the ascending limb of the loop of Henle
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Indications: Pulmonary edema, heart failure
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Contraindications: Hypersensitivity to bumetanide, furosemide, or sulfonamides | Hypovolemia, anuria, acid-based imbalance, electrolyte imbalance, hepatic coma | Use with caution in patients with hepatic cirrhosis, ascites, or diabetes
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Adverse Reactions: Dehydration | Dizziness | Headache | Hypotension | ECG changes due to electrolyte depletion | N/V | Itching (in pts w/ liver disease) | Fatigue
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Drug Interactions: NSAIDs reduce the effects of diuretics | May increase risk of lithium poisoning | Antihypertensives can cause further hypotension
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Dosages:
Adult.
0.5 to 1 mg IV slowly over 1 to 2 minutes or IM
Paediatric.
Not recommended for children younger than 12 years due to limited research; consult Medical Command
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Duration: Onset: Immediate | Peak effect: 15 to 30 minutes | Duration: 3 to 6 hours
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Special Conditions: Pregnancy safety: Category C | Not Recommended in breastfeeding women | Bumetanide does not have the vasodilatory effects of furosemide | Diuretic potency is about 40 times greater than furosemide
Furosemide (Lasix)
Type: Loop dieuretic
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MOA:
(not listed per textbook)
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Indications: heart failure | HTN
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Contraindications: hypersensitivity to furosemide or sulfonamide medications | hypovolemia | anuria |hepatic coma | suspected electrolyte imbalance
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Adverse Reactions: Dizziness | Headache | EKG chances | Blurred vision | orthostatic hypotension | dysrhythmias | N/V | diarrhea | dry mouth | may exacerbate hypovolemia and hypokalemia, tinnitus, hyperglycemia (due to hemoconcentration)
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Drug Interactions: Lithium toxicity may be potentiated by sodium depletion | Digitalis toxicity may be potentiated by potassium depletion
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Dosages:
(not listed per textbook)
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Duration: (not listed per textbook)
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Special Conditions: Pregnancy safety: Category C | Ototoxicity may occur if too high a dose is taken or if the pt has severe kidney dysfunction
Mannitol (Osmitrol)
Type: Osmotic diuretic
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MOA:
Promotes the movement of fluid from the intracellular space to the extracellular space | Decreases cerebral edema and ICP | Promotes urinary excretion of toxins
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Indications: Reduction of ICP in managing neurologic emergencies; Promotes diuresis for excretion of toxic substances and metabolites
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Contraindications: Known hypersensitivity, hypotension, pulmonary edema | Severe pulmonary congestion | Electrolyte abnormalities | Severe dehydration | Intracranial bleeding | Heart failure | Use with caution in patients with impaired renal function (fluid overload can result)
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Adverse Reactions: Headache, confusion, blurred vision | Tachycardia | Chest pain | Heart failure | Hypotension/hypertension | Hypokalemia/hyperkalemia | Hyponatremia/hypernatremia | N/V | Masking or worsening dehydration | Rebound increases in ICE | Injection site reaction
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Drug Interactions: Many | May precipitate digitalism toxicity when given concurrently | Avoid use of other diuretics in combination, if possible | Concomitant administration may potentiate renal toxicity | Avoid use with salicylates and NSAIDs | Use with nitrates can cause hypotension
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Dosages:
Adult.
Give 0.5 to 1 g/kg IV infusion over 5 to 10 minutes through an in-line filter ; Additional doses of 0.25 to 2 g/kg can be given every 4 to 6 hours as needed
Paediatric.
Consult medical direction
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Duration: Onset: 1 to 3 hours for diuretic effect ; 15 minutes for reduction of ICP | Peak effect: Variable | Duration: 4 to 6 hours for diuretic effect ; 3 to 8 hours for reduction of ICP
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Special Conditions: Pregnancy safety: Category C | May crystallize at low temperatures | Usage and dosages in emergency care are controversial | Be sure to have ventilatory support available
