Diuretics Flashcards
What are the main actions of diuretics?
- Increase urine volume
- Increase sodium excretion
- Prevent fluid retention
What are the main indications of diuretics?
- edema r/t congestive heart failure
- acute pulmonary edema
- liver disease
- renal disease
- hypertension
- hyperkalemia
What are the 5 classes of diuretics?
- Thiazide/Thiazide like diuretics
- Loop Diuretics
- Carbonic Anhydrase Inhibitors
- Potassium Sparing Diuretics
- Osmotic Diuretics
Considerations for Diuretics in Children
- Thiazides, Loop, and spironolactone can be used
- Rapid drug effect and adverse effects
- Monitor closely: Fluid and electrolyte imbalances
Considerations for Diuretics in Adults
- Patient education
- Daily weights to check for fluid imbalance
- Adequate fluid intake
- Awareness of fluid loss situations
- DO NOT use in lactation
- Only when benefits outweigh risks in pregnancy
Considerations for Diuretics in Older Adults
- Underlying renal and hepatic impairment
- Monitor fluid and electrolyte imbalance closely
- maintain oral fluid intake
- maintain same activity levels
- avoid excessive salt (causes fluid retention)
Thiazide and Thiazide like Diuretics
Drug Names
- Hydrochlorothiazide
- Chlorothiazide
- Chlorathalidone
Thiazide and Thiazide like Diuretics
MOA
Action is to BLOCK the chloride pump in the DCT (distal convoluted tubule)
Keeps chloride and sodiium IN the tubule to be excreted in the urine, preventing the reabsorption of both into the vascular system
Thiazide and Thiazide like Diuretics
Indications
- Hypertension
Thiazide and Thiazide like Diuretics
Contraindications
Absolute: Allergy
Relative:
* Allergy to sulfonamides
* Hypovolemia
* Severe renal disease
Cautions:
* Lupus (causes kidney issues)
* Liver Disease (altered metabolism => toxicity)
* Diabetes or glucose tolerance abnormalities (may cause increase in glucose)
Thiazide and Thiazide like Diuretics
Adverse Effects
Electrolyte and glucose imbalances:
* HYPOkalemia
* HYPERcalcemia
* HYPERglycemia (with long term use)
Fluid Loss:
* dizziness, weakness, fatigue
Alkalinized Urine:
* bladder infections
Thiazide and Thiazide like Diuretics
Drug Interactions
- Digoxin => increased risk of digoxin toxicity r/t potassium changes
- Antidiabetic agents => may need to adjust
- Lithium => increased risk of lithium toxicity - measure lithium and sodium levels closely
Loop Diuretics
MOA
- Blocks the chloride pump in the LOOP of Henle
- This keeps sodium and chloride in the loop, prevents reabsorption into circulation
- Large amount of sodium and chloride rich urine is excreted
- Works quickly
Loop Diuretics
Indications
- Heart failure
- Pulmonary edema
- Edema r/t heart failure, renal failure, or liver disease
- Hypertension
Loop Diuretics
Drug Names
- Furosemide (tends to be safest. Brand: Lasix)
- Bumetanide
- Torsemide
Loop Diuretics
Contraindications
Absolute: Allergy
Relative:
* Electrolyte depletion
* Severe renal disease
* liver failure
Cautions:
* Lupus
* Hyperglycemia
Loop Diuretics
Adverse Effects
- HYPOkalemia
- HYPOcalcemia
- HYPERglycemia
- Ototoxicity (otic nerve - could cause deafness - reversible)
- Hypotension and dizziness
Loop Diuretics
Drug Interactions
- Aminoglycosides or cisplatin (Inc. risk of ototoxicity)
- Anticoagulants (effects of anticoagulants are increased)
- Digoxin (increased risk of digoxin toxicity r/t potassium changes)
- Antidiabetic Agents (may need to adjust)
- Lithium (Inc. risk of lithium toxicity)
- Indomethacin, ibuprofen, salicylates, or NSAIDs (decreased therapeutic effect of diuretic)
Carbonic AnHYdrase Inhibitors
MOA
- Blocks the affect of carbonic anhydrase; slows down the movement of hydrogen ions
- more sodium and bicarbonate are lost in the urine
Carbonic AnHYdrase Inhibitors
Drug Name
“-amide”
- Acetazolamide
Carbonic AnHYdrase Inhibitors
Indications
- Adjuncts to other diuretics
- Glaucoma
Carbonic AnHYdrase Inhibitors
Contraindications
Absolute: Allergy
Relative: allergy to sulfonamides or thiazides
Cautions (can make these worse):
* Renal or hepatic disease
* Adrenocortical insufficiency
* Respiratory acidosis/COPD
Carbonic AnHYdrase Inhibitors
Adverse Effects
- Metabolic acidosis (d/t acid-base imbalance)
- HYPOkalemia
- CNS effects: paresthesia of extremities, confusion, drowsiness (r/t fluid imbalance)
Carbonic AnHYdrase Inhibitors
Drug Interaction
Aspirin
Potassium Sparing Diuretics
MOA
Loss of sodium WITH the retention of potassium
Spironolactone:
* Aldosterone antagonist: blocks aldosterone in the distal tubule which results in the secretion of sodium
Triamterene:
* Blocks potassium secretion through the tubule (excreting sodium)
Potassium Sparing Diuretics
Indications
- Adjuncts with thiazide or loop diuretics
- Those who need a diuretic but are at risk for hypokalemia
- Hyperaldosteronism
Potassium Sparing Diuretics
Contraindications
Absolute: Allergy
Relative: Hyperkalemia, Severe Renal Disease
Potassium Sparing Diuretics
Drug Interactions
Aspirin
(decreased diuretic effect)
Potassium Sparing Diuretics
Drug Names
Spironolactone
Triamterene
Potassium Sparing Diuretics
Adverse Effects
*Hyperkalemia
*Androgen effects:
gynecomastia (enlargement of breast tissue in men)
Irregular menses
Hirsutism (increase in body hair)
Deepening of the voice
Osmotic Diuretics
MOA
- Pulls water** INTO the renal tubule** without sodium loss
- ONLY adminsitered by IV
- Pulls fluid from extravascular space into the intravascular space
Osmotic Diuretics
Indications
- Increased Intracranial Pressure (ICP)
- ACUTE renal failure due to shock, drug overdose, or trauma
- Decrease Intraocular Pressure (IOP) before eye surgery or in ACUTE glaucoma attacks
Osmotic Diuretics
Drug Name
Mannitol
Osmotic Diuretics
Contraindications
Relative:
* Pre-existing severe renal disease
* Pulmonary congestion and edema
* Intracranial bleeding (except during surgery)
* Heart Failure
Osmotic Diuretics
Adverse Effects
r/t SUDDEN drop in fluid levels
- Fluid & Electrolyte imbalance
- Nausea and Vomiting
- Hypotension
- Light-headedness
- Confusion
- Headache
- Heart Failure
- Pulmonary edema
Diuretic Agents
Assessment
History:
* Allergies, pregnancy, lactation
* Fluid and electrolyte disturbances; hyperglycemia
* Contraindications or cautions for each drug class
Physical:
* baseline: Skin, mucus membranes, heart and lung sounds
* intake and output: voiding patterns
* vitals, weight
Labs:
* Renal and hepatic function tests
* electrolytes
* glucose
Diuretic Agents
Nursing conclusions
- Risk for alterations in fluid volume
- Risk for electrolyte disturbances
- Hypotension risk
- Knowledge Deficit
Diuretic Agents
Interventions/patient teaching
- Can take with food or milk
- EARLY in the day
- Administer IV diuretics SLOWLY and switch to Oral form ASAP
- Assess weight daily: Report >3lbs gain in one day or >5lbs gain in one week
- Assess for dehydration and electrolyte imbalance
- Appropriate amount of potassium
- Appropriate amount of fluid to prevent fluid rebound
- Safety precautions: avoid excessive sweating, readily available bathroom
- Patient teaching
6 Ls
Signs of HYPOkalemia
6 Ls
Lethargy
Leg Cramps
Limp Muscles
Low, shallow respirations
Lethal cardiac rhythms
Lots of urine (polyuria)
MURDER
Signs of HYPERkalemia
MURDER
Muscle aches
Urine - oliguria or anuria
Respiratory Distress
Decreased Cardiac contractility
ECG changes
Reflexes - hyperreflexia or areflexia
Banana Spin Pot Song
Potassium Rich Foods
Banana Spin Pot Song
Bananas
Spinach
Potatoes
Salt Substitutes
Orange (Citrus)
Nuts
Grapefruit (Citrus)
