Diuretics Flashcards
Thiazide Diuretics
hydrochlorothiazide (Microzide)
POTASSIUM WASTING!!
not recommended for pregnancy and breastfeeding
Thiazide Diuretic Mechanism of Action
blocking sodium-chloride channel in distal convoluted tubule of kidney, preventing it from reabsorbing Na and increasing K and H2O excretion
Thiazide Diuretic SE
dizziness (OH)
hypokalemia
HA
hypo Na
hyperuricemia (GOUT)
hyperglycemia
hypo Mg
hyper Ca
hypo Cl
hyperlipidemia
n/v
constipation
urticaria
fluid loss
Thiazide Diuretic ADE
significant hypokalemia
dehydration
blood dycrasias
renal failure
Thiazide Diuretic Nursing Interventions
check peripheral extremities for edema
monitor electrolytes (K!!), bloodwork, and vitals, elevated glucose (may need insulin change)
I/O
fall risk (bedside commode or change positions slowly)
give in the AM to avoid sleep disturbances from peeing a lot
daily weights
High Ceiling (Loop) Diuretics
furosemide (Lasix)
MORE POWERFUL!!; ALSO POTASSIUM WASTING
not recommended for pregnancy and breastfeeding
High Ceiling (Loop) Diuretics Mechanism of Action
loop of henle; block reabsorption of sodium chloride, K and H2O
High Ceiling (Loop) Diuretics SE
dizziness (OH)
hypokalemia
hyponatremia
hypocalcemia
tinnitus
fatigue
postural hypotension
elevated BUN and Cr (good for renal failure pts)
hypo Mg
hypo Cl
hyperglycemia
hyperlipidemia
fluid loss
High Ceiling (Loop) Diuretics ADE
fall risk w/ OH
muscle weakness
irregular heart rhythms
ototoxicity
hyperglycemia
blood dycrasias
High Ceiling (Loop) Diuretics Nursing Interventions
administer IV slowly to avoid hearing loss
monitor electrolytes (K!!, especially with digoxin), bloodwork, and vitals; normal K is 3.5-5; report muscle weakness and dysrhythmias
I/O
fall risk (bedside commode or change positions slowly)
give in the AM
daily weights
Potassium Sparing Diuretics
spironolactone (Aldactone)
ALDOSTERONE-ANTAGONIST
safety not established for pediatrics or pregnant/breastfeeding; safe for infants
Potassium Sparing Diuretics Mechanism of Action
blocks aldosterone, allowing Na to go out and K sparing
Potassium Sparing Diuretics SE
hypotension
hyponatremia
gynecomastia
impotence
amenorrhea
GI upset
muscle weakness
fatigue
fluid loss
Potassium Sparing Diuretics ADE
fainting/falling
hyperkalemia
blood dycrasias
Potassium Sparing Diuretics Nursing Interventions
hyperkalemia monitoring!
avoid foods high in K (bananas, avocados, tomatoes, carrots)
avoid salt substitutes (Mrs.Dash)
monitor electrolytes (K!!), bloodwork, and vitals
I/O
fall risk (bedside commode or change positions slowly)
give in the AM
daily weights
Main Goals of Diuretics
lower BP and decrease edema
primarily used in pts with relative fluid overload and presence of heart, kidney or liver failure and HTN; also traumatic brain injury and glaucoma
where sodium goes, water follows
Natriuretics
thiazide and thiazide-like
loop
potassium-sparing
Osmotic Diuretics
increase blood flow to kidneys; usually for critical care
Carbonic Anhydrase Inhibitors
primarily used for glaucoma
Thiazide Primary Use
treat mild/moderate HTN; also indicated to reduce edema associated with HF, ascites, nephrotic syndrome, Ca containing renal calculus
Loop Diuretics Primary Use
reduce edema associated with heart, hepatic or renal failure; pulmonary edema
Potassium-Sparing Diuretics Primary Use
for edema in heart failure and cirrhosis; diuresis w/o K loss
Osmotic Diuretics Mechanism of Action
mannitol (Osmitrol)
by increasing osmotic pressure of the plasma, extract fluid from intracellular compartments in brain to quickly reduce plasma volume; typically for critical care (ICP, IOP in glaucoma)
administered IV
perform frequent neuro checks
Osmotic Diuretics SE/Contraindications
fluid/electrolyte imbalances
pulmonary edema
n/v
tachycardia
acidosis
crystallization of mannitol
HF and RF
Carbonic Anhydrase Inhibitors Mechanism of Action
block action of enzyme carbonic anhydrase; excreted Na, K and bicarbonate
primarily used to decrease IOP in pts with open angle (chronic) glaucoma
Carbonic Anhydrase Inhibitors SE
confusion
OH
GI distress
metabolic acidosis
fluid/electrolyte imbalances
crystalluria, renal calculi
hemolytic anemia
General Diuretics Nursing Interventions
fall precautions; monitor BP before and after
daily weights
I + O
monitor electrolyte levels and EKG changes
administer in the morning to prevent nocturia
low Na diet to prevent fluid retention
Hyperkalemia signs
dysrhythmias
peaked T waves
muscle weakness or cramping
Foods High in K
bananas
oranges
dates
broccoli
green beans
legumes
potatoes
tomatoes
leafy green veggies
beans
milk
yogurt
salt substitutes
Foods Low in K
apples
grapes
pineapples
asparagus
carrots
cucumbers
green/wax beans
onions
rice
noodles
pasta
bread (not whole grain)
