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Lilley Chapter 26
Diuretic Drugs
| Question | Answer |
|---|---|
| Aldosterone | A mineralocorticoid steroid hormone prudeced by the adrenal cortex that mediates the actions of sodium and potassium balance in the blood |
| Open-angle Glaucoma | a condition in which pressure is elevated in the eye because of obstruction of the outflow of aqueous humor, but access to the trabecular meshwork remains open |
| Carbonic Anhydrase Inhibitors (CAIs) | chemical derivatives of sulfonamide antibiotics. Treatment for glaucoma, edema, and high altitude sickness. Acetazolamide is most commonly used |
| Acetazolamide (Diamox) | Carbonic Anhydrase inhibitor Contraindicated in pts who have shown hypersensitivity, liver or kidney dysfunction, low serum potassium or sodium levels, acidosis, or adrenal gland failure. |
| Loop Diuretics - Drugs | Bumetanide, ethacrynic acid, furosemide(Lasix), and torsemide |
| Loop Diuretics Mechanism of action | rapid diuresis, rapid onset of action results in dilatation of the blood vessels of the kidneys, and the lungs, and the rest of the body (ie. reduction in renal, pulmonary, and systemic vascular resistance) lasts for atleast 2 hours |
| Loop Indications | used to manage edema associated with heart failure and hepatic or renal disease, to control hypertension, and to increase the renal excretion of calcium in pts with hypercalcemia |
| Loop Diuretics: Common drug interactions | Aminoglycosides - Cloroquine & Vancomycin Additive effect Corticosteroids & Digoxin - Hypokalemia Lithium - Decrease in renal excretion NSAIDs- Inhibition of renal prostaglandins Sulfonylureas - Decrease in glucose tolerance |
| Osmotic Diutetics - Drugs | Mannitol, urea, organic acids, and glucose |
| Mannitol (Osmitrol) | promotes excretion of toxic substances, reduce intracranial pressure, treat cerebral edema Contraindications- severe renal disease, pulmonary edema & active intracranial bleeding Adverse Effects - convulsions, thrombophlebitis, and pulmonary congestion |
| Potassium-Sparing Diuretics-Drugs | amiloride (Midamor), spironolactone, and triamterene theses are referred to as aldosterone-inhibiting diuretics |
| Potassium-Sparing Drug - amiloride (Midamor) | indications - Edema, heart failure (as an adjunct to loop diuretics) |
| Potassium-Sparing Drugs - Spironalactone (Aldactone) and Triamterene (Dyrenium) | Edema, hypertension, heart failure, ascites |
| Thiazides and Thiazide-like Diuretics - Drugs | Benzothiadiazines-chemical derivatives of sulfonamide antibiotics, Chlorothiazide, hydrochlorothiazide (most common used), bendroflumethiazide - inhibit resorption of sodium, potassium, chloride - Thiazides don't use if creatinine clearance < 30-50mL/min |
| Hydrochlorothiazide (Esidrix, HydroDIURIL) | Thiazide diuretic Indicaitons - edema, heart failure (as an adjuct to the loop diuretics) |
| Metolazone ( Mykrox, Diulo, Zaroxolyn) | Thiazide-like diuretic Indicaitons - Edema, heart failure (as an adjuct to loop diuretics) remains effective to a creatinine clearance of 10mL/min, and thus is used in cases of renal failure |
| Thiazides and Thiazide-like Diuretics - Indications | treatment of edema of various origins, idiopathic hyperclciuris, and diabetes insipidus, in addition to hypertension They are also used as adjunct drugs in the mgnt of heart failure and hepatic cirrhosis |
| Thiazides and Thiazide-like Diuretics - Contraindications and Adverse Effects | contraindicaitons - hepatic coma (metolazone), anuria, and severa renal failure. Adverse - electrolyte and metabolic disturbances, they reduce potassium levels,elevate calcium, lipids, glucose, uric acid- photosensitiveity, thrombocytopenia, pancreatitis |
| Thiazides and Thiazide-like Diuretics - toxicity and mgnt of od | symptoms - anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension |
| Hydroclorothiazide (HydroDIURIL) | very commonly prescribed, very safe and effective used in combination with many other drugs, including methyldopa, propranolol, spironolactone, triamterene, hydralazine, ACE inhibitors, beta-blockers, and labetalol Dosage ceiling effect is 50mg/day |
| Pts taking diuretics should maintain proper nutritional Intake and eat a potassium-rich foods except when contraindicated | Foods high in potassium include bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes |
| Encourage patients to change positions slowly and to rise slowly after sitting or lying to prevent dizziness and possible fainting (syncope) | pt should be educated about the signs and symptoms of hypokalemia, such as weakness, leg cramps, and other muscle cramps. Caution to avoid hot climates, excessive sweating, feaver, and the use of saunas or hot tubs. |
| Diabetic pts who are taking thiazide and/or loop diuretics require education about th eneed for closse monitoring of blood glucose levels |
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