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renal failure


diuretics Increase rate of urine flow and excretion of excess fluid tx for HTN, HF, kidney failure, liver failure/cirrhosis, or pulmonary edema.
Three types of diuretics Loop diuretics thiazides potassium sparing
Electrolyte Small charge molecules essential to homeostasis. Too little or too much can result in serious complications and must be quickly corrected
Kidney/renal failure pt's w/ Renal impairment have increased risk of drug toxicity. Lower doses are indicated. labs: urinalysis serum creatinine (CR) blood urea nitrogen (BUN) Glomerular filtration rate (GFR).
Adverse effects of all diuretics Fluid and electrolyte disturbances dehydration orthostatic hypotension (sitting, standing, lying) potassium and sodium and balances
Furosemide/ Lasix bumetanide/ Bumex Loop diuretics act by blocking the reabsorption NA+ and CL- in the loop of Henle to reduce edema w heart hepatic renal failure HTN. action: HF/HTN admin: check K+ & Preg Cat C. side: hypokalemia dehydration hypotension hypovolemia syncope ototoxicity
loop diuretics- contraindictions/ drug interactions contrain: Hypersensitivity anuria the hepatic coma drug: cardiac glycosides w digoxin monitored. no w aminoglycoside antibiotics poss nephrotoxicity & ototoxicity. loop w/ K+ depleting corticosteroids, amphotercin B (hypokalemia) lasix (-) hypoglycemic
Loop diuretics – labs/herbal/food labs: ^ Bld glucose, BUN, serum amylase or electrolytes, cholesterol and triglycerides herbal/food: Hawthorne ^ hypotensive effects, ginseng decrease effectiveness, ^ NA+ decrease effectiveness.
hydrochlorathiazide / Microzide Class: thiazide diuretics act on the distal tubal to block NA+ reabsorption, increase K+ & H2O excretion. Action: HTN & edema admin: give am to prevent nocturia Preg Cat B. increase K+ intake. side: electrolyte imbalance, gout, hyperuricemia
thiazide diuretics- contraindictions/interactions Con:Hypersensitivity preeclampsia preg HTN inter:Anti-HTN ^ effects on BP (-) effects of anticoagulants sulfonylureas or anti-DM Cholestyramine (-) the absorption of med ^ renal toxicity from NSAIDs Corticosteroids ^ K+ loss -digoxin (-) lithium tox
thiazide diuretics- labs/herbal/food labs: ^ Glucose, cholesterol, bilirubin, triglyceride & calcium. (-) Serum magnesium, potassium, sodium ginkgo biloba produce paradoxical + BP, Hawthorne ^ hypotensive effect
Spironolactone/ Aldactone triamterene Class: potassium sparing that blocks the action of the hormone aldosterone and NA+ and H2O excretion increased and K+ retained. Action: antihypertensive reducing edema admin: Give with food and other anti-HTN, No K+ suppl, Preg Cat C
Potassium sparing diuretics- side affects/warnings/labs Side: Hyperkalemia, muscle weakness, fatigue, bradycardia. Men- gynecomastia, impotence, (-) libido women- irregular menses, hirsutism, breast tenderness Warming: only for specific indications Labs: ^ plasma cortisol & interfere w serum glucose level
Potassium sparing diuretics- interactions drugs/food.herbal Inter: ammonium chloride (acidosis), ASA ^ half-life (digoxin toxicity), w/ digoxin (-) effects of digoxin, w/ K+, ACE, ARB's (hyperkalemia), other anti-HTN (^ hypotensive effect) herbal: Hawthorne ^ hypotensive effect
assessments for diuretics all baseline and monitor Patient's weight intake/output skin turgor/moisture vital signs sounds presence of edema BUN/CR/GFR labs ECG
lifespan of diuretics older adults- hypotension/ risk of falls/ electrolyte imbalances infants/young children- audiology pregnancy/ breast-feeding Cat D should not be used
Created by: bryant-41892