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Diuretics
Renal Drugs
| Term | Definition |
|---|---|
| 5 Classes of Diuretics | Thiazide/Thiazide like Loop Carbonic Anhydrase Inhibitors Potassium Sparing Osmotic |
| Thiazides | Chlorothiazide Hydrochlorothiazide |
| Thiazide-like | Chlorthalidone Metolazone |
| Thiazide & Thiazide-like diuretics therapeutic action | Block chloride pump keeps Cl/Na in tubule Prevents Cl/Na reabsorption in blood excreted in urine |
| Thiazide & Thiazide-like diuretics PK | Absorbed in the GI tract Metabolized in liver Excreted in urine Crosses placenta and breast milk |
| Thiazide & Thiazide-like diuretics Contraindication | Fluid/electrolyte imbalance Severe kidney disease Diabetes/glucose tolerance issues Gout Hyperparathyroidism Bipolar Lupus P/L |
| Thiazide & Thiazide-like diuretics AEs | GI upset Hypotension Uric acid release Alkaline urine Electrolyte imbalances (hypokalemia, decreased calcium excretion) |
| Thiazide & Thiazide-like diuretics drug to drug | Decreased absorption of Cholestryramine and colestipol Digoxin toxicity increased Quinidine toxicity Decreased effectiveness of anti-diabetics Lithium toxicity |
| Thiazide Thiazide-like diuretics nursing consideration | Check labs, Na, K, Ca, glucose, renal and liver function Baseline weight and daily weight Accurate I &Os watch for hypotension Give in AM Monitor safety for dizziness |
| Loop Diuretics therapeutic action | Work in loop Henle, high degree of diuresis Blocks chloride pump in ascending loop decreases Na/Cl reabsorption Produces large amounts of Na rich urine |
| Loop Diuretics | Bumetanide Furosemide Toresmide Nesirtide |
| Loop Diuretics PK | Available in IV, PO, and IM Metabiolized and excreted in the kidneys |
| Loop diuretics Contraindications | anuria hepatic coma lupus DM, glucose intolerance Gout Children |
| Loop diuretics AEs | Electrolyte imbalances Alkalosis Calcium loss Hypotension Hyperglycemia Ototoxicity |
| Loop Diuretics Drug to drug | Aminoglycosides and cisplatin anticoagulants indomethacin, Ibuprofen, Salicylates, NSAIDs |
| Loop diuretics Nursing considerations | labs - Na, K, Ca, glucose, renal and liver function Baseline weight and daily weight watch for hypotension give PO in AM IV slow push Monitor dizziness |
| Carbonic Anhydrase Inhibitors (CAI) | Acetazolamide Methazolimide |
| CAI therapeutic Action | enzyme carbonic anhydrase forms NaHCO3/excretion of hydrogen slowing down movement of hydrogen, Na, and HCO3 lost in urine. Treats glaucoma or adjunct to other diuretics Mild diuretic action |
| CAI PK | PO or IV route Excreted in urine |
| CAI Contraindications | chronic non-congestive angle-closure glaucome Allergies to Thiazides or sulfonamides Fluid or electrolyte imbalances Renal/Hepatic disease Adrenal insufficiency COPD/Resp acidosis |
| CAI AEs | Related to acid-base disturbances -metabolic acidosis -hypokalemia -paresthesia -confusion -drowsiness |
| CAI Drug to drug | salicylates lithium |
| CAI nursing considerations | labs: Ph, K, renal and liver function Baseline and daily weight Accurate I & Os monitor dizziness |
| Potassium-Sparing Diuretics | Amiloride Spironolactone Triamterene |
| Potassium-Sparing Diuretics therapeutic action | Causes noss of Na+ Aldosteron antagonist (blocker) Used as adjunct therapy, not as powerful as loop diuretics Treats hyperaldosteronism in cirrhosis |
| Potassium-Sparring Diuretics PK | PO route Metabolized in liver excreted in urine |
| Potassium-Sparing diuretics Contraindications | Hyper K+ Kidney disease/anuria |
| Potassium-Sparing diuretics AE | Hyperkalemia |
| Potassium-sparing diuretics Drug to drug | salicylates |
| Potassium-Sparing diuretics nursing considerations | labs: Na, K, renal and liver function Baseline and daily weight Accurate I & Os monitor for dizziness avoid high K foods teach sx of hyperkalemia |
| Osmotic Diuretics | Mannitol |
| Osmotic diuretics therapeutic action | A sugar that has osmotic pull pulls fluid into urine and vasc system from exravasc spaces Used to decrease intraocular or intracranial pressures used in acute renal failure due to shock, drug OD, severe trauma |
| Osmotic diuretics PK | IV only filtered by kidneys resistant to metabolism |
| Osmotic diuretics contraindications | renal disease/anuria pulmonary congestion intracranial hemorrhage dehydration heart failure P/L |
| Osmotic diuretics AEs | R/T sudden drop in fluid levels -N/V Hypotension Confusion dizziness shock |
| Osmotic Diuretics nursing considerations | labs: Na, K, Ca, renal and liver function Accurate I & Os monitor for dizziness |