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Renal Drugs

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



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