Question | Answer |
Adverse Effects of all diuretics. | Renal failure, dehydration, hypotension, dizziness, GI distress (nausea, vomiting, diarrhea). |
Contraindication for all diuretics. | Complete renal failure (Caution with renal injury). |
Teaching points for all diuretics. | Take in morning.
Monitor serum potassium levels.
Careful with potassium supplements and potassium rich foods.
Diabetics should monitor blood sugar more closely.
Change positions slowly.
Monitor weight daily. |
3 functions of diuretic agents. | Increase urine production.
Increase sodium excretion.
Block re-absorption of sodium. |
Indications for diuretic use. | Heart failure, pulmonary edema, edema, liver disease, renal disease, hypertension, hyperkalemia. |
Symptoms of heart failure | Tiredness/fatigue, shortness of breath/coughing, pulmonary edema, weakend pumping action of the heart, pleural effusion, swelling in the abdomen, swelling in the ankles and legs. |
Thiazide and Thiazide-Like diuretics
PROTOTYPE: | Hydrochlorothiazide (Hydro Diuril) |
Thiazide's MOA | Hydrochlorothiazide retains sodium in the distal tubule. |
Thiazide's Indications | Hydrochlorothiazide is indicated for hypertension and mild to moderate heart failure. |
Thiazide's adverse effects | Hypokalemia, hyperglycemia (diabetics), hyponatremia. |
Thiazide Contraindications/Cautions | Diabetes, Gout, hypokalemia, dehydration and kidney failure. |
Thiazide (Hydrochlorothiazide) interactions | Digoxin. |
Loop Diuretics
PROTOTYPE: | furosemide (Lasix) |
Loop Diuretics MOA. | furosemide (Lasix) retain sodium and chloride in the ascending loop of henle. |
Loop Diuretics indication | furosemide (Lasix) are indicated for hypertension, heart failure and edema that is not responding to thiazides. |
Loop diuretics adverse effects. | hypokalemia |
Loop diuretics (furosemide, Lasix) contraindications/cautions | Hypokalemia, Gout, Dehydration, Kidney Failure |
Loop Diuretics (furosemide, Lasix) interactions | NSAIDs (prostaglandin blocking decreases renal blood flow)
Aminoglycosides
Digoxin
Lithium |
Potassium-sparing diuretics
PROTOTYPE: | spironolactone (Aldactone) |
Potassium-sparing diuretics MOA | spironolactone (Aldactone) Antagonizes aldosterone causing a loss of sodium but retention of potassium in the collecting duct. |
Potassium-sparing diuretics indication. | spironolactone (Aldactone) is indicated for patients at risk for hypokalemia. |
Potassium-sparing diuretics adverse effects | Hyperkalemia |
Potassium-sparing diuretics contraindications/cautions | Hyperkalemia, dehydration, kidney failure. |
Potassium-sparing diuretics drug interactions. | ACE inhibitors, potassium supplements, NSAIDs |
Osmotic Diuretics
PROTOTYPE: | mannitol (Osmitrol) |
Osmotic Diuretics Indications | mannitol (Osmitrol) is indicated only for intercranial pressure and sever fluid over load. It is administered only IV typically in emergent/ICU settings. |
Osmotic Diuretics MOA | Pulls water into the proximal tubule without sodium loss, increases osmotic pressure in the tubule. |
Osmotic Diuretics Adverse Effects | hypotension, dizziness, confusion, headache, nausea, vomiting |
Osmotic Diuretics Contraindications/Cautions | Intracranial bleeding, Dehydration/kidney failure |