antidiuretics
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| diuretics | Increase rate of urine flow and excretion of excess fluid
tx for HTN, HF, kidney failure, liver failure/cirrhosis, or pulmonary edema.
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| Three types of diuretics | Loop diuretics
thiazides
potassium sparing
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| Electrolyte | Small charge molecules essential to homeostasis. Too little or too much can result in serious complications and must be quickly corrected
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| 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).
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| Adverse effects of all diuretics | Fluid and electrolyte disturbances
dehydration
orthostatic hypotension (sitting, standing, lying)
potassium and sodium and balances
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| 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
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| 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
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| 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.
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| 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
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| 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
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| thiazide diuretics- labs/herbal/food | labs: ^ Glucose, cholesterol, bilirubin, triglyceride & calcium. (-) Serum magnesium, potassium, sodium
ginkgo biloba produce paradoxical + BP, Hawthorne ^ hypotensive effect
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| 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
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| 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
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| 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
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| 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
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| lifespan of diuretics | older adults- hypotension/ risk of falls/ electrolyte imbalances
infants/young children- audiology
pregnancy/ breast-feeding Cat D should not be used
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