DIURETICS
Diuretics increase the rate of urine formation removal of sodium & water “ water pills” 2 main indications: 1. decrease blood pressure 2. decrease edema
Types of Diuretics: 1. Carbonic Anhydrase inhibitors acetazolamide (Diamox)* methazolamide dichlorphenamide 2. Osmotic Diuretics
mannitol urea glycerin isosorbide
4. Thiazide Diuretics
hydrochlorothiazide (Hydrodiuril) chlorothiazide
Thiazide –like diuretics
chlorthalidone metolazone
5. Potassium – sparing diuretics
spironolactone amiloride Triamterene
3. Loop Diuretics
furosemide (Lasix)* bumetanide torsemide ethacrynic
I. Carbonic Anhydrase Inhibitors) MOA: (proximal tubule ) inhibit carbonic anhydrase prevent exchange of H ions with Na inhibit H secretion promote Na ,K & HCO3 excretion diuresis Indications/ Uses: 1. glaucoma 2. edema secondary to CHF 3. high- altitude sickness SE / Adverse effects: metabolic acidosis hypokalemia paresthesias drowsiness & confusion
II. Osmotic diuretics MOA: (glomerulus &proximal tubule) pull water into blood vessels & nephrons from tissues diuresis Indications: 1. acute renal failure (oliguric phase) 2. increased intracranial pressure 3. cerebral edema SE/ Adverse effects: headache, confusion nausea & vomiting hypotension & lightheadedness convulsions, shock CI: anuria , dehydration heart failure pulmonary edema
III. Loop Diuretics MOA: (Loop of Henle) inhibit Na & chloride reabsorption more Na & water loss increase renal blood flow by 40% excrete Na, Cl, K, Mg, Ca Indications: 1. edema assoc. with CHF, liver or kidney dses 2. hypertension SE/Adverse Effects: dizziness, headache, tinnitus, blurred vision N & V, diarrhea agranulocytosis, neutropenia, thrombocytosis hyponatremia ,hypokalemia,hypocalcemia, hypomagnesemia hyperglycemia, hyperuricemia
IV. Thiazides & Thiazide-like diuretics MOA: (distal convoluted tubule) inhibit Na & chloride reabsorption minor loss of water
Indications: 1. edema 2. hypertension SE/Adverse effects: same CNS & GIT effects of Loop diuretics Impotence Urticaria, photosensitivity hypokalemia, hypomagnesemia hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia
V. Potassium- sparing diuretics MOA: (collecting ducts & distal convoluted tubules) Inhibit Na – K exchange Inhibit aldosterone action Inhibit Na channels Indications: Spironolactone & triamterene 1. hyperaldosteronism 2. hypertension 3. prevent K loss caused by potassium-losing drugs Amiloride 1. CHF SE/Adverse effects: same CNS & GIT effects as loop diuretics hyperkalemia gynecomastia, hirsutism, irregular mense, amenorrhea
Nsg. Implications in giving diuretics: Thorough Hx & PE Baseline I & O, serum electrolytes, weight, VS Take in AM Monitor serum K during therapy. Except for K -sparing diuretics, encourage K rich foods. Monitor for digoxin toxicity. Monitor blood glucose when using thiazides/ loop diuretics in diabetic pxs. Change position slowly. Notify physician ASAP for tachycardia , syncope. Monitor for adverse effects: metabolic alkalosis drowsiness, lethargy, decreased mental status hypokalemia hypotension tachycardia
Your MIND is like a parachute, it works best when opened.
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