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Diuretics: Class of Drug Actions Uses Side Effects Nursing Implications

Diuretics are classified as thiazide/thiazide-like, loop, and potassium-sparing. Thiazide/thiazide-like diuretics such as hydrochlorothiazide inhibit sodium and chloride reabsorption in the distal tubule and are used to treat mild edema and hypertension. Loop diuretics like furosemide block sodium reabsorption in the ascending loop of Henle and are used to treat edema, hypertension, congestive heart failure, and renal/hepatic dysfunction. Potassium-sparing diuretics like spironolactone antagonize aldosterone to reduce sodium reabsorption while retaining potassium and hydrogen, and are used to treat hyperaldoster

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49 views1 page

Diuretics: Class of Drug Actions Uses Side Effects Nursing Implications

Diuretics are classified as thiazide/thiazide-like, loop, and potassium-sparing. Thiazide/thiazide-like diuretics such as hydrochlorothiazide inhibit sodium and chloride reabsorption in the distal tubule and are used to treat mild edema and hypertension. Loop diuretics like furosemide block sodium reabsorption in the ascending loop of Henle and are used to treat edema, hypertension, congestive heart failure, and renal/hepatic dysfunction. Potassium-sparing diuretics like spironolactone antagonize aldosterone to reduce sodium reabsorption while retaining potassium and hydrogen, and are used to treat hyperaldoster

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Raju Niraula
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© © All Rights Reserved
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Diuretics

Class of Drug
Thiazide &
Thiazide-like
Hydrochlorothiazide
Chlorothiazide
Chlorothalidone
Quinethazone
Indapamide

Actions
- Inhibits Na & Cl reabsorption in
the distal tubule

Uses
- Mild edema
- Essential hypertension

- Has longer duration of action


than loop diuretics

Loop Diuretics
- Highly protein bound
furosemide (LASIX)
- Sulfonamide derivative

- Blocks reabsorption of Na by
inhibiting Na/K/2Cl pump in the
ascending loop

torsemide (DEMADEX)
- Sulfonamide derivative
- Longer half-life so q day dosing

- Edema
- Hypertension (pts with
decreased. renal blood flow)
- CHF (adjunct to digoxin)
- Renal & hepatic dysfunction

bumetanide (BUMEX)
- Sulfonamide derivative
- More potent than furosemide
- Decr. incidence of hyperglycemia

Side Effects
- Orthostatic hypotension
- K & Cl depletion
- Hyperuricemia (decr. excretion)
- Hypercalcemia when taking Ca
supplements
- Anorexia, N/V, general GI
- Glucose intolerance
- Dry mouth, thirst
- Weakness, lethargy, muscle
cramps
- Decreased excretion of Li
- Increased dysrhythmia

- Teach about signs of hypokalemia:


anorexia, nausea, lethargy & mental
confusion, muscle weakness,
cardiac arrythmias
- Teach management of orthostatic
hypotension

- Increased excretion Na, K, Cl, H,


Ca
- Arrhythmias due to electrolyte
depletion
- Excessive diuresis
- Weakness, lethargy, dizziness
- Transient hearing loss
- Orthostatic hypotension
- Abdominal pain, diarrhea, anorexia
- Impaired glucose tolerance
- Decreased excretion of Li
- Incontinence

- Assess for allergy to sulfonamides


(w/ furosemide, torsemide,
bumetanide)
- Teach about signs of hypokalemia
- K supplementation
- Assess for dehydration: urine
color, I & O, mucous membranes,
increased HR
- Schedule dose in the morning
- Lab monitoring: K, Na & PT/INR if
on Coumadin
- Avoid switching brands
(bioavailability)

-NOT related to sulfonamides


- Decr. incidence of GI disturbances
- Decr. incidence of hyperglycemia

spironolactone (ALDACTONE)
- Keep in dark container
- Agranulocytosis
SE: Hirutism, menstrual
irregularities, gynecomastia in men

triamterene (DYTAC)
- Urine may turn blue
- Agranulocytosis, thrombocytopenia
- Photosensitivity rxs

amiloride (MIDAMOR)
- Excreted unchanged in urine
- Aplastic anemia, neutropenia

Drug/Drug Interactions (DDIs):


EtOH, oral hypoglycemics, insulin,
antihypertensives can cause
hypotension

Drug/Drug Interactions (DDIs):


(Lasix) digitalis, corticosteroids,
lithium, sulfonylureas, warfarin,
decreased absorption w/ food

ethacrynic acid (EDECRIN)

Potassium Sparing

Nursing Implications

- Antagonist of aldactone:
inhibits pump that exchanges K
for Na in distal tubule
- Reduces Na reabsorption
while retaining K & H

- Hyperaldosteronism
(spironolactone)
- Edema in CHF
- Cirrhosis of liver
- Hypertension
- Hypokalemia: helps retain K
(Used as adjunct therapy,
seldom used alone)

- Hyperkalemia
- Hypotension
- GI Upset: nausea/vomiting
- Increases Li reabsorption
- Weakness, fatigue

- Teach to avoid high K foods:


prunes, potatoes, raisins, dates,
bananas
- Teach S/Sx of hyperkalemia
- Monitor other meds with K
Contraindicated:
- Pts w/ renal insufficiency (inc.
hyperkalemia potential)
- Pts on other K-sparing drugs (inc.
hyperkalemia potential)
Drug/Drug Interactions (DDIs):
ACE inhibitor, K supplements
(increased K levels)

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