Diuretics - Thiazide, thiazide-like, loop, and potassium-sparing diuretics: Nursing pharmacology

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DIURETICS: THIAZIDE, LOOP, AND POTASSIUM-SPARING, PART 1
DRUG NAME	chlorothiazide (Diuril), hydrochlorothiazide (Microzide), indapamide (Lozol)	furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), torsemide
CLASS	Thiazide and thiazide-like diuretics	Loop diuretics
MECHANISM OF ACTION	Inhibit sodium-chloride channels in the distal convoluted tubules → prevent the reabsorption of sodium and chloride → salt and water excretion	Inhibit Na-K-2Cl transporter in the thick ascending limb of loop of Henle → excretion of sodium, potassium, and chloride → water excretion
INDICATIONS	Hypertension Pulmonary edema Heart failure Edema caused by renal and hepatic diseases
ROUTE(S) OF ADMINISTRATION	PO IV	PO IV IM
SIDE EFFECTS	Hypercalcemia Hyperuricemia Hypomagnesemia Hypochloremia Hyponatremia Hypokalemia Metabolic alkalosis Hyperglycemia Hypercholesterolemia Increased LDL	Hypomagnesemia Hypochloremia Hyponatremia Hypokalemia Metabolic alkalosis Hypotension Hyperglycemia
CONTRAINDICATIONS AND CAUTIONS	Gout Diabetes mellitus Hyperlipidemia Renal failure with anuria	Existing electrolyte imbalance Renal failure with anuria Hepatic encephalopathy Diabetes mellitus

DIURETICS: THIAZIDE, LOOP, AND POTASSIUM-SPARING, PART 2
DRUG NAME	spironolactone (Aldactone), eplerenone (Inspra, Epnone, Dosterep)	amiloride (Midamor), triamterene (Dyrenium)
CLASS	Potassium-sparing diuretics
MECHANISM OF ACTION	Block aldosterone receptors → decrease the synthesis of epithelial sodium channels (ENaC) and hydrogen pumps → increase sodium excretion, and decrease potassium and hydrogen excretion	Block ENaC → increase sodium excretion, while preserving potassium
INDICATIONS	Hypertension Pulmonary edema Heart failure Edema caused by renal and hepatic diseases Hyperaldosteronism (spironolactone)
ROUTE(S) OF ADMINISTRATION	PO
SIDE EFFECTS	Hyperkalemia Metabolic acidosis Gynecomastia Impotence	Hyperkalemia Metabolic acidosis Kidney stones
CONTRAINDICATIONS AND CAUTIONS	Hyperkalemia Renal failure with anuria Severe liver diseases

NURSING CONSIDERATIONS: THIAZIDE, LOOP, AND POTASSIUM-SPARING DIURETICS
CLASS	Thiazide and thiazide-like diuretics	Loop diuretics	Potassium-sparing diuretics
ASSESSMENT & MONITORING	Thiazide, thiazide-like, loop, and potassium sparing diuretics Weight, vital signs, fluid balance: skin turgor, mucous membranes For edema: assess and monitor location and extent of the edema For heart failure, pulmonary edema: assess and monitor respiratory status; auscultate lung sounds Ascites: measure abdominal girth; continue to monitor Labs: electrolytes (sodium, potassium, calcium, chloride), glucose, uric acid, renal and hepatic function, lipid profile Monitor Weight I&O, renal function Signs of dehydration Signs / symptoms of hypokalemia or hyperkalemia Clients with diabetes: glucose levels Ototoxicity (loop diuretics)
CLIENT EDUCATION	Thiazide, thiazide-like, loop, and potassium sparing diuretics Purpose of medication Take medication in the morning to avoid nocturia Weigh daily; report significant changes Can take with food to prevent GI upset Make position changes slowly
	Report symptoms of hypokalemia; e.g., muscle cramps, heart palpitations ototoxicity; e.g., ringing in the ears (tinnitus), dizziness, decreased hearing	Include foods containing potassium in diet; e.g., bananas, cantaloupe, potatoes Blood pressure self-monitoring Continue prescribed regimen of diet, exercise, and weight reduction as needed Follow-up appointments and routine laboratory tests needed during therapy Report symptoms of hypokalemia; e.g., muscle cramps, heart palpitations	Avoid high-potassium foods and salt substitutes Report Nausea, vomiting, muscle twitching or cramps, trouble breathing, heart palpitations Endocrine problems; e.g., menstrual irregularities, gynecomastia, impotence

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Content Reviewers

Antonella Melani, MD,Lisa Miklush, PhD, RNC, CNS,Ashley Mauldin MSN, APRN, FNP-BC,Gabrielle Proper, RN, BScN, MN

Contributors

Sam Gillespie, BSc,Jessica Reynolds, MS

Diuretics, also called water pills, are medications that act on the kidneys to increase diuresis, or the production of urine, to help excrete more water from the body. Therefore, they are generally used to treat hypertension, as well as edema caused by fluid overload conditions, such as heart failure and pulmonary edema, as well as renal diseases like nephrotic syndrome, and hepatic diseases like cirrhosis. Diuretics are most often administered orally, but some of them can also be administered intravenously.

Once administered, these diuretics act on the kidneys’ basic unit, the nephron, to induce electrolyte and water excretion.

Zooming into the nephron, it’s made up of a glomerulus, which filters the blood. The filtered content goes through the renal tubules, which have four parts: the proximal convoluted tubule; the U-shaped loop of Henle, with a thin descending, a thin ascending, and a thick ascending limb; the distal convoluted tubule; and the collecting duct, which drain the urine out of the kidneys.

Now, the main classes of diuretics include thiazide and thiazide-like diuretics, loop diuretics, and potassium sparing diuretics.

Okay, starting with thiazide diuretics and thiazide-like diuretics, which have a slightly different structure but act in the same way. Available thiazide diuretics include chlorothiazide and hydrochlorothiazide, while examples of thiazide-like diuretics are chlorthalidone and indapamide.

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Diuretics - Thiazide, thiazide-like, loop, and potassium-sparing diuretics: Nursing pharmacology

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