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

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Notes

Notes

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

Transcript

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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