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What is the action of Diuretic Drugs?
- They accelerate the rate of urine formation.
- Resulting in removal of sodium & water
- (preventing reabsorption)
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In the nephron, where sodium goes, water follows. If the water is NOT absorbed where does it go?
Excreted as urine
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List the Diuretic drug classifications.
- Potassium-losing diuretics
- Thiazide & Thiazide-like diuretics
- Loop diuretics
- Carbonic Anhydrase Inhibitors (CAIs)
- *K+ loosing diuretics
- Osmotic Diuretics
- K+ sparing diuretics
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What are the different K+ loosing diuretics?
- Thiazide & Thiazide-like diuretics
- Loop diuretics
- Carbonic Anhydrase Inhibitors
- Osmotic diuretics
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If your client has +3 pitting BLE edema & good kidney fxn, what drugs might they be put on?
- Thiazide-like diuretics
- Hygroton, Mykrox
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What is the mechanism of action for the Thiazide/Thiazide-like diuretics?
- Inhibit tubular resorption of Na+, Chloride, & K+ ions.
- Dilate the arterioles by direct relaxation
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What are the a/e of Thiazides & Thiazide-like diuretics?
- CNS: dizziness, HA, blurred vision, paresthesiase, <libido
- CV: Hypotension
- GI: Anorexia, N/V/D, constipation
- Skin: Urticaria, photosensitivity
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Loop diuretics are the strongest diuretics, name them.
- Lasix
- Bumetanide (Bumex)
- Edecrin
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What is the mechanism of action with Loop Diuretics?
- Act directly on the ascending limb of the loop of Henle to inhibit chloride & sodium reabsorption
- Work fast!!
- Potent diuresis & subsequent loss of fluid
- <FV causes <BP
- ^loss of K+ & Na+
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What are types of medical issues are Loop Diuretics used for?
Edema, HTN
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What is an important factor to remember about Loop Diuretics?
- <FV causes <BP
- Loss of K+ & Na+
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What are the A/R of Loop Diuretics?
- CNS: dizzness, HA, tinnitus, blurred vision
- CV: Hypotension
- GI: N/V/D
- Hematologic: Agranulocytosis, neutropenia, <platelets
- Metabolic: Hypokalemia, hyponatremia, <Ca+, <Mg, hyperglycemia, hyperuricemia, ^BUN & Creat.
- LOOSE ALL ELECTROLYTES
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Name the K+ loosing Carbonic Anhydrase Inhibitor diuretics.
- Acetazolamide (Diamox)
- Methazolamide
- Dichlorphenamide
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What is the mechanism of action for the K+ loosing diuretics Carbonic Ahnydrase Inhibitors?
- Block the action of carbonic anhydrase, prevents exchange of H+ ions w/Na+ & water -> decreased resorption of water.
- =ther is ^ excretion of bicarbonate, Na+, water, & K+, urine volume is ^.
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With the K+ loosing Carbonic Anhydrase Inhibitor drugs causeing ^ excretion of bicarbonate can lead to what severe issue?
Metabolic acidosis.
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What are the A/E of Carbonic Anhydrase Inhibitors? (K+ loosing diuretics)
- Metabolic Acidosis
- Hypokalemia
- Drowsiness, parasthesias, urticaria, photosensitivity, anorexia hematuria, melena
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What is the mechanism of action for the Osmotic Diuretic, Mannitol (Osmitrol)?
- Pulls water into the renal tubules from the surrounding tissues.
- Inhibits tubular resorption of water & solutes, producing a rapid diuresis.
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The rapid diuresis caused by the Osmotic drug Osmitrol is useful in what conditions?
- <Intracranial pressure.
- NOT used for peripheral edema
- ^glomerular filtration & renal plasma flow = helps to prevent kidney damage during acute renal failure.
- <excessive intraocular pressure
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What are the A/E of the K+ loosing diuretic Osmitrol?
- Convulsions, Thrombophlebitis, Pulmonary congestion
- IV use only
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Name the K+ Sparing diuretics.
- Amiloride (Midamor)
- Spironolactone (Aldactone)
- Triamterene (Dyrenium)
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What is the mechanism of action for K+ sparing drugs like Spironolactone?
- Interferes w/the Na/K+ exchange = Blocks the resorption of Na+ & water.
- *allows K+ back in
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What are the indications for K+-sparing drugs like Spironolactone?
- HTN, Hyperaldosteroinism, HF
- **Reversing the K+ loss caused by K+-loosing drugs.**
- Given w/K+ loosing drugs to balance K+
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What are the A/E of K+ Sparing drugs like Spironolactone?
- CNS: dizziness, HA
- GI: cramps, N/V/D
- Urinary frequency, weakness, HTN
- **Hyperkalemia**
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What are the nursing implications when a client is using Diuretics?
- before admin: BP & K+ levels
- Assess: baseline FV status, I&O, serum electrolyte values, Wt, VS (orthos)
- Know foods ^in K: Bananas, oranges, dates, raisins, plums, fresh veg, potatoes, meat, fish, apricots, whole grain cereals, legumes
- S/S of Hypokalemia: muscle weakness, constipation, irregular heart beat, lethargy
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What other information will the nurse teach the client taking diuretics?
- Take in AM, change positions slowly, rise slowly
- Keep log of: daily Wt for MD
- ^K+ rich foods (not w/K+sparing drugs)
- CALL MD: ^HR or syncope (dizziness/falling down), Wt gain of 2# or more/day, or 5# or more/week
- Diabetics: blood glucose
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