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What are the 2 major applications of diuretics?
- (1) treatment of hypertension
- 2) mobilization of edematous fluid (associated with heart failure, cirrhosis, and kidney disease).
- 3) In addition, because of their ability to maintain urine flow, diuretics are used to prevent renal failure.
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What are the 4 major categories of diuretics?
- 1) high-ceiling (loop) diuretics (eg, furosemide);
- (2) thiazide diuretics (eg, hydrochlorothiazide);
- (3) osmotic diuretics (eg, mannitol); and
- (4) potassium-sparing diuretics.
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How do diuretics work?
decrease reabsorption of sodium and water along the renal tubules of the nephron in the kidney
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What is an example of a loop diuretic
furosemide (Lasix)
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What does lasix promote the excretion of
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Lasix is used to treat:
- Hypertension (especially if renal disease is present)
- pulmonary edema
- Heart failure
- edema of hepatic, cardiac, or renal origin that has been unresponsive to less efficacious diuretics
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What are the adverse effects of a loop diuretic
- hyponatremia
- hypochloremia
- dehydration
- hypotension
- hypokalemia
- ototoxicity (hearing impairment, rare)
- hyperglycemia
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Loop diuretics are in what pregnancy category
C
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***Furosomide administration should occur no faster than 80mg/2min
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What is an example of a thiazide diuretic?
Hydrochlorothiazide (HCTZ)
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How does HCTZ work?
- –Weak diuretic that acts in the distal tubule
- –Increases the excretion of sodium, chloride, potassium, and water
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What is the principle difference between high-cieling diuretics and thiazides?
that the maximum diuresis produced by the thiazides is considerably lower than the maximum diuresis produced by the high-ceiling drugs.
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What are the therapeutic uses of thiazide diuretics
- edema
- hypertension
- diabetes insipidus
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What are the adverse effects of thiazide diuretics
- hypnatremia
- hypochloremia
- hypokalemia
- dehydration
- hyperglycemia
- GI: nausea, vomiting
- CNS: dizziness, vertigo
- polyuria, nocturia
- CV: orthostatic hypotension
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**thiazides should not be used during pregnancy
**should not be used if pt has pre existing renal disease because it can slow the GFR
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If a pt is taking a thiazide diuretic, the nurse should
- monitor I & O
- weight
- BP and Pulse
- electrolyte levels
- glucose levels
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What are the 2 sub categories of K-sparing diuretics?
aldosterone antagonists and nonaldosterone antagonists.
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*** K-sparing diuretics have the weakest diuretic effect of the diuretics if given alone, but works synergistically with other diuretics
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What is an example of an aldosterone antagonist diuretic?
spironolactone blocks the actions of aldosterone in the distal nephron.
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What is an example of a nonaldosterone antagonist
triamterene and amiloride
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How does Spironolactone work?
- works in the distal tubule to promote sodium and water excretion
- promotes re-absorption of Potassium
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What are the therapeutic uses of Spironolactone?
- Edema
- Hypertension
- Heart failure
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What are the adverse effects of Spironolactone?
- benign and malignant tumors
- Endocrine disorders (gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice.)
- hyperkalemia
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What are the adverse effects of triamterene?
Relatively common side effects include nausea, vomiting, leg cramps, and dizziness.
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What is an example of a Osmotic Diuretic
Mannitol (Osmitrol)
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What are some therapeutic uses of Osmotic Diuretics
- Decrease in Intracranial Pressure
- Decrease of Intraocular pressure
- treatment of acute renal failure
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What are the adverse effects of Mannitol?
- Serious fluid electrolyte imbalance
- may induce fluid overload
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Carbonic Anhydrase inhibitors are used for?
•Used primarily in treating chronic, open-angle glaucoma
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How does mannitol work?
Draws water into the vascular space through osmosis
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Triamterene works where?
in the distal tubule of the kidney
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