Diuretic & Cardiac Drugs PDF

**DIURETIC & CARDIAC DRUGS** **Types of Diuretics** - Loop (BEST ORAL DIURETIC), Thiazide, Osmotic, K sparing - Diuretics increase urine output(diuresis)  - Normal urine output is considered to be 30 ml/hour or greater  - Normal GFR = 125 mL/hr.  - Normal output = about 60 mL/hr.  -...

**DIURETIC & CARDIAC DRUGS** **Types of Diuretics** - Loop (BEST ORAL DIURETIC), Thiazide, Osmotic, K sparing - Diuretics increase urine output(diuresis)  - Normal urine output is considered to be 30 ml/hour or greater  - Normal GFR = 125 mL/hr.  - Normal output = about 60 mL/hr.  - GFR = 1 mL/min = 60 mL/hr.  - Diuretics mainly affect maintenance of the ECF (to do this the kidneys filter, reabsorb/secrete) **FUROSEMIDE (LASIX)** Classification  Loop diuretic, **K wasting diuretic** -------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- MOA Rapid acting loop diuretic, inhibits Na/Cl reabsorption in ascending Loop of Henle, decreases edema/BP Uses **Very powerful diuretic given for massive movement of fluids and diuresis**, usually in both acute/CHF; if a lesser diuretic such as a thiazide can be used, it is generally best to do so Dose/ Route PO, IV, IM; 20-80 mg; IV starts in 5 min/lasts for 2 hours Adverse effects  postural hypotension, Hypokalemia, Hyponatremia, Hypomagnesium, Hyperchloremia, N/V, dehydration; tinnitus, aplastic anemia; circulatory collapse Drug interactions  If low K, high r/f dig toxicity; **Digoxin toxicity causes many different drug dysrhythmias; hearing loss when combined w/other ototoxic drugs such as aminoglycosides**; Lithium (causes high Na levels); hypotension (combined w/any other antihypertensive Patient Education **Check K level before giving (3.5- 5.0**); check BP before giving (\>110/60); Weigh daily to evaluate its effectiveness (gain 3+ lbs./few days means infective); rapid IV use has caused cardiac arrest; monitor pts closely during high volume diuresis for hypotension, circulatory collapse, check pulse, HF is \#1 reason for readmitting (teach pts about ineffective Rx/report to MD), **Increase K foods/supplements (Ex. OJ)** **HYDROCHLOROTHIAZIDE (HYDRODIURIL)** Classification  Thiazide diuretic, **K wasting diuretic** -------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- MOA **Blocks reabsorption of Na/Cl in early segment of the distal convoluted tubule**, drug not effective if there is low GFR \< 15-20 ml/min. Uses HTN, frequently 1st choice drug especially in African Americans. Can also be used in mild to moderate HF, mobilize edema associated w/hepatic or RD Dose/ Route PO, dosage depends of formulation  Adverse effects  Hyponatremia, hypochloremia, dehydration, hypokalemia; Fetal harm, can enter breast milk; elevate glucose levels in DM; May precipitate gouty arthritis Drug interactions  Promote digoxin toxicity due to promoting K loss; Increase r/o hypotension when combined w/other anti-hypertensives Patient Education Not given to pts who are Pregnant, breast feeding, DM, gouty arthritis, check K, Na, Cl levels, **Increase K foods/supplements** **MANNITOL (OSMITROL)** Classification  **Osmotic diuretic ** ------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- MOA In the proximal convoluted tubule, mannitol creates osmotic action that inhibits passive reabsorption of water; no significant effect on excretion of K  Uses Prevent/slow onset of RF in severe HTN, hypovolemic shock; reduction of ICP (caused by cerebral edema); reduction in intraocular pressure in causes not responding to usual therapy  Dose/ Route IV infusion-- hospital use only, Solutions are 5-25% (infusion percentage)/**usually crystallized warmed in water bec originally cold & frozen**; give IV infusion to obtain urine flow rate for 30-50 mL, measure w/hydrometer Adverse effects  HA, N/V, electrolyte imbalance, pulmonary edema/CHF edema Patient Education **SPRIONOLACTONE (ALDACTONE)** Classification  **K Sparing Diuretics** -- Aldosterone antagonist -------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- MOA **Blocks action of aldosterone in the distal nephron**; Since aldosterone promotes Na uptake in exchange for K secretion, inhibition of aldosterone causes retention of K/excretion of Na. Uses HTN/edema; Usually given in combo w/a Loop or thiazide diuretic because of low diuresis Adverse effects  **Hyperkalemia \>5.0** (injection of insulin can reverse this) **resulting in fatal cardiac dysrhythmias such as VFib**, Endocrine effects such as gynecomastia/menstrual irregularities since the drug is similar in chemical structure to steroid hormones. Drug interactions  **use caution if combined w/ACE inhibitors**, ARBS, direct renin inhibitors. Patient Education Monitor K levels -- **never give Aldactone in conjunction w/K, salt substitutes or another K sparing drug (Ace inhibitor)** **TRIAMTERINE (DYRENIUM)** Classification  **K Sparing Diuretics - Non-Aldosterone Sparing Diuretic** -------------------- ----------------------------------------------------------------------------------------------- MOA Disrupts Na-K exchange DIRECTLY in the distal nephron Uses HTN/edema (scant diuresis); used mainly to counteract the K wasting effects of Lasix etc. Adverse effects  N/V, leg cramps, dizziness; hyperkalemia Drug interactions  use caution if combined w/ACE inhibitors, ARBS, direct renin inhibitors. Patient Education Monitor K levels -- never give in conjunction w/K, salt substitutes or another K sparing drug **POTSSIUM CHLORIDE** +-----------------------------------+-----------------------------------+ | Classification  | **K Supplementation ** | +===================================+===================================+ | MOA | Replacement of K, transmission of | | | nerve impulses especially in the | | | heart, hypo or hyperkalemia will | | | both cause cardiac dysrhythmias | +-----------------------------------+-----------------------------------+ | Uses | Hypokalemia  | +-----------------------------------+-----------------------------------+ | Dose/ Route | Oral pills, liquid, IV infusion | | | (Dilute 10 meq in 100 ml; | | | 40meq/500-1000) | +-----------------------------------+-----------------------------------+ | Adverse effects  | Oral KCl can irritate GI tract | | | causing Abd. discomfort, N/V/D; | | | large pills can cause SEVERE | | | intestinal ulcers can resulting | | | in bleeding/ perforation., | | | Hyperkalemia can cause cardiac | | | dysrhythmias- (mild, 5-7: | | | Prolonged PR, Tented t waves); | | | (severe \>7: cardiac arrest due | | | to V-tach or V-Fib). | +-----------------------------------+-----------------------------------+ | Patient Education | Oral: make sure to give large | | | pills w/water/w/pt sitting up; | | | Liquid KCl: dilute in orange | | | juice according to directions; | | | | | | IV, can only be given per IV drip | | | NEVER push/no faster than 10 meq | | | per hour (instant death); never | | | add KCL to an existing IV; check | | | K level before giving each dose | | | (X3); Mix K well in the IV | | | solution, K is lost in V/D, wound | | | drainage, prolonged diuresis/DKA | +-----------------------------------+-----------------------------------+ **Removal of K** Symptoms in addition to cardiac can include: confusion, anxiety, dyspnea, heaviness or tingling of legs, numbness/tingling of hands, lips, feet.  **Steps to control/remove K:** - Withhold K containing foods/meds, including K sparing diuretics (spironolactone/triamterene) - **Infuse Ca gluconate IV (counteracts cardiotoxicity)** - Infuse insulin/glucose (forces K into cells) - Infuse Na bicarbonate (increase ph/increase cellular intake of K) - Give either oral or by enema Kayexalate (Na polystyrene sulfonate) an exchange resin that removes K (Na/K are inverse. Infuse Na to bring K down) - Do peritoneal or hemodialysis to remove K. A chart of pressure categories AI-generated content may be incorrect. Normal = LESS THAN 120/80 (not equal to) **ATROPINE ** Classification  **Anticholinergic (dry everything out) drug**; only drug used for CV purposes  -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- MOA Muscarinic antagonists selectively block the effects of acetylcholine at the muscarinic receptors  Uses Bradycardia in ICU (low BP, dizziness/syncope, Cognitive changes), nurse gives per emergency protocols; surgical pretreatment to prevent bradycardia during surgery. **HR/BP should both rise** (doesn't happen w/heart damage), dry secretions pre-surgical, Not used in HTN Dose/ Route 0.4 mg; 0.5-1 mg IV infusion (diluted) or IM, don't need to know dose, don't need to call dr, slow infusion if HR too high Adverse effects  Dry mouth, blurred vision, photophobia, elevation of intraocular pressure, urinary retention, anhidrosis (inability to sweat), tachycardia Drug interactions  Antihistamines, phenothiazine, antipsychotics, TCAs Patient Education I/Os, provide oral care, do not give to patient w/glaucoma or those who work in hot weather **Actions of Adrenergic Receptors (heart related only) \*\*\*\*\*** - **Alpha 1- Arterioles/veins- constriction ** - **Alpha 2 -- nerves only** - **Beta 1- heart/kidney; Heart- increase rate, force of contraction, AV conduction speed; Kidney- release of renin** - **Beta 2- bronchi- dilation, arterioles, heart, lung, skeletal muscle** **PRAZOSIN (MINIPRESS)** Classification  **Alpha adrenergic antagonists ** -------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- MOA Inhibits alpha 1 receptors (arterioles/veins), causes vasodilation, resulting in decreased BP/CO Uses Essential HTN, BPH, Raynaud's Adverse effects  Dizziness, HA, drowsiness, impotence (alpha 1 blockage inhibits ejaculation, reflex tachycardia, nasal congestion, edema/postural hypotension), OH Drug interactions  Diuretics/other hypotensive agents potentiate effects -- watch for 1^st^ dose effect  Patient Education Impotence is major reason for nonadherence **BETA BLOCKADE** Uses Angina, HTN (but not as effective as once thought), cardiac dysrhythmias (SA node, sinus tachy/PAC's), MI, HF --------------------- -------------------------------------------------------------------------------------------------------------------------- Therapeutic effects **Reduced HR**, peripheral vascular resistance w/long term use, **force of contraction, speed of AV conduction** Adverse effects  Bradycardia, reduced CO, precipitation of HF, AV heart block Patient Education  **Rapid withdrawal of drug will cause angina or ventricular dysrhythmias (need to taper withdrawal over several weeks)**   **PROPANOLOL (INDERAL XL)** Classification  **1st Gen nonselective beta 1/2 adrenergic blocker** -------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- MOA **Blocks adrenergic receptors in the cardiac (beta 1), lungs (beta 2)/renal (beta 1); suppresses renin secretion**, Therapeutic action: antihypertensive, \*\*reduces HR, CO used in MI, CAD, HTN, cardiac dysrhythmias  Uses HTN Dose/ Route Usually give PO but occasionally IV Adverse effects  Hypotension, bradycardia, bronchoconstriction, may rarely cause depression  Drug interactions  Ca channel blockers (may cause cardiac suppression, very low HR/BP) Alcohol may mask symptoms of hypoglycemia Patient Education  **Take apical pulse (don't give if below \