Diuretics PDF

DIURETICS Vy Wyatt, MS, RN, CNE LEARNING OBJECTIVES 1. Recognize normal renal physiology and the conditions requiring diuretic administration. 2. Identify the loop diuretics in terms of their prototype, mechanism of action, indications for use, major adverse effects, and nursing implications. 3. D...

DIURETICS Vy Wyatt, MS, RN, CNE LEARNING OBJECTIVES 1. Recognize normal renal physiology and the conditions requiring diuretic administration. 2. Identify the loop diuretics in terms of their prototype, mechanism of action, indications for use, major adverse effects, and nursing implications. 3. Describe the thiazide diuretics in terms of their prototype, mechanism of action, indications for use, major adverse effects, and nursing implications. 4. Describe the potassium-sparing diuretics in terms of their prototype, mechanism of action, indications for use, major adverse effects, and nursing implications. 5. Describe the osmotic diuretics in terms of their prototype, mechanism of action, indications for use, major adverse effects, and nursing implications. 6. Implement the nursing process in the care of patients receiving diuretics. 2 WHAT ARE DIURETICS? • Drugs to treat excess fluid in the body by increasing urine formation and output • Indications • Edema • Heart failure • Renal disease • Hepatic disease • Hypertension • Increased intracranial pressure https://www.jing.fm/iclip/bJhJTi_overview-of-symptoms-of-heart-failure-abdomen-congestive/ RENAL PHYSIOLOGY http://southshorenephrology.com/education/nephron-structure DIURETIC DRUGS WORK ON DIFFERENT SITES OF THE NEPHRON 5 LOOP DIURETICS This Photo by Unknown Author is licensed under CC BY-SA LOOP DIURETICS Prototype: furosemide (Lasix) Inhibit sodium and chloride reabsorption in the ascending limb of the loop of Henle • Drug of choice for rapid effects • Potent drugs producing significant diuresis • Dosage can be titrated to produce greater diuresis • Effective in patients with low GFR 7 https://www.pinterest.com/pin/738097826408966807/ LOOP DIURETICS (CONT.) Prototype: furosemide (Lasix) • Cautious with use in chronic renal failure and worsening renal function • Cautious with use in hepatic impairment • Adverse effects: hyponatremia, hypokalemia, excess fluid loss, ototoxicity • Contraindications: sulfonamide allergy, pregnancy H2 O K+ Na+ K+ H2 O 8 THIAZIDE DIURETICS THIAZIDE DIURETICS Prototype: hydrochlorothiazide Decrease reabsorption of sodium, water, chloride, and bicarbonate in the distal convoluted tubule • • • • • Weaker diuretic Requires adequate urine flow & has ceiling threshold Drug of choice for long-term management of HTN and HF edema Caution in use with hepatic impairment Contraindications: sulfonamide sensitivity, renal failure, anuria, pregnancy • Adverse effects: hearing impairment, tinnitus, dizziness, ototoxicity 10 POTASSIUM SPARING DIURETICS POTASSIUM SPARING DIURETICS Prototype: spironolactone (Aldactone) Competes for aldosterone-sensitive Na+/K+ channel at the distal tubule of the nephron to decrease sodium and water reabsorption and potassium excretion 12 • Aldosterone antagonist • Why is this referred to as potassium sparing? • Uses: HF, ascites, hypokalemia, hypertension, hyperaldosteronism, • PO therapy may require a long time before seeing results POTASSIUM SPARING DIURETICS Prototype: • • • • spironolactone (Aldactone) Caution with use in renal failure Caution with use in hepatic disease Educate patients to avoid food high in potassium Adverse effects: deepening of the voice, gynecomastia, menstrual irregularities, and testicular atrophy • BLACK BOX WARNING: tumorigenic • Contraindications: renal insufficiency, first trimester pregnancy, digoxin therapy, lithium therapy 13 ADJUVANT DRUGS OSMOTIC DIURETICS Prototype: mannitol (Osmitrol) Produces rapid diuresis by increasing the solute load (osmotic pressure) of the glomerular filtrate Pulls water from extravascular sites into the bloodstream • Useful in managing oliguria or anuria • Important uses: Reduces ICP for neurosurgery, reduces IOP before ophthalmic surgery, excrete toxic substances 15 COMBINATION PRODUCTS COMBINATION PRODUCTS 17 CARING FOR PATIENTS ON DIURETICS Baseline fluid excess Assessment Contraindications: Renal & hepatic disease, cross-sensitivity (sulfonamides), pregnancy, concurrent drug therapy Timing of administration Intervention Education: Salt and potassium intake Monitor for adverse effects Assess for therapeutic outcomes Evaluation Weigh patient Intake/output 18 REFERENCES FRANDSEN, G & PENNINGTON, S.S. (2023). ABRAMS’ CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE (12TH ED.). PHILADELPHIA, PA: WOLTERS KLUWER.