6024 Mod 9 Diuretics.pdf

/Module 9 Lecture Study Guide Fall 2023 Diuretics Kidneys primary function→ filtration Starts in the glomerulus then enter the nephrons→ nephrons excrete Na & chloride→ each nephron secretes a different % All diuretics block Na and chloride from being absorbed Osmotic—Osmotol (Mannitol) ● Location o...

/Module 9 Lecture Study Guide Fall 2023 Diuretics Kidneys primary function→ filtration Starts in the glomerulus then enter the nephrons→ nephrons excrete Na & chloride→ each nephron secretes a different % All diuretics block Na and chloride from being absorbed Osmotic—Osmotol (Mannitol) ● Location of nephron ○ Proximal convoluted tubule (PCT) ● MOA ○ Blocks PCT from reabsorbing NaCl; creates osmotic force within the lumen of nephron ● SE ○ HA, Nausea, Vomiting ● Indications ○ Increased ICP/cerebral edema ○ Intraocular pressures ● Contraindication ○ CHF; pulmonary edema ● Monitoring ○ Edema→ due to it NOT crossing the capillary membrane ○ Electrolytes ○ I&O balance ● Facts/Population Considerations ○ Does not cross BBB or capillary membrane ○ Very potent diuretic Loop—Furosemide (Lasix) Torsemide (Demadex) Bumetanide (Bumex) ● MOA ○ Blocks thick loop of henle from reabsorbing Nacl ● SE ○ Hypotension ● ● ● ● ○ Hyponatremia ○ Hypochloremia ○ Hypokalemia→ dysrhythmias→ interacts w/ Digoxin ○ Hypocalcemia→ muscle spasms/tetany ○ Ototoxicity–especially if you push too fast IVP ○ May cause hyperglycemia in some pts Indications ○ 1st line tx for HF FVO acute/chronic ○ 1st line for cardiorenal syndrome ○ ESLD—concurrent use of loop w/ AA diuretics to prevent hepatic encephalopathy Contraindications ○ Hypotension ○ BBW–for hyponatremia due to dehydration ○ caution w/ renal pts Monitoring ○ renal/electrolytes ■ NSAIDs may blunt effects due to prostaglandins being released→ dilation of glomerulus→ decreased blood flow Facts/Population Considerations ○ Furosemide is the least bioavailable but is the most common RX ○ Caution with someone w/ a sulfa allergy Thiazide—Hydrochlorothiazide (HCTZ) Metolazone (Zaroxolyn) Chlorthalidone (Thalitone) Chlorothiazide (Diuril) ● MOA ○ Blocks DCT from reabsorbing NaCl ● SE ○ Hypotension ○ dizziness/weakness ○ hyponatremia/hypomagnesemia, hypokalemia, hypercalcemia ● Indications ○ HTN & edema ○ Induces vasodilation→ 1st line tx for HTN ○ Given for HF w/ ACEI ● Contraindications ○ AKI hold if CrCl < 20 ○ ESRD ○ Hx of SJS ● Monitoring ○ renal/electrolytes ○ Uric acid levels if hx of gout ○ Increase risk of SJS & photosensitivity ○ Increases blood sugar→ caution w/ diabetics ● Facts/Population Considerations ○ Less effective than loops ○ Careful with NSAIDs due to prostaglandins ○ Crosses the placenta→ category B (do not take if pregnant) **Aldosterone→ secreted from the zona glomerulosa (adrenal cortex) AA/Potassium Sparing/MRA—Spironolactone (Aldactone) Eplerenone (Inspra) ● MOA ○ Same as thiazides, but spares K+ ● SE ○ Gynecomastia (swollen male breast tissue) ○ Hyperchloremic metabolic acidosis (loss of bicarb) ○ Hyperkalemia ● Indications ○ 3rd/4th line tx for HTN ○ Use in GDMT for HFrEF if CrCl > 30 and K+ is WNL ○ Hyperaldosteronism ○ Cirrhosis ○ Nephrotic syndrome ○ Hypokalemia ○ Off label use—acne mostly in women ● Contraindications ○ Acute renal failure ○ ESRD ○ Hyperkalemia ● Monitoring ○ renal/electrolytes ○ I&Os ● Facts/Population Considerations ○ Weak–rarely used solo ○ Women should be cautious if they want to avoid becoming pregnant and have some form of birth control ○ Watch diet high in K+ Carbonic Anhydrase Inhibitors—Acetazolamide (Diamox) ● MOA ○ Inactivates carbonic anhydrase→ PCT increases excretion of HCO3, taking Na+ H2O and K+ with it ○ Alkalines our urine and promotes diuresis ● SE ○ Hyperchloremic metabolic acidosis ○ Hypokalemia; hyponatremia ○ Hyperammonemia ○ Dehydration ● Indications ○ Refractory volume overload (pt not responsive to loop diuretics) ○ Most commonly when ppl have altitude sickness or correct metabolic alkalosis ○ Acute closed angle glaucoma ○ Pseudotumor cerebri ● Contraindications ○ Hyperchloremic metabolic acidosis ○ hypokalemia/natremia ○ Hyperammonemia ○ Dehydrated ● Monitoring ○ renal/electrolytes/acid base ○ I&Os Drug interactions for diuretics