Diuretics Drug List Flashcards
What are diuretics used to treat?
Edema/Volume Overload
Hypertension
Congestive Heart Failure
Can be used to prevent renal failure
What determines the effectiveness of a diuretic?
Effectiveness of diuretics depends on amt of Na/Cl blocked. Action early in nephron –> greater diuretic effect.
What’s the MOA of diuretics?
Block Na/Cl reabsorbtion in nephron, blocking passive H20 reabsorption
- amt urine r/t amt of na/cl blocked
- early in nephron = greatest effect
Describe the pharmacokinetics of diuretics.
- Oral or Parenteral (rapid onset)
- Effect @ diffferent sections of nephron
- Excreted and metabolized in kidney in liver
- Drug action specific to drug
What imbalances occur with diuretics?
Hypovolemia
Electrolyte:
- hyponatremia
- hypokalemia - give supplements, potassium rich foods)
- hypokalemia (dysrhythmia, muscle weakness, cramping, flaccid paralysis, leg discomfort, extreme thirst, confusion)
- hyperkalemia (if aldosterone is blocked)
What are the nursing implications for diuretics use?
Nursing implicatinos for diuretics usage:
- Assess volume: output > input
- Monitor weight loss 2.2lbs=1L=1kg
- Assess / monitor mucus membranes, edema, skin turgor
- Assess for orthostatic hypotension
- Assess electrolyte abnormalities
- Dose in AM prevent nocturia –> falls!
MANNITOL: Describe the type, MOA, location of action, uses, pharmacokinetics, side/adverse effects, and potential drug interactions.
Drug: Mannitol
Type: Osmotic diuretic
MOA:
suger solute, cant be filtered/absorbed, added to filtrate in nephron, causes water to pull into tubule via osmosis, results in diuresis.
Occurs in proximal tubule
Uses: Kidney protection: low flow, mannitol remains in nephron preserving urine flow preventing renal failure. Also, intracranial hypertension - Mannitol cant cross BBB, draws H20 out of brain: (intracranial hypertension
increased intraocular pressure)
Pharmacokinetics:
- more mannitol present = more diuresis
- must be given IV
Side / adverse effects:
Hypokalemia
Hypovolemia
Contraindicated in heart failure: vascular osmotic effect precedes renal diuretic effect, draws H20 into all blood vessels increasing HTN
What is the MOA of Mannitol?
MOA:
suger solute, cant be filtered/absorbed, added to filtrate in nephron, causes water to pull into tubule via osmosis, results in diuresis. Occurs in proximal tubule.
What is Mannitol used for?
Uses: Kidney protection: low flow, mannitol remains in nephron preserving urine flow preventing renal failure
Intracranial hypertension:
Mannitol cant cross BBB, draws H20 out of brain: (intracranial hypertension
increased intraocular pressure)
What are some PK notes on Mannitol?
Pharmacokinetics:
- more mannitol present = more diuresis
- must be given IV
What are some side effects of Mannitol?
Side / adverse effects:
Hypokalemia
Hypovolemia
Contraindicated in heart failure: vascular osmotic effect precedes renal diuretic effect, draws H20 into all blood vessels increasing HTN
FUROSEMIDE: Describe the type, MOA, location of action, uses, pharmacokinetics, side/adverse effects, and potential drug interactions.
DRUG: Furosemide
TYPE: Loop diuretic
MOA:
- produce more loss of fluid/electrolytes than any other diuretic –> profound diuresis
- can be used even when urine flow is SCANT
EFFECT:
- blocks 20% of Na/Cl/H20 @ ascending loop
- high ceiling diuretic
USES:
- Fluid Overload (pulmonary edema, renal/cardiac)
- Hypertension that cant be treated w/ other diuretics
- All patients who need diuretic and have low renal blood flow
PK:
Oral or Parenteral (good if emergency)
Works with patients with renal failure ( antibiotics
DRUG INTERACTIONS:
- Digoxin: hypokalemia, increase risk dysrhythmias
- Aminoglycocides antibiotics: ototoxicity
- Potassium sparing diuretics can be used to offset hypokalemia
What is the MOA of FUROSEMIDE? What is the effect?
MOA:
- produce more loss of fluid/electrolytes than any other diuretic –> profound diuresis
- can be used even when urine flow is SCANT
- blocks 20% of Na/Cl/H20 @ ascending loop
- high ceiling diuretic
What is FUROSEMIDE used for?
USES:
- Fluid Overload (pulmonary edema, renal/cardiac)
- Hypertension that cant be treated w/ other diuretics
- All patients who need diuretic and have low renal blood flow
What are some PK notes on FUROSEMIDE?
PK:
Oral or Parenteral (good if emergency)
Works with patients with renal failure (<15-20ml/min, normal is 125ml/min) even if GFR is low
What are some side effects of FUROSEMIDE?
SIDE EFFECTS:
- Hypokalemia: fatal dysrhythmias under 3.5
- Hypovolemia
- Hypotension (r/t loss volume and relaxing venous smooth muscle)
- Severe dehydration (risk for thrombosis/embolism
- Electrolyte imbalances:
- hyponatremia (decrease Na causes a decrease in Cl)
- hypochloremia
- hypokalemia (decrease in K causes a decrease in Mg)
- hypomagnesemia
- Hyperglycemia: inhibits insulin release pancreas.
- Hyperuricemia: uric acid esp w/ those at risk for gout
- Altered fat metabolism (increase LDL, TG, decrease HDL)
- Ototoxicity r/t high ceiling diuretic, esp w/ ototoxic drugs -‘mycin’ antibiotics
What are the drug interactions of FUROSEMIDE?
DRUG INTERACTIONS:
- Digoxin: hypokalemia, increase risk dysrhythmias
- Aminoglycocides antibiotics: ototoxicity
- Potassium sparing diuretics can be used to offset hypokalemia
What drug is similar to FUROSEMIDE? What is a major way that it differs?
HYDROCHLOROTHIAZIDE (HCTZ) is similar to FUROSEMIDE but HYDROCHLOROTHIAZIDE can’t be used when urine is scant. Also, FUROSEMIDE is ototoxic, while HYDROCHLOROTHIAZIDE is NOT ototoxic.
What drug is similar to HYDROCHLOROTHIAZIDE? What is a major way that it differs?
HYDROCHLOROTHIAZIDE (HCTZ) is similar to FUROSEMIDE but HYDROCHLOROTHIAZIDE can’t be used when urine is scant. Also, FUROSEMIDE is ototoxic, while HYDROCHLOROTHIAZIDE is NOT ototoxic.
HYDROCHLOROTHIAZIDE (HCTZ): Describe the type, MOA, location of action, uses, pharmacokinetics, side/adverse effects, and potential drug interactions.
Drug: HYDROCHLOROTHIAZIDE (HCTZ)
Type: Thiazide
MOA:
Similar to furosemide but can’t be used when urine is scant (i.e. renal failure patients)
Diuresis effect is lower, no ototoxicity
cant be used w/ renal failure patients
Blocks 10% of Na, Cl, H20 @ early distal convoluted tubule
USES:
first line drug for HTN and Edema
* useful for AA HTN (salt sensitivity)”
PK:
oral only, and ineffective with renal failure (low glomerular filtration)
SIDE/ADVERSE EFFECTS:
Hypovolemia Hypotension hyponatremia hypochloremia hypokalemia hypomagnesemia Hyperglycemia Hyperuricemia hypercholesterolemia, triglyceridemia NO OTOTOXICITY
DRUG INTERACTIONS:
- digoxacin: hypokalemia
- combined w/ antihypertensives as a single pill to improve compliance
What is the MOA of HYDROCHLOROTHIAZIDE? What is the effect?
Drug: HYDROCHLOROTHIAZIDE (HCTZ)
Type: Thiazide
MOA:
Similar to furosemide but can’t be used when urine is scant (i.e. renal failure patients)
Diuresis effect is lower, no ototoxicity
Blocks 10% of Na, Cl, H20 @ early distal convoluted tubule
What is HYDROCHLOROTHIAZIDE used for?
USES of HYDROCHLOROTHIAZIDE:
First line drug for HTN and Edema
* useful for AA HTN (salt sensitivity)
What are some PK notes on HYDROCHLOROTHIAZIDE?
PK of HYDROCHLOROTHIAZIDE:
- oral only
- ineffective with renal failure (low glomerular filtration)
What are some side effects / adverse effects of HYDROCHLOROTHIAZIDE?
SIDE EFFECTS of HYDROCHLOROTHIAZIDE:
Hypovolemia
Hypotension
hyponatremia
hypochloremia
hypokalemia
hypomagnesemia
HYPERglycemia
HYPERuricemia
HYPERcholesterolemia
Triglyceridemia
NO OTOTOXICITY
