Diuretics
Osmotic Diuretics
Inhibits reabsorption of water and Na. Increase the osmolarity of blood and renal filtrate.
Uses: renal failure, excretion of toxic substances and cerebral edema
Ex: mannitol (Osmitrol)
Action: increases osmotic pressure and pulls fluid into the renal tubules and reduces cerebral edema
Interactions: none significant
Contraindications: severe renal disease, pulmonary edema (use loop diuretics instead), intracranial bleed
Adverse effects: cause seizures, thrombophlebitis
Loop Diuretics
Uses: edema (heart failure), HTN, renal failure, hypercalcemia, pulmonary edema
Ex: furosemide (Lasix), torsemide (Demadex)
Action: potent diuretics that block chloride and sodium reabsorption in the loop of Henle in the Kidney
Interactions: vancomycin (can cause ototoxicity), digoxin (can cause hypokalmeia), NSAIDs (decrease diuretic activity)
Adverse Effects: dizziness, N/V/D, tinidus, hypokalemia, hyperglycemia,
Make sure kidney OK before administration Gets rid of potassium
Potassium-sparing Diuretics
Uses: HTN, and used with loop diuretics to prevent K loss, heart failure
Ex: amiloride (Midamor), spironolactone (Aldactone)
Action: block aldosterone receptors, causing Na and H2O excretion (weak diuretic effect)
Interactions: lithium, ACE inhibitors or K-supplements can result in significant hyperkalemia!!
Adverse effects: dizziness, headache, cramps, N/V/D, hyperkalemia!!
Contraindications: high potassium, severe renal failure
Thiazide and Thiazide-like Diuretics
Uses: High BP, heart failure and edema; commonly prescribed because relatively cheap
Ex: metolazone (zaroxolyn) hydrochlorothiazide (hydrodiuril)
Action: inhibit reabsorption of Na, Cl and K in the distal tubule
Interactions: steroids (can increase potassium lvl), digoxin(increase of dig toxicity), oral hypoglycemics (increase sugar level)
Adverse effects: N/V/D, hypokalemia, hyperglycemia, increased uric acid
Interactions: steroids (can increase potassium lvl), digoxin(increase of dig toxicity), oral hypoglycemics (increase sugar lvl)
Implementation for Diuretics
Administer in the morning/not nice (because they’d be up all night urinating)
VS
Assess electrolytes
I&O
Watch constipation
Daily weights
Have patient change positions slowly
Videos
Mike Linares (SimpleNursing) YouTube: Search Diuretics
EmpoweRN: Pharmacology Tips Loop Diuretics Lasix
*Post based off of my notes from class.