#thiazide

[scholarshipportal]

(via Thiazide Diuretics - Chlorothiazide & Hydrochlorothiazide Uses & Mechanism)

[scholarshipportal]

(via Thiazide Diuretics - Mechanism, Uses, Side Effects, and Nursing Considerations)

[enhancedathlete]

Gained probably 10lbs of fat post #bodybuilding competition. Took #dnp for 2 days and a #thiazide #diazide diuretic and holy cow I have #abs again. Today was a #spa and #pool day then shot crazy videos with Frank Yang. (at Road Castle洛德城堡親水園區)

[medicowesome]

Why does thiazide, a diuretic, cause a paradoxical anti-diuretic effect in Diabetes insipidus?

Hey everyone! I have explained this before (In one of my earlier posts on free water clearance) but someone found my language too complicated to understand. So I decided to write this post.. An explanation which is "free" of complicated terms like free water clearance. Yaay! :D ADH absorbs water. In nephrogenic diabetes insipidus, the kidney is unresponsive to ADH. What do you then? You use a drug called thiazide. Thiazide diuretics inhibit the NaCl co-transporter  in the renal distal convoluted tubule (DCT). The DCT is water impermeable.. So the DCT action is NOT how thiazides preserve water. Then what is preserving water? The antidiuretic action of thiazides is secondary to increased renal sodium excretion. The renal sodium loss causes extracellular volume contraction leading to lowered GFR and increased proximal tubular sodium and water reabsorption. Hence, less water and solutes are delivered to the distal tubule and collecting duct and are lost as urine. Also, there are other mechanisms that may come into play, like upregulation of aquaporin channels and ENaC subunits, which you can read on Ryan's blog, here. That's all! -IkaN

[road-to-rn]

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.

[sharepearls-blog]

Diuretic induced hyponatremia almost always is due to thiazide diuretics. It occurs mostly in the elderly. Thiazides inhibit sodium and potassium reabsorption in the distal tubule, leading to Na and K depletion and AVP-medicated water retention.