Diuretics

1
Diuretics

• Remove sodium water
• tx hypertension, CHF, pulmonary edema, kidney
  disease
• nursing diagnosis - fluid volume excess

2
Renal Physiology

• Urine formation occurs in nephron where blood
  plasma is processed into urine
• ADH released when osmolality of extracellular
  fluid increases which increases water
  reabsoprtion
• Acid-base regulation
• Usual urine production is less than 2L/day

3
Carbonic Anhydrase Inhibitor

• Enzyme (carbonic anhydrase) acts to promote
  reabsorption of sodium and bicarbonate
• Diamox (acetazolamide)
• Agents used more for glaucoma than as diuretic
• may cause false positive urine protein test
• take with meals

4
Loop Diuretics

• Inhibit reabsorption of sodium and chloride in
  the ascending loop of Henle
• effective even with impaired GFR
• watch for hypokalemia
• Lasix (furosemide) - may raise glucose level,
  push slowly with IV, store oral solution in
  refrigerator

5
Osmotic Diuretics

• These agents are filtered by glomerulus but have
  limited capability of being reabsorbed
• Used primarily with increased intracranial
  pressure but also may be used with ARF
• mannitol (Osmitrol) - IV, if crystals form, warm
  sol. then cool to body temp., IV set must have
  filter, infiltration may result in tissue necrosis

6
Thiazide Diuretics

• Safest diuretic
• Structurally related to antibacterial
  sulfonamides
• inhibit sodium and chloride reabsorption in early
  portion of distal tubule
• watch for hypokalmia
• adverse effects - hyperglycemia and
  hyperuricemia)
• HydroDIURIL (hydrochlorothiazide)

7
Potassium-sparing Diuretics

• The drugs in this class have different modes of
  action
• Dyrenium (triamterene) Midamor (amloride)
  blocks sodium reabsorption in distal tubule
• Aldactone (spironolactone) - inhibits action of
  aldosterone, adverse effect is gynecomastia for
  male clients
• Generally used with potassium-depleting diuretic

8
Combination Diuretics

• Combines potassium sparing diuretic with
  hydrochlorothiazide (HCTZ) (thiazide diuretic)
• Aldactozide (spirolactone HCTZ)

9
Nursing Implications

• Monitor IO, weights
• Monitor potassium, chloride, glucose, uric acid
• Give early in day
• Watch for Digoxin toxicity for clients on Digoxin

10
Critical Thinking

• Ms. Jones is admitted with CHF. She is started on
  HydroDIURIL. What type of diuretic is this?
• What lab data would you check prior to giving
  this medication?
• What are the adverse effects you will be
  monitoring for?
• What do you expect to see if Ms. Jones has a
  therapeutic response?

11
Critical Thinking (cont)

• Ms. Jones is having difficulty breathing. The
  physician orders Lasix IV.
• Is impaired renal function a contraindication?
• What primary electrolyte imbalance will you
  monitor for?
• What precautions will you take when administering
  Lasix IV?