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major clinical indications for diuretics are deem, heart failure and hypertension.
Diuretics indirectly reduce blood pressure by producing sodium and water loss and lowering the tone or rigidity of the arteries. they block sodium reabsorption in the nephron.
digoxin toxicity with all diuretic.
THIAZIDE hydrochlorothiazide is the most commonly used. It is the only one that can be given IV. Thiazides are frequently prescribed in the long term management of heart failure and hypertension and edema. they act to decrease reabsorption of sodium, water,chloride in the
distal tubule.
they have a ceiling dose or threshold. that ceiling dose if dependant on the type of diuretic used and the individuals disease. Thiazides must be used cautiously in patients allergic to sulfonamide drugs. they must also be used cautiously in pregnant women because it can cross the placenta.
Therapeutic effects
1.promotes diuresis
- reduces BP
Ineffective with decrease renal failure—most of the sodium has already been reabsorbed
Adverse effect of Thiazide diuretics
photosensitivity because of the sulphonamide relation. hypoglycemia this drug can increase the attack of gout.
LOOP DIURETIC
these drugs inhibit sodium and chloride reabsorption in the ascending limb of the loop of henle. these potent drugs produce significant diuresis.. loop diuretics are the most effective and versatile diuretic available. it can be given both orally and IV. so these are the drugs of choice when rapid effect is needed and when renal function is impaired. Furosemide is the most commonly used loop diuretic. very potent and you will urinate within 2 hours of administration. so again : Mechanism of Action
Act directly on the ascending limb of the loop of Henle to enhance secretion of sodium, chloride and potassium
Therapeutic Effect
Rapid diuresis: last at least 2 hrs
↓ BP
used for pulmonary edema or hypertension. this is the only one that
can be used with renal failure.
contraindictation
not producing any urine
Adverse effects of Loop Diuretics
Hypokalemia, hyponatremia, photosensitivity
Ototoxicity ( only place where it is) signs tinnitus, decreased hearing
abilities
you do not give it with someone on gentamycin.
POTASSIUM-SPARING DIURETICS(psd)
it is used with excessive aldosterone excretion. addison’s disease.
they act at the distal tubule to decrease sodium reabsorption.
aldosterone makes you secrete postassium. so it blocks aldosterone to
prevent you from losing potassium. there is a drug called
spironolactone an aldosterone antagonist. this drug blocks the sodium
retaining effects of aldosterone. Just to note that male patients taking
that drug may develop breast(gynecomastia). it cause impotence.
there is also a drug called indapamide. it is used for hypertension,
edema due to HF. it can cause orthostatic hypotension, vertigo, gastric
distress, rash, photosensitivity reactions.
psd are weak when used alone. they are generally given with
potassium losing diuretics to prevent or manage hypokalemia.
Mechanism of Action
Interferes with sodium reabsorption in the distal tubule by blocking the action of aldosterone
Promotes sodium and water excretion and ↑ potassium retention
Therapeutic Effect
it can cause dry mouth and thirst.
so all these drugs are used for the treatment of deem associated with HF, hypertension, renal disease, acute glaucoma. they are contraindicated in patients with sensitivity to the drug, electrolyte imbalnaces, severe liver or kidney disease and anuria( that is the cessation of urine production).
so just to note that these drug are cautiously used in patients with renal dysfunction.
when taking diuretics older patients are more susceptible to pastoral hypotension, hypokalemia and increased serum glucose levels. lower doses are advised in older adults. patients taking these drugs should be monitored for potassium loss. when discontinuing the drugs it should be gradually discontinued to prevent edema.
okay so before administering any of these drugs the nurse needs to obtain baseline BP readings in both the supine and standing position. obtain weight,BP and apical pulse( because of the dyrrihmias or hypokalemia). get lab studies done to check for electrolyte imbalances. and check for patients state of hydration.
so patients with edema you should check their weight over everything else. patients with hypertension you should check their BP over everything. when thiazide especially is given renal function should be checked periodically.
so some nursing actions are that these drugs should be given early in the day to prevent any nighttime sleep pattens or falls. give furosemide IV at a rate of 4mg/min or less and give at least 1-2 min apart from others.
in order to observe for therapeutic effects the nurse should weight the patient before breakfast or drinking anything and after they have urinated. also intake and output should be recorded. this can tell whether or not they are retaining any fluids. observe and monitor urine. in patients with HF or acute pulmonary edema should be observed for dyspnea, crackles, cough and cyanosis because of decreased fluid in lunds.
in the case of furosemide and thiazide and adverse effect can be hypokalemia and hyponatremia. but patients who are taking furosemide are at a higher rate of getting hypokalemia. another adverse effect is dehydration and hyperglycemia( toxic effect), pulmonary edema and ototoxicity. with psd spironolactone nurses should observe for hyperkalemia because the renal system is not function well and they are taking in potassium.
educating the patient
. if GI upset occurs take the drug with food and milk. . hypertensive patients should avoid drugs that cause BP to go up. . if weight loss exceed 3 or 5 call doctor
.avoid exposure to sunlight.
.when taking loop or thiazide blood glucose levels can go up and be present in the urine.
. for patients taking psd avoid eating foods high in potassium and avoid the use of salt substitutes contain potassium. . thiazide may cause gout . Teach patients to eat more potassium-rich foods when taking thiazide or loop diuretics ( loop means lose so you lose the potassium).
both the thiazide and loop are used cautiously in patients with liver disease, diabetes, lupus or diarrhea.
some general consideration:
hypokalemia may be as a result of the use of hydrochlorothiazide and furosemide.
it is good to check your weight 2-3 times a week to check for edema and weight gain or loss.
it may cause increase in glucose or sensitivity to the sun.
take or give diuretic with or after food to decrease stomach upset
be cautious with patients with hypocalcima and hpyovolema
big major effect is cough. if presented with that move from ace inhibitors to arbs.
headache , dizzness fatigue.
toxic effect
synocpe. becarse ful with hypercaliema
less than 90 hold the drug heart rate less than 60 also
check lung sound
ACE reduces BP, preserves cardiac output and increase renal blood flow.
so when administering ace inhibitors you should check baseline BP. hold med is stole is less than 90 and HR is less than 60.
obtain a history of bowel elimination. get lab studies like BUN and CBC.
ask whether patient is pregnant and look out for persistent cough.
Afriacn americians do not respond well to ACE 2
An example of arbs Candesartan and Losartan
contraindictation
pregnacy and agniedma
becasreful with patients taking potassium supplements
toxic effect hypotension bradycardia
assess apical pulse for 1 and monitor for fluctuations
calcium channel blockers
very nice drugs aaa
decrease tpr and calcium channels
beta blockers all end in lol
