Thiazide Diuretics
hydrochlorothiazide
hydrochlorothiazide route
PO
hydrochlorothiazide uses
treat edema and prevent renal calculiUsed for hypertension and heart failure
hydrochlorothiazide action
Decreases reabsorption of sodium, water, chloride, and bicarbonate in the distal convoluted tubule
hydrochlorothiazide a/e
HypotensionWeaknessDizzinessGI upsethyperglycemiaCan cause fluid and electrolyte imbalancesDehydration, hypokalemia, hyponatremia
Thiazide Diuretics admin
Give in morning to decrease nocturiaPatients with sulfa allergy may have sensitivity to drugDo not give if patient is anuric (no urine output)Interactions Box 32.1 Page 596Ceiling threshold
only thiazide that can be given IV
Chlorothiazide
Loop diuretics
furosemide
furosemide route
PO, IV
furosemide uses
Used for hypertension, acute pulmonary edema, edema, heart failure, hepatic and renal disease
furosemide action
Inhibition of sodium and chloride reabsorption in ascending limb of loop of Henle
furosemide a/e
HyperglycemiaFluid and electrolyte imbalancesMetabolic alkalosis, hypovolemia, dehydration, hyponatremia, hypokalemia, hypomagnesemiaOtotoxicityGI upset
loop diuretics admin
Allergic to sulfa, may be allergic to furosemideDo not give if patient is anuric Do not give in pregnancy (unless benefits outweigh risks)Give IV push over 1-2 minutes
Potassium sparing diuretics
spironolactone
spironolactone route
PO
spironolactone uses
Used for edema, cirrhosis, nephrotic syndrome, heart failure, hypertension
spironolactone action
Direct action on the collecting ducts and distal tubule of the kidneys
spironolactone a/e
DizzinessHeadacheGI upsetVoice deepening
spironolactone c/i
Renal insufficiency
spironolactone note
Weaker diuretic and antihypertensive effects than other diuretics but conserve potassium
Potassium sparing diuretics admin
Administer at same time each dayDon't use potassium supplements or eat a potassium rich diet
Osmotic diuretics
mannitol
mannitol route
IV
mannitol uses
Used for acute renal failure, cerebral edema, and reduction of intracranial and intraocular pressure
mannitol action
Cause diuresis through osmosisIncrease the osmotic pressure of the glomerular filtrate
mannitol a/e
SeizuresThrombophlebitisPulmonary congestionHeadachesChest painTachycardiaBlurred visionChillsFeverRebound intracranial pressure
mannitol interactions
none!
Hypokalemia management
Give supplemental potassium(Sustained release tablets are usually better tolerated than liquid preparations)Increase potassium in diet(Orange juice, apple juice, grape juice, bananas pineapple juice, prunes)Restrict sodium in diet
Hyperkalemia management
Avoid potassium-sparing diuretics and potassium supplements in those with renal impairmentAvoid excessive use of supplementsAvoid salt substitutes (most are potassium chloride)Maintain urine output(Major way body eliminates potassium from body)