DIURETICS

Diuretics
 increase the rate of urine formation  removal of sodium & water
 “ water pills”

2 main indications:
1. decrease blood pressure
2. decrease edema

Types of Diuretics:

1. Carbonic Anhydrase inhibitors

• acetazolamide (Diamox)* 4. Thiazide Diuretics
• methazolamide • hydrochlorothiazide (Hydrodiuril)
• dichlorphenamide • chlorothiazide

2. Osmotic Diuretics Thiazide –like diuretics

• mannitol • chlorthalidone
• urea • metolazone
• glycerin
• isosorbide 5. Potassium – sparing diuretics
• spironolactone
3. Loop Diuretics • amiloride
• furosemide (Lasix)* • Triamterene
• bumetanide
• torsemide
• ethacrynic
I. Carbonic Anhydrase Inhibitors)

MOA: (proximal tubule )

 inhibit carbonic anhydrase  prevent exchange of H ions with Na
 inhibit H secretion  promote Na ,K & HCO3 excretion  diuresis

Indications/ Uses:
1. glaucoma
2. edema secondary to CHF
3. high- altitude sickness

SE / Adverse effects:
• metabolic acidosis
• hypokalemia
• paresthesias
• drowsiness & confusion

II. Osmotic diuretics

MOA: (glomerulus &proximal tubule)

 pull water into blood vessels & nephrons from tissues  diuresis

Indications:
1. acute renal failure (oliguric phase)
2. increased intracranial pressure
3. cerebral edema

SE/ Adverse effects:

• headache, confusion
• nausea & vomiting
• hypotension & lightheadedness
• convulsions, shock

CI:
 anuria , dehydration
 heart failure
 pulmonary edema
III. Loop Diuretics

MOA: (Loop of Henle)

 inhibit Na & chloride reabsorption  more Na & water loss
 increase renal blood flow by 40%
 excrete Na, Cl, K, Mg, Ca

Indications:
1. edema assoc. with CHF, liver or kidney dses
2. hypertension

SE/Adverse Effects:
• dizziness, headache, tinnitus, blurred vision
• N & V, diarrhea
• agranulocytosis, neutropenia, thrombocytosis
• hyponatremia ,hypokalemia,hypocalcemia, hypomagnesemia
• hyperglycemia, hyperuricemia

IV. Thiazides & Thiazide-like diuretics

MOA: (distal convoluted tubule)

 inhibit Na & chloride reabsorption  minor loss of water

Indications:
1. edema
2. hypertension

SE/Adverse effects:
• same CNS & GIT effects of Loop diuretics
• Impotence
• Urticaria, photosensitivity
• hypokalemia, hypomagnesemia
• hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia
V. Potassium- sparing diuretics

MOA: (collecting ducts & distal convoluted tubules)

 Inhibit Na – K exchange
 Inhibit aldosterone action
 Inhibit Na channels

Indications:
Spironolactone & triamterene
1. hyperaldosteronism
2. hypertension
3. prevent K loss caused by potassium-losing drugs

Amiloride
1. CHF

SE/Adverse effects:
• same CNS & GIT effects as loop diuretics
• hyperkalemia
• gynecomastia, hirsutism, irregular mense, amenorrhea

Nsg. Implications in giving diuretics:

 Thorough Hx & PE
 Baseline I & O, serum electrolytes, weight, VS
 Take in AM
 Monitor serum K during therapy.
 Except for K -sparing diuretics, encourage K rich foods.
 Monitor for digoxin toxicity.
 Monitor blood glucose when using thiazides/ loop diuretics in diabetic pxs.
 Change position slowly.
 Notify physician ASAP for tachycardia , syncope.
 Monitor for adverse effects:
 metabolic alkalosis
 drowsiness, lethargy, decreased mental status
 hypokalemia
 hypotension
 tachycardia
Your MIND is like a parachute, it works best when opened.
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