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P. Sutton, MS, RN
Nursing 2 DHSON
Pharmacology Chapter 26
Diuretics
Drugs that accelerate urine
formation
Remove sodium and water from the
body
Most commonly prescribed drugs
Hypotensive activity
Exert effect on nephron
GFR used to adjust doses
Advantages
Relatively low in cost
Favorable safety profile
Problems
Metabolic adverse effects that result
from excessive fluid and electrolyte loss
Effects are usually dose related and
controlled with dose titration/adjustment
See Table 26-1 pg 405
LOOP DIURETICS
Potent diuretics
Chemically related to sulfonamide
antibiotics
Contraindicated in sulfa allergic
patients
Commonly given to patients with
sulfa allergies
Nurse to be aware of potential for
allergic reactions
Mechanism of Action
Indications
Manage edema associated with heart
failure and hepatic or renal disease
Control hypertension
Increase renal excretion of calcium
Heart failure resulting from diastolic
dysfunction
Contraindications
Drug allergy
Also consider drug allergy to
sulfanamides
Hepatic coma
Severe electrolyte loss
Adverse Effects
CNS dizziness, headache, tinnitus,
blurred vision
GI Nausea, vomiting, diarrhea
Hematologic agranulocytosis,
thrombocytopenia, neutropenia
Metabolic hypokalemia,
hyperglycemia, hyperuricemia
Drug Interactions- See Table 26-3 pg
407
Bumetanide 1mg
Ethacrynic Acid 50mg
Furosemide 40mg
Torsemide 10mg
Furosemide (Lasix)
Most commonly used loop diuretic
Has all therapeutic effects of loop
diuretics
Used to manage
Pulmonary edema
Liver disease
Edema assoc with heart failure Ascites
Nephrotic syndrome
HTN
Onset:
Peak:
Half Life
Duration
IV
IV
IV
IV
5min PO 30-60min
15min PO 1-2 hr
1-2 hr PO 1-2 hr
2hr
PO 6-8 hrs
POTASSIUM SPARING
DIURETICS
Referred to as aldosterone inhibiting
diuretics
Spironolactone is competitive
antagonist of aldosterone
Cause sodium and water to be
excreted while retaining potassium
Mechanism of Action
Work in collecting ducts and distal
convoluted tubules
Interfere with sodium-potassium
exchange
Spironolactone binds to aldosterone
receptors
Amiloride and triamterene do not
bind to aldosterone receptors, but
inhibit aldosterone induced and basal
sodium reabsorption
Indications
Applications vary depending on the
drug
Spironolactone and Triamterene used
to treat hyperaldosteranism and HTN
Spironolactone and cardioprotective
benefits
Amiloride less effective for long term
use
Amilrode useful in metabolic alkalosis
and primarily used to treat heart
Adverse Effects
Significant effects are specific to
individual drugs
Spironolactone
Gynecomastia
Amenorrhea
Irregular menses
Postmenapausal bleeding
Triamterene
Reduces folic acid levels and causes
renal calculi and urinary casts
Precipitates megoblastic anemia
(rare)
Hyperkalemia can result when
Potassium Sparing Diuretics are used
in combination with each other and/or
other Potassium Sparing drugs (ie
ACEIs)
Interactions
Concurrent use of potassium sparing
diuretics and lithium
ACEIs
Potassium Supplements
NSAIDS
Amiloride (Midamor)
Used in combination with loop or
thiazide diuretics to treat heart
failure
Hyperkalemia may occur when taken
alone
Use in caution for pts with renal
impairement or DM and in the elderly
Weak antihypertensive properties
Available in oral form only
Available in comb for w/
Onset: 2 hrs
Peak 6-10 hrs
Half Life 6-9 hrs
Duration 24 hrs
Spironolactone
Synthetic steroid that blocks aldosterone
receptors
Used in high doses to treat ascites
Hyperkalemia common complication
Frequent K+ monitoring
Most commonly ordered Potassium Sparing
Diuretic for children w/ heart failure
Available in oral form only and in comb
with hydrochlorothiazide
Triamterene
Similar to amiloride
Acts directly on distal renal tubule of
nephron
Depresses sodium resorption and
excretion of potassium and hydrogen
Available in oral form only
Available in combination form with
hydrochlorothiazide
Indications
Contraindications
GI disturbances
Skin rashes
Photosensitivity
Thrombocytopenia
Pancreatitis
Cholecystitis
Toxicity
Overdose leads to electrolyte imbalance from
hypokalemia
Anorexia
Nausea
Lethargy
Muscle weakness
Mental confusion
Hypotnesion
Treatment for Toxicity is Electrolyte
Replacement
Interactions
Corticosteroids
Diazoxide
Digitalis
Oral hypoglycemic
Excessive licorice consumption
Hydrochlorothiazide
(HydroDIURIL)
Considered the prototypical thiazide
diuretic
Commonly prescribed and
inexpensive drug
Safe and effective
Used in combination with other drugs
Available in oral form only
Ceiling Effect
Onset 2 hr
Peak 4-6 hrs
Half life 5-15 hrs
Duration 6-12 hrs
Metolazone (Zyroxolyn)
Thiazide-like diuretic
More potent than thiazide drugs
Greater potency most visible in pts
with renal dysfunction
Advantage: remains effective with
low creatinine clearance
May be given in combo w/ loop
diuretics
Available in oral form only
Onset 1 hr
Peak 1-2 hrs
Half life 6-20 hrs
Duration 24 hrs