Drugs Used for Diuresis

Chapter 29Chapter 29

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Chapter 29

Lesson 29.1

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ObjectivesObjectives

• Identify the action of diuretics• Describe the goal of administering diuretics to

treat hypertension, heart failure, or increased intraocular pressure or before vascular surgery in the brain

• Identify the effects of diuretics on blood pressure, electrolytes, and diabetic or prediabetic patients

• Review possible underlying pathologic conditions that may contribute to the development of excess fluid volume in the body

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DiureticsDiuretics

• Used to increase flow of urine to reduce excess water in the body

• Primarily used to treat heart failure, hypertension

• Other uses: liver disease, renal disease, cerebral edema, increased intraocular pressure, treat hypercalcemia

• Therapeutic outcomes: reduce edema, improve symptoms of excess fluid

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Pathologic Conditions Pathologic Conditions Contributing to Excess FluidContributing to Excess Fluid

• Heart failure Edema, adventitious lung sounds, dyspnea,

change in mental status

• Liver disease Jaundice, ascites, disorientation, history of

alcohol dependence, overdose of OTC medications

• Adverse outcomes if diuretics not given: renal failure, pulmonary congestion, edema, hypertension, stroke, death

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Sites of Action in the NephronSites of Action in the Nephron

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Chapter 29

Lesson 29.2

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Slide 8

ObjectivesObjectives

• Cite nursing assessments used to evaluate renal function

• Cite nursing assessments used to evaluate a patient’s state of hydration

• State which electrolytes may be altered by diuretic therapy

• Review the signs and symptoms of electrolyte imbalance and normal laboratory values of potassium, sodium, and chloride

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Objectives (cont’d)Objectives (cont’d)

• Explain the rationale for administering diuretics cautiously to older adults and individuals with impaired renal function, cirrhosis of the liver, or diabetes mellitus

• Develop objectives for patient education for patients taking loop, thiazide, and potassium-sparing diuretics

• List adverse effects that can be anticipated whenever a diuretic is administered

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Objectives (cont’d)Objectives (cont’d)

• State the nursing assessments needed to monitor therapeutic response or the development of common or serious adverse effects from diuretic therapy

• Cite alterations in diet that may be prescribed concurrently with loop, thiazide, or potassium-sparing diuretic therapy

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Renal Function: AssessmentRenal Function: Assessment

• History of related causative disorders/factors• History of current symptoms• Pattern of urination• Medication history• Hydration status• Electrolyte imbalance

Often subtle changes, such as in mental status, muscle strength/cramps, tremors, nausea, general appearance

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Nursing Assessment Nursing Assessment for Hydration Statusfor Hydration Status

• Evaluate for dehydration: skin turgor, oral mucous membranes

• Monitor laboratory values for changes• Evaluate location of edema, signs of

reduction• Obtain daily weights• Measure intake and output

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Electrolyte ImbalanceElectrolyte Imbalance

• Susceptible people: history of renal or cardiac disease, hormonal disorders, massive trauma or burns

• Assess mental status, muscle strength and cramps, tremors, nausea, general appearance

• Serum potassium < 3.5 mEq/L (hypokalemia), > 5.5 mEq/L (hyperkalemia)

• Serum sodium < 135 mEq/L (hyponatremia), > 145 mEq/L (hypernatremia)

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Patient Education ConsiderationsPatient Education Considerations

• Accurate measurement of fluid intake and output

• Purpose of diuresis• Medication considerations• Nutrition• Health maintenance• Written record/patient self-assessment form

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Drug Class: Drug Class: Carbonic Anhydrase InhibitorCarbonic Anhydrase Inhibitor

• Drug: acetazolamide (Diamox)• Actions

Weak diuretic; inhibits the enzyme carbonic anhydrase in kidney, brain, eye

• Uses Reduces intraocular pressure with glaucoma;

reduce seizure activity with certain types of epilepsy

• See Chapters 19 and 43 for further discussion

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Drug Class: Drug Class: Sulfonamide-Type Loop DiureticsSulfonamide-Type Loop Diuretics

• Actions Inhibit sodium and chloride reabsorption in

ascending limb of the loop of Henle

• Uses Treat conditions such as edema resulting from

heart failure, cirrhosis of the liver, renal disease

• Common adverse effects Oral irritation, dry mouth; orthostatic hypotension

• Serious adverse effects Gastric irritation, abdominal pain; electrolyte

imbalance, dehydration; hyperuricemia; hyperglycemia; hives, pruritus, rash

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Drug Class: Thiazide DiureticsDrug Class: Thiazide Diuretics

• Actions Block reabsorption of sodium and chloride

ions from the tubule

• Uses Treat edema associated with heart failure,

renal disease, hepatic disease, pregnancy, obesity, premenstrual syndrome

• Common adverse effects Orthostatic hypotension

• Serious adverse effects Gastric irritation, electrolyte imbalance,

hyperuricemia, hyperglycemiaMosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Drug Class: Drug Class: Potassium-Sparing DiureticsPotassium-Sparing Diuretics

• Drugs: amiloride (Midamor), spironolactone (Aldactone), triamterene (Dyrenium)

• Actions Induce retention of potassium; excrete sodium

at the distal renal tubules

• Uses In combination with other diuretics to treat

hypertension or heart failure, prevent hypokalemia

• Common and serious adverse effects Nausea, vomiting, anorexia, flatulence,

headache, electrolyte imbalance, dehydrationMosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Drug Class: Drug Class: Combination Diuretic ProductsCombination Diuretic Products

• Drugs Spironolactone/hydrochlorothiazide (Aldactazide) Triamterene/hydrochlorothiazide (Dyazide,

Maxzide) Amiloride/hydrochlorothiazide (Moduretic)

• Actions Potassium-sparing diuretics / thiazide diuretics

• Uses Promote diuresis while maintaining normal

potassium levels

• Common adverse effects Hyperkalemia, hyponatremia

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