- loop duiretics: indications and mechanism of action - duiretics: possible side effects - thiazides - pottasuim sparing duiretics - nursing considerations - gout

1. Genito- & Reproductive system
By C SettleyCompiled by C Settley

2. Duiretics- pg 159
• These drugs increase urine volume by increasing
urine production in the nephron by different
mechanisms.
• Increased Na+ (Sodium) excretion in urine.
• Prevention of H2O reabsorption (osmotic diuresis).
• Preventing reabsorption of NaHCO3 (Sodium
bicarbonate).
Compiled by C Settley

3. 1. Loop diuretics – pg 160
• Loop diuretics are diuretics that act at the ascending limb
of the loop of Henle in the kidney. They are primarily used
in medicine to treat hypertension and edema often due to
congestive heart failure or renal insufficiency.
• As more fluid is passed out by the kidneys, less fluid
remains in the bloodstream. So any fluid which has
accumulated in the tissues of the lungs or body is drawn
back into the bloodstream to replace the fluid passed out
by the kidneys. This eases symptoms such as oedema and
breathlessness caused by the congestion of fluid.
• E.g. furosemide, bumetanide and torasemide.
Compiled by C Settley

4. Loop diuretics-
Indications & Mechanism of action
• Indication: Oedema associated with heart failure, liver cirrhosis, kidney
impairment, nephrotic syndrome.
• Hypertension.
• Cerebral/pulmonary oedema where rapid diuresis is required (IV
injection).
• Mechanism of action: Inhibit sodium, chloride and potassium
reabsorption.
Compiled by C Settley

5. Loop diuretics-
possible side effects
• Side-effects are uncommon when routine low doses are used. The higher the dose,
the greater the risk of side-effects developing. The leaflet which comes in the
tablet package provides a full list of possible side-effects. So, it is important to read
that leaflet if you are prescribed a loop diuretic. Common or serious possible side-
effects include:
• The salt balance in the bloodstream sometimes being upset, which can cause a
low blood level of potassium, sodium, and magnesium, and a high level of calcium.
• An upset stomach
• Dizziness on standing - due to too low blood pressure (hypotension).
Compiled by C Settley

6. 2. Thiazide diuretics- pg 160
• E.g. hydrochlorothiazide
• Indication: Often used for long term management of hypertension
• Side effect(s): Causes arteriolar vasodilatation & hyponatraemia and
hypokalaemia (disorders of water metabolism). Vasodilation refers to the
widening of blood vessels. It results from relaxation of smooth muscle
cells within the vessel walls, in particular in the large veins.
• Mechanism of action: It reduces blood volume by acting on the kidneys
to reduce sodium (Na+) reabsorption.
Compiled by C Settley

7. 3. Potassium-sparing diuretics-
pg 161
• E.g. spironolactone
• Congestive heart failure: For the management of edema and sodium
retention when the patient is only partially responsive to, or is intolerant
of, other therapeutic measures. ALDACTONE is also indicated for patients
with congestive heart failure taking digitalis when other therapies are
considered inappropriate.
• Cirrhosis of the liver accompanied by edema and/or ascites: Aldosterone
levels may be exceptionally high in this condition. ALDACTONE is indicated
for maintenance therapy together with bed rest and the restriction of fluid
and sodium.
• Nephrotic syndrome: For nephrotic patients when treatment of the
underlying disease, restriction of fluid and sodium intake, and the use of
other diuretics do not provide an adequate response.
Compiled by C Settley

8. Diuretics:
Nursing consideration
• Link to mealtimes
• Patient sleeping pattern
• Bathroom/toilet
• Intake/output (fluid control and monitoring)
• Catheter
• Constipation
• Dehydrated
Compiled by C Settley

9. Gout
• Gout is one of the most painful forms of
arthritis. It occurs when too much uric acid
builds up in the body. The buildup of uric acid
can lead to: Sharp uric acid crystal deposits in
joints, often in the big toe. Deposits of uric
acid (called tophi) that look like lumps under
the skin.
Compiled by C Settley

10. Compiled by C Settley

11. Gout
• Gout is a disorder of purin metabolism: Increased levels of uric acid in the
blood
• Caused by increased production or decreased excretion by kidneys
• Urate crystals are deposited:
in connective tissue & articular cartilage &
in the renal pelvis
• Drug management (pg 162):
• Chronic treatment: Allupurinol (Reduces the production of uric acid in the
body)
• NSAIDs
• Colchicine (for acute attack)
Compiled by C Settley

12. Reproductive system
• Hormone replacement therapy- pages 162-
168
Compiled by C Settley

13. References
• Chronic heart failure: Management of chronic
heart failure in adults in primary and
secondary care; NICE Clinical Guideline
(August 2010)
• Hypertension: management of hypertension
in adults in primary care; NICE Clinical
Guideline (August 2011)
• British National Formulary; NICE Evidence
Services (UK access only)
Compiled by C Settley