Nurses responsibilities on Diuretics

DIURETICS AND ITS NURSES
RESPONSIBILITIES
MATHEW VARGHESE V
MSN(RAK),FHNP (CMC Vellore),CPEPC
Nursing officer
AIIMS Delhi
1
mathewvmaths@yahoo.co.in

DEFINITION
Diuretics, also called water pills, are
medications designed to increase the
amount of water and salt expelled from
the body as urine.
2

TYPES
DIURETICS
THIAZIDE
DIURETICS
LOOP
DIURETICS
K+ SPARING
DIURETICS
CARBONIC
ANHYDRASE
INHIBITORS
OSMOTIC
DIURETICS
3

THIAZIDE DIURETICS
 Thiazides are the most commonly prescribed
diuretics.
 They’re most often used to treat high blood
pressure.
 These drugs not only decrease fluids, they also
cause your blood vessels to relax.
 Thiazides are sometimes taken with other
medications used to lower blood pressure.
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THIAZIDE DIURETICS
Examples of thiazides include:
 Chlorthalidone
 Hydrochlorothiazide (Microzide)
 Metolazone
 Indapamide
Thiazide diuretics increase the elimination of sodium
and chloride in approximately equivalent amounts.
They do this by inhibiting the reabsorption of sodium
and chloride in the distalconvoluted tubules in the
kidneys.
5

LOOP DIURETICS
 Loop diuretics are often used to treat heart failure.
 Examples of these drugs include:
 Torsemide (Demadex)
 Furosemide (Lasix)
 Bumetanide
6

LOOP DIURETICS
 Loop diuretics are the most potent diuretics as they
increase the elimination of sodium and chloride by primarily
preventing reabsorption of sodium and chloride.
 The high efficacy of loop diuretics is due to the unique site
of action involving the loop of Henle (a portion of the
renal tubule) in the kidneys.
7

POTASSIUM-SPARING DIURETICS
 Potassium-sparing diuretics reduce fluid levels in
your body without causing you to lose potassium,
an important nutrient.
 The other types of diuretics cause you to lose
potassium, which can lead to health problems such
as arrhythmia.
 Potassium-sparing diuretics may be prescribed for
people at risk of low potassium levels, such as
those who take other medications that deplete
potassium.
8

 In the distal tubule, potassiumis excreted into the
forming urine coupled with the reabsorption of
sodium.
 Potassium-sparing diuretics reduce sodium
reabsorption at the distal tubule, thus decreasing
potassium secretion.
 Potassium-sparing diuretics when used alone are
rather weak, hence they are used most commonly
in combination therapy with thiazide and loop
diuretics.
9

 Potassium-sparing diuretics don’t reduce blood
pressure as well as the other types of diuretics do.
 Therefore, prescribe a potassium-sparing diuretic
with another medication that also lowers blood
pressure.
 Examples of potassium-sparing diuretics include:
 Amiloride
 Triamterene (Dyrenium)
 Spironolactone (Aldactone)
 Eplerenone (Inspra)
10

CARBONIC ANHYDRASE INHIBITORS
 Carbonic anhydrase inhibitors inhibit the enzyme
carbonic anhydrase which is found in the proximal
convoluted tubule.
 This results in several effects including bicarbonate
accumulation in the urine and decreased sodium
absorption.
 Carbonic anhydrase inhibitors work by increasing
the excretion of sodium, potassium, bicarbonate
and water from the renal tubules
 Drugs in this class include acetazolamide
and methazolamide
11

OSMOTIC DIURETICS
 Osmotic diuretics are low-molecular-weight substances that
are filtered out of the blood and into the tubules where they
are present in high concentrations.
 Osmotic diuretics (e.g. mannitol) are substances that
increase osmolarity but have limited tubular epithelial cell
permeability.
 They work primarily by expanding extracellular fluid and
plasma volume, therefore increasing blood flow to
the kidney, particularly the peritubular capillaries. This
reduces medullary osmolality and thus impairs the
concentration of urine in the loop of Henle
 They work by preventing the reabsorption of water, sodium
and chloride. 12

INDICATIONS
Diuretics are used with other types of medications
(adjunctive therapy) in edema associated with
 Congestive heart failure(CHF),
 Cirrhosis of the liver,
 Corticosteroid and estrogen therapy.
Diuretics also are useful in edema caused
by renal dysfunction CAUSED BY
 Nephrotic syndrome,
 Acute glomerulonephritis
 Chronic renal failure
Diuretics are used to lower urinary calcium excretion,
making them useful in preventing calcium-
containing kidney stones. 13

INDICATIONS
 Diuretics are used as the sole therapeutic agents to
treat hypertension.
 Diuretics can also be used in combination with
other antihypertensive drugs to treat more severe
forms of hypertension.
 Diuretics (specifically the carbonic anhydrase
inhibitors) are used as adjunctive treatment
of chronic simple (open-angle) glaucoma and
secondary glaucoma
14

INDICATIONS
 Thiazide diuretic uses for osteoporosis
in postmenopausal women.
They can be given alone or in combination with
calcium or estrogen.
 Thiazide diuretics also used for treating diabetes
insipidus
 Osmotic diuretics used in the treatment of
incearsed ICP , cerebral oedema, head injury
15

SIDE EFFECTS
 Dry mouth
 Thirst
 Weakness
 Lethargy
 Drowsiness
 Restlessness
 Muscle pains or
cramps
 Confusion
 Seizures
 Muscular fatigue
 Hypotension
 Oliguria
 Tachycardia
 Gastrointestinal (GI)
disturbances
16

SERIOUS SIDE EFFECTS
 In rare cases, diuretics may cause serious side
effects. These can include:
 Allergic reaction
 Kidney failure
 Irregular heartbeat
 Extremely low levels of sodium caused by thiazide
diuretics have been associated with death and
neurologic damage in elderly patients.
 Thiazide diuretics are associated with increase uric
acid levels which may cause gout.
17

DRUG INTERACTIONS
 Thiazide diuretics given concurrently with antidiabetic
drugs causes a decreased blood level of antidiabetic
drugs, hence doses of antidiabetic drugs may need to
be increased.
 Among patients taking digoxin (Lanoxin), low levels of
potassium caused by concurrent digoxin and diuretics
(thiazide & loop diuretics) may cause weakness,
cramps, and irregular heartbeats.
 Lithium given concurrently with diuretics (thiazides and
loop diuretics) may induce lithium toxicity due to
decreased renal elimination of lithium.
 Lithium levels should be monitored to ensure safety.
18

DRUG INTERACTIONS
 Potassium-sparing diuretics given with angiotensin
converting enzyme (ACE) inhibitors or nonsteroidal anti-
inflammatory drugs (NSAIDs) have been associated
with severely elevated levels of potassium
(hyperkalemia).
 Severe hyperkalemia may present as muscle weakness,
fatigue and slow heart rate (bradycardia).
 It is important to monitor potassium blood levels and to
have an electrocardiogram performed.
 Diuretics are often prescribed with other medications for
high blood pressure and heart disease.
 This may increase the effects of these medications,
potentially causing electrolyte abnormalities (such as
reduced levels of potassium). 19

NURSING MANAGEMENT
 Potential Nursing Diagnoses
 ■ Fluid Volume, Excess
 ■ Fluid Volume, Deficient, Risk for
 ■ Urinary Elimination, Impaired, related to diuretic
use
20

ASSESSMENT
Prior to administration:
 ■ Obtain a complete health history (mental and
physical), including data on recent surgeries or
trauma.
 ■ Obtain vital signs; assess in context of client’s
baseline values.
 ■ Obtain client’s medication history, including
nicotine and alcohol consumption and use of herbal
supplements or alternative therapies to determine
possible drug allergies and/or interactions.
 ■ Obtain blood and urine specimens for laboratory
analysis
21

THANK YOU
25

Nurses responsibilities on Diuretics

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