Ppt chapter 51-1

Diuretic Agents
Chapter 51
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Classes of Diuretics
• Thiazide and Thiazide-like Diuretics
• Loop Diuretics
• Carbonic Anhydrase Inhibitors
• Potassium-Sparing Diuretics
• Osmotic Diuretics

Function of Diuretic Agents
• Increase the amount of urine produced by the kidneys
• Increase sodium excretion

Indications for Diuretic Use
• Edema associated with congestive heart failure
• Acute pulmonary edema
• Liver disease (including cirrhosis)
• Renal disease
• Hypertension
• Conditions that cause hyperkalemia

Sites of Action of Diuretics

Thiazide and Thiazide-Like Diuretics
• Hydrochlorothiazide (HydroDIURIL)
• Chlorothiazide (Diuril)
• Bendroflumethiazide (Naturetin)
• Benzthiazide (Exna)
• Hydroflumethiazide (Diucardin)
• Methyclothiazide (Aquatensen)
• Polythiazide (Renese)
• Trichlormethiazide (Diurese)

(cont.)
• Actions
– Action is to block the chloride pump
– Keeps chloride and the sodium in the tubule to be
excreted in the urine, thus preventing the
reabsorption of both in the vascular system
• Indications
– Treatment of edema associated with CHF, liver, or
renal disease
– Monotherapy or adjuncts for the treatment of
hypertension

(cont.)
• Pharmacokinetics
– Well absorbed for the GI tract, metabolized in the
liver and excreted in the urine.
• Contraindications
– Allergy to thiazides or sulfonamides
– Fluid and electrolyte imbalances, and renal and liver
disease
– Bipolar disorders
– Pregnancy and lactation

(cont.)
• Caution
– Gout
– Systemic lupus
– Diabetes
– Hyperparathyroidism
• Adverse Effects
– Related to interference with the normal regulatory
mechanisms of the nephron
– Hypokalemia
– Lithium

(cont.)
• Adverse Effects (cont.)
– Decreased calcium excretion
– Altered blood glucose levels
– Urine will be slightly alkalinized
• Drug-to-Drug Interactions
– Cholestyramine or colestipol
– Digoxin
– Antidiabetic agents

Question
What is the action of thiazide diuretics?
A. Blocks the chloride pump
B. Blocks the sodium pump
C. Blocks the potassium pump
D. Blocks the carbonic anhydrase pump

Answer
A. Blocks the chloride pump
Rationale: Thiazide and thiazide-like diuretics act to block
the chloride pump. Chloride is actively pumped out of the
tubule by cells lining the ascending limb of the loop of
Henle and the distal tubule.

Loop Diuretics
• Furosemide (Lasix)
– Most commonly used; less powerful than new drugs;
larger margin of safety for home use
• Bumetanide (Bumex) and Torsemide (Demadex)
– New drugs; more powerful than Lasix
• Ethacrynic acid (Edecrin)
– First loop diuretic introduced, used less frequently in
the clinical setting

Loop Diuretics (cont.)
• Actions
– Block the chloride pump in the ascending loop of
Henle
– This causes reabsorption of sodium and chloride
• Indications
– Acute CHF
– Acute pulmonary edema
– Edema associated with CHF
– Edema associated with renal or liver disease
– Hypertension

– Metabolized and excreted primarily through the urine
– Allergy
– Electrolyte depletion
– Anuria
– Severe renal failure
– Hepatic coma

• Caution
– SLE, gout, and diabetes mellitus
• Adverse Effects
– Related to the imbalance in electrolytes and fluid
– Hypokalemia
– Alkalosis
– Hypocalcemia

– Aminoglycosides or cisplatine
– Anticoagulation
– Indomethacin, ibuprofen, salicylates, or NSAIDs

Carbonic Anhydrase Inhibitors
• Actions
– Block the effects of carbonic anhydrase; slow down
the movement of hydrogen ions
– More sodium and bicarbonate are lost in the urine
• Indications
– Adjuncts to other diuretics
– Glaucoma

Carbonic Anhydrase Inhibitors (cont.)
– Rapidly absorbed and widely distributed
– Excreted in the urine
– Allergy
– Angle closure glaucoma

• Caution
– Lactation
– Fluid or electrolyte imbalances
– Renal or hepatic disease
– Adrenocortical insufficiency
– Respiratory acidosis
– COPD

• Adverse Effects
– Related to disturbances in acid and base balance and
electrolyte balances
– Metabolic acidosis
– Hypokalemia
– Paresthesias of extremities, confusion, drowsiness
– Salicylates and lithium

Question
Please answer the following statement as true or false.
The loop diuretics cause the body to excrete a copious
amount of potassium-rich urine.

Answer
False
Rationale: The loop diuretics have a similar effect in the
descending loop of Henle and in the distal convoluted
tubule, resulting in the production of a copious amount of
sodium-rich urine.

Potassium-Sparing Diuretics
• Actions
– Cause a loss of sodium while retaining potassium
– Block the actions of aldosterone in the distal tubule
• Indications
– Adjuncts with thiazide or loop diuretics
– Patients who are at risk for hypokalemia
– Well absorbed, protein bound, and widely distributed
– Metabolized in the liver and excreted in the urine

Potassium-Sparing Diuretics (cont.)
– Allergy
– Hyperkalemia, renal disease, or anuria
– Patients taking amiloride or triamterene
• Caution
• Adverse Effects
– Hyperkalemia
– Salicylates

Osmotic Diuretics
• Actions
– Pull water into the renal tubule without sodium loss
• Indications
– Increased cranial pressure or acute renal failure due
to shock, drug overdose, or trauma
– Freely filtered at the renal glomerulus, poorly
reabsorbed by the renal tubule
– Not secreted by the tubule
– Resistant to metabolism

Osmotic Diuretics (cont.)
– Renal disease and anuria
– Pulmonary congestion
– Intracranial bleeding, dehydration
– CHF
• Adverse Effects
– Related to sudden drop in fluid levels
– Nausea, vomiting, hypotension, light-headedness,
confusion, and headache

Use of Diuretic Agents Across
the Lifespan

Prototype Thiazide and Thiazide-Like
Diuretics

Prototype Loop Diuretics

Prototype Carbonic Anhydrase Inhibitors

Prototype Potassium-Sparing Diuretics

Prototype Osmotic Diuretics

Prototype Osmotic Diuretics (Continued)

Question
How do carbonic anhydrase inhibitors work?
A. Slow down the reabsorption of sodium
B. Speeds up creation of sodium bicarbonate
C. Balances acidic and alkaline solutes in urine
D. Slows down the movement of hydrogen ions

Answer
D. Slows down the movement of hydrogen ions
Rationale: Diuretics that block the effects of carbonic
anhydrase slow down the movement of hydrogen ions. As
a result, more sodium and bicarbonate are lost in the
urine.

Nursing Considerations for Thiazide and
Thiazide-Like Diuretics
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Nursing Considerations for Loop Diuretics
• Implementation
• Evaluation

Nursing Considerations for Carbonic Anhydrase
Inhibitors
• Implementation
• Evaluation

Nursing Considerations for Potassium-
Sparing Diuretics
• Implementation
• Evaluation

Nursing Considerations for Osmotic
Diuretics
• Implementation
• Evaluation

Ppt chapter 51-1

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