Diuretics

Question 1

MOA

Act primarily on the ascending loop of Henle in kidneys

Block Cl- and Na+ reabsorption resulting in diuresis

This decreased fluid volume reduces BP, systemic vascular & pulmonary vascular resistance, central venous pressure, & left ventricular end-diastolic pressure

Answer 1

Useful when rapid diuresis needed b/c rapid onset of action & lasts @ least 2 hrs

Diuretic action continues even when creatinine clearance dec below <25mL/min

Question 2

Contraindications

• Allergy to sulfonamide abx, severe electrolyte loss, hypersensitivity, hepatic coma

Answer 2

Drug/lab interactions

• Inc effect w/thiazide diuretics; dec effect w/NSAIDs
• Inc risk of neurotoxicity w/aminoglycosides
• Inc risk of digoxin & lithium toxicity
• Dec effects of sulfonylureas; inc risk of hypokalemia w/corticosteroids
• Inc serum uric acid, glucose, ALT & AST

Question 3

Nursing

• I&O, daily weights & report wt gain >2 lbs
• VS, monitor electrolytes (esp K+)
• Teach client to monitor for s/s of hypokalemia (leg cramps); eat K+ rich foods

Answer 3

• Admin in am to prevent nocturia; eval effectiveness of diuretic (dec edema/HTN/HF)
• Monitor for orthostatic hypotension
• BUN, creatinine

Question 4

Thiazide-type = ?

Answer 4

Hydrochlorothiazide

Question 5

Loop diuretics = ? (3)

Answer 5

furosemide, torsemide, bumetanide

Question 6

K+-sparing diuretics =? (3)

Answer 6

spironolactone, amiloride, triamterene

! Be aware of elevated K+ w/these

Question 7

K+ rich foods

• Apricots, avocados, bananas
• Cantaloupes, carrots, dried beans
• Peas, dried fruits, melons, oranges

Answer 7

• OJ, peanuts, potatoes (white or sweet)
• Prune juice, spinach, swiss chard, tomatoes (juice sauce), winter squash