Diuretics

Diuretics

1. DIURETICS PREPARED BY: USHA RANI KANDULA, ASSISTANT PROFESSOR, DEPARTMENT OF ADULT HEALTH NURSING ARSI UNIVERSITY,ASELLA,ETHIOPIA , SOUTH EAST AFRICA.

2. The diuretics act by inhibiting tubular reabsorption .

3. CLASSIFICATION OF DIURETICS

4. HIGH EFFICACY DIURETICS

5. Furosemide : 20-80 mg/day (oral/IM/IV ) Bumetanide : 1mg IV loading dose 0.5-2mg/day PO divided q 12 h ( oral/IV) Piretanide Ethacrynic acid Torsemide : 2.5-5 mg/day Azosemide HIGH EFFICACY DIURETICS

6. MECHANISM OF HIGH EFFICACY DIURETICS

7. Frusemide acts by inhibiting NaCl reassorption in the thick ascending limb of the henle’s loop. MOA

8. It blocks the Na, K, Cl in the thick ascending limb of the henle’s loop because of which it is called is a loop diuretic.

9. It greatly increases the excretion of Na and Cl in the urine . As a large amount of NaCl is absorbed in this segment, loop diuretics are highly efficacious.

10. Diuretic response increases with dose and over increased treatment can cause dehydration.

11. Acute CHF Acute pulmonary edema Edema associated with CHF Hypertension Acute renal failure Cerebral edema Acute hypercalcemia and hyperkalemia INDICATIONS

12. Anuria Severe renal failure Hepatic coma Pregnancy and lactation CONTRAINDICATIONS

13. Hypotension and volume depletion Dose related toxicity Hypersensitivity reactions GI disturbances. SIDE EFFECTS

14. NURSES RESPONSIBILITIES

15. Administer drug at day time to avoid sleep disturbances. Monitor serum electrolytes, liver and renal function. Administer pottassium rich diet to patient.

16. PATIENT EDUCATION

17. To weight regularly To eat pottassium rich diet INSTRUCT PATIENT

18. MODERATE EFFICACY DIURETICS

19. Thiazides act on the early distal tubule. Thiazides have a moderate efficacy because 90% of the filtered sodium is already reabsorbed before reaching the distal tubule. MOA THIAZIDES

20. This group of drugs block Na/ Cl cotransport system in the early distal tubule. Thiazides enhance excretion of Mg and K. But they inhibit excretion of Ca and uric acid resulting in hypercalcemia and hyperuricemia .

21. Thiazides : ( Benzothiadiazines ) – Chlorothiazide (adult -0.5-1g)(10-20ML/day) ( oral / IV) Hydrochlorothiazide (adult-25-100mg/day (oral) Polythiazide Bendroflumethiazide Cyclopenthiazide MODERATE EFFICACY DIURETICS

22. Thiazide related agents – Chlorthalidone Clopamide : 10-60 mg/day (oral/IV) Indapamide : 2.5-5mg/day (oral/IV) Metolazone : 5-10 mg/day (oral/IV) Xipamide : 20-40 mg/day (oral/IV)

23. Edema Hypertension Diabetes insipidus Hypercalciurea Liver cirrhosis INDICATIONS

24. Allergy to thiazides Fluid or electrolyte imbalance Renal disease Liver disease Anuria CONTRAINDICATIONS

25. NURSES RESPONSIBILITIES

26. Reduce dose of other antihypertensives by at least 50% if given with thiazides . Readjust dosages as blood pressure responds. Measure and record weights to monitor fluid changes.

27. LOW EFFICACY DIURETICS

28. potassium sparing diuretics act as aldostrone antagonist by reduce Na reabsorption and reduce K secretion in the distal part of the nephron . These are not potent diuretics when used alone. MOA POTASSIUM SPARING DIURETICS

29. They are primarily used in combination with other diuretics. It enhances the excretion of calcium by a direct action on the renal tubules.

30. It is an enzyme that catalyzes the formation of carbonic acid, which spontaneously ionizes to H and Hco3 . This Hco3 combines with Na and is reabsorbed. MOA OF CARBONIC ANHYDRASE INHIBITORS

31. carbonic anhydrase inhibitors block sodium bicarbonate reabsorption and cause Hco3 diuresis . carbonic anhydrase is present in the nephron , eyes, gastric mucosa, pancreas etc.

32. Potassium sparing diuretics Triamterene : child 5mg/oral Amiloride : Adult : 100mg /oral Spironolactone : Adult : 25-200mg/oral LOW EFFICACY DIURETICS

33. Carbonic anhydrase inhibitors Acetazolamide : 250mg/oral Methazolamide Dorzolamide

34. Glaucoma To alkaline urine Epilepsy Hyperphosphatemia INDICATIONS

35. NURSING RESPONSIBILITIES

36. Electrolyte level Vital signs Weight of the patient Signs of metabolic acidosis Check

37. Osmotic diuretics Mannitol : 10%, 20% IV Urea Glycerol : 0.5-1.5g/kg as oral solution

38. Methylxanthines Theophylline : it have mild diuretic effect.

39. Primary aldosteronism Edema associated with CHF, nephrotic syndrome, hepatic cirrhosis Prevention of hypokalemia Cardiac arrhythmias Hypertension in combination of other drugs. INDICATIONS

40. Allergy Hyperkalemia Renal disease Anuria Pregnancy and lactation CONTRAINDICATIONS

41. NURSING RESPONSIBILITIES

42. Measure and record regular weight to monitor mobilization of edema fluid. Regular evaluation of serum electrolytes and blood urea nitrogen. Avoid foods rich in pottassium .

43. OSMOTIC DIURETICS

44. It causes water to be retained in the proximal tubule and descending limb of henle’s loop by osmotic effect resulting in water diuresis . There is some loss of sodium.

45. Increased intracranial or intraocular tension. Acute renal failure to maintain GFR. INDICATIONS

46. Assess electrolytes level Check vital signs Weight of the patient NURSING CONSIDERATIONS

47. THANKING YOU