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Exam 3 pharm study guide
Loop, potassium-sparing, and thiazide diuretics
Drug classification
Thiazides
Thiazide-like diuretics
Loop
High ceiling diuretics
Potassium-sparing
Potassium sparing diuretics
Thiazide
Action
Acts on the distal convoluted renal tube.
Promotes sodium, chloride, and water excretion
Indications
Hydrochlorothiazide
Decrease blood pressure
Decrease amount of fluid within the body
Treats peripheral edema
Side effects Hyperglycemia
Hypercalcemia
Hypokalemia
Dizziness
Vertigo
Adverse reactions
Cardiac dysrhythmias
Orthostatic hypotension
Severe hypokalemia
Contraindications
Renal failure
Diabetes
Interactions Digoxin
Herbal products
Loop diuretics Action
Act on the loop on henle by inhibiting chloride transport of sodium and passive
reabsorption of sodium.
As more fluid is passed out by the kidneys, less fluid remains in the
bloodstream Indications Furosemide
HF
Renal dysfunction
Hypertension
Peripheral and pulmonary edema Side
effects
Electrolyte imbalances
Decrease in potassium, magnesium, sodium, calcium
Hyperglycemia
Dizziness
Headache
Adverse reactions
Hypokalemia
Hyponatremia
, Hypomagnesemia
Orthostatic hypotension
Renal failure
Contraindications
Severe electrolyte imbalance
Hypovolemia
Anuria
Diabetes mellitus
Hypotension
Interactions
Digoxin-risk for digitalis toxicity
Lithium
Potassium-sparing
Action
Blocks the action of aldosterone
Promotes sodium and water excretion and promotes potassium retention
Indications
Spironolactone
Edema/fluid retention
Hypertension
Congestive heart failure
Kidney disease
Side effects Dizziness
GI upset
Weakness
Headache
Adverse reactions
Hyperkalemia
Hepatoxicity
Contraindications
Severe kidney and liver disease
Interactions
Potassium supplements
Ace inhibitors
Diuretics and the nursing process Assessment
(for all diuretics) Baseline vitals
Weight pt
Look for third spacing
Medical history
Peripheral edema
Baseline labs
Electrolytes, potassium, magnesium, and glucose Urine
output
Interventions
Monitor urine output
Daily weight
Monitor vitals
Loop diuretics
IV very slowly to avoid hearing loss
, Thiazide and loop diuretics
Watch for hypokalemia (low potassium)
Potassium sparing diuretics
Watch for hyperkalemia (high potassium)
Hypokalemia ( low potassium) s/s
Muscle weakness
Cramps
Cardiac dysrhythmias
Hyperkalemia (high potassium) s/s
Nausea
Diarrhea
Abdominal cramping
Tingling In hands and feet
Pt evaluation
Decrease in bp or within normal limits
Increase urine output
Decrease in fluid retention
Weight goes down
Pt teaching
Diet-either high or low potassium
Loop or thiazide: eat more potassium
Potassium sparing: eat less potassium s/s of
hyper or hypokalemia teach pt to stand up
slowly pt should take meds in the morning
daily weights: 1 or 2lbs daily shift is normal
loop diuretics: stronger and not self-limiting
thiazide diuretics: self-limiting
Summary
Thiazide Diuretics
It is important to monitor electrolytes in patients taking thiazide diuretics.
Patients should see decrease in BP and peripheral edema.
Teach the patient about signs and symptoms of hypokalemia.
Loop Diuretics
Loop Diuretics are used to treat Heart failure, HTN, and peripheral edema.
During the nursing intervention, it is important to monitor electrolytes.
Signs and symptoms of hypokalemia are muscle weakness/cramps and
cardiac dysrhythmias.
Potassium-Sparing Diuretics
Potassium sparing diuretics are used to treat hypertension, edema, and
heart failure.
During a nursing intervention, it is important to monitor electrolyte levels,
at risk for hyperkalemia.
, Potassium sparing diuretics may not be given with ACE inhibitors.
Osmotic diuretics
Classifications Osmotic
diuretic
Action
Increases osmolality and sodium reabsorption in the proximal tubule, drawing in
more water.
Kidneys excrete sodium, chloride, potassium, and water
Indications
Mannitol
Increased cranial pressure
Cerebral edema
Increased ocular pressure
Prevent renal failure
Side effects
Electrolyte imbalances
GI problems
Adverse reactions
Pulmonary edema
Tachycardia
Acidosis
Contraindications
Heart disease
Heart failure
Renal failure
Interactions
Hypokalemia; increase risk of digoxin toxicity
Nursing process: osmotic diuretics
Overview: mannitol
Normally used to remove large amounts of fluids in emergency situations and
ICU
Also used to prevent kidney failure
Diuresis usually happens 1-3hrs after medication is administered
Assessment v/s
dehydration
baseline
labs
interventions monitor patient
closely strict Is and Os
measure fluids going in, and output of fluid
keep checking lab values monitor for
dehydration
monitor for side effects and adverse reactions
pulmonary edema
listen to lungs for sounds monitor
n/v, tachycardia, acidosis
do not administer if vial contains crystals (usually when exposed to cold
temperature) not for pts with HF or renal failure
Exam 3 pharm study guide
Loop, potassium-sparing, and thiazide diuretics
Drug classification
Thiazides
Thiazide-like diuretics
Loop
High ceiling diuretics
Potassium-sparing
Potassium sparing diuretics
Thiazide
Action
Acts on the distal convoluted renal tube.
Promotes sodium, chloride, and water excretion
Indications
Hydrochlorothiazide
Decrease blood pressure
Decrease amount of fluid within the body
Treats peripheral edema
Side effects Hyperglycemia
Hypercalcemia
Hypokalemia
Dizziness
Vertigo
Adverse reactions
Cardiac dysrhythmias
Orthostatic hypotension
Severe hypokalemia
Contraindications
Renal failure
Diabetes
Interactions Digoxin
Herbal products
Loop diuretics Action
Act on the loop on henle by inhibiting chloride transport of sodium and passive
reabsorption of sodium.
As more fluid is passed out by the kidneys, less fluid remains in the
bloodstream Indications Furosemide
HF
Renal dysfunction
Hypertension
Peripheral and pulmonary edema Side
effects
Electrolyte imbalances
Decrease in potassium, magnesium, sodium, calcium
Hyperglycemia
Dizziness
Headache
Adverse reactions
Hypokalemia
Hyponatremia
, Hypomagnesemia
Orthostatic hypotension
Renal failure
Contraindications
Severe electrolyte imbalance
Hypovolemia
Anuria
Diabetes mellitus
Hypotension
Interactions
Digoxin-risk for digitalis toxicity
Lithium
Potassium-sparing
Action
Blocks the action of aldosterone
Promotes sodium and water excretion and promotes potassium retention
Indications
Spironolactone
Edema/fluid retention
Hypertension
Congestive heart failure
Kidney disease
Side effects Dizziness
GI upset
Weakness
Headache
Adverse reactions
Hyperkalemia
Hepatoxicity
Contraindications
Severe kidney and liver disease
Interactions
Potassium supplements
Ace inhibitors
Diuretics and the nursing process Assessment
(for all diuretics) Baseline vitals
Weight pt
Look for third spacing
Medical history
Peripheral edema
Baseline labs
Electrolytes, potassium, magnesium, and glucose Urine
output
Interventions
Monitor urine output
Daily weight
Monitor vitals
Loop diuretics
IV very slowly to avoid hearing loss
, Thiazide and loop diuretics
Watch for hypokalemia (low potassium)
Potassium sparing diuretics
Watch for hyperkalemia (high potassium)
Hypokalemia ( low potassium) s/s
Muscle weakness
Cramps
Cardiac dysrhythmias
Hyperkalemia (high potassium) s/s
Nausea
Diarrhea
Abdominal cramping
Tingling In hands and feet
Pt evaluation
Decrease in bp or within normal limits
Increase urine output
Decrease in fluid retention
Weight goes down
Pt teaching
Diet-either high or low potassium
Loop or thiazide: eat more potassium
Potassium sparing: eat less potassium s/s of
hyper or hypokalemia teach pt to stand up
slowly pt should take meds in the morning
daily weights: 1 or 2lbs daily shift is normal
loop diuretics: stronger and not self-limiting
thiazide diuretics: self-limiting
Summary
Thiazide Diuretics
It is important to monitor electrolytes in patients taking thiazide diuretics.
Patients should see decrease in BP and peripheral edema.
Teach the patient about signs and symptoms of hypokalemia.
Loop Diuretics
Loop Diuretics are used to treat Heart failure, HTN, and peripheral edema.
During the nursing intervention, it is important to monitor electrolytes.
Signs and symptoms of hypokalemia are muscle weakness/cramps and
cardiac dysrhythmias.
Potassium-Sparing Diuretics
Potassium sparing diuretics are used to treat hypertension, edema, and
heart failure.
During a nursing intervention, it is important to monitor electrolyte levels,
at risk for hyperkalemia.
, Potassium sparing diuretics may not be given with ACE inhibitors.
Osmotic diuretics
Classifications Osmotic
diuretic
Action
Increases osmolality and sodium reabsorption in the proximal tubule, drawing in
more water.
Kidneys excrete sodium, chloride, potassium, and water
Indications
Mannitol
Increased cranial pressure
Cerebral edema
Increased ocular pressure
Prevent renal failure
Side effects
Electrolyte imbalances
GI problems
Adverse reactions
Pulmonary edema
Tachycardia
Acidosis
Contraindications
Heart disease
Heart failure
Renal failure
Interactions
Hypokalemia; increase risk of digoxin toxicity
Nursing process: osmotic diuretics
Overview: mannitol
Normally used to remove large amounts of fluids in emergency situations and
ICU
Also used to prevent kidney failure
Diuresis usually happens 1-3hrs after medication is administered
Assessment v/s
dehydration
baseline
labs
interventions monitor patient
closely strict Is and Os
measure fluids going in, and output of fluid
keep checking lab values monitor for
dehydration
monitor for side effects and adverse reactions
pulmonary edema
listen to lungs for sounds monitor
n/v, tachycardia, acidosis
do not administer if vial contains crystals (usually when exposed to cold
temperature) not for pts with HF or renal failure
