all right so now we're going to get into the different classes okay so this is where as we're talking through this and you have your powerpoint next to you you can kind of flip back and forth so you can look at uh the different sites of action for these classes so for loop diuretics important to remember these are very very potent diuretics we have very rapid diuresis diuresis we're pulling fluid off okay mechanism of action is important to remember it inhibits sodium and chloride reabsorption in the loop of henle okay so that's the part of the kidney tubule where actual water and salts are reabsorbed into the blood okay so inhibits sodium and chloride reabsorption in the loop of henle and so therefore we have um and therefore water so we're getting rid of water basically it does aid in dilating the blood vessels so we have decreased systemic vascular resistance therapeutic effects so again you see it again potent diuresis and it results in substantial fluid loss so what happens is we have decreased blood pressure because it has such a great volume of diuresis indications we would give it for somebody who has high blood pressure and important to remember we also give lube diuretics for people who are fluid overloaded and they may have edema and it's associated with chf or congested heart failure important to remember for this class um also those who may have hepatic or even renal disease but we just have to be careful with that renal function precautions um impaired renal function you're like wait wait a second i thought we'd give it four um patients who have renal disease so we just have to be precautious with that okay they have to have some renal function because there's renal excretion that occurs with the drug uh pre-existing dehydration hopefully that makes sense right we're pulling off a bunch of fluids so if they're already dehydrated we're going to put them in a much worse dehydrated state and then pre-existing electrolyte disturbances so in parentheses it says here hypokalemia right which is decreased potassium so hypokalemia means decreased or low potassium so why we say that and what's important to remember about loop diuretics is they're not potassium sparing so as the patient is diuresing and we're pulling off fluid they're also losing potassium so potassium level is really important to monitor when you have a patient on a diuretic specifically a loop diuretic and then contraindications again we just got to be careful with that renal function so someone in a chronic renal failure okay so a patient who has chronic renal failure and and urea so this is the patient who does not produce any urine or at least less than 100 milliliters per day that would be contraindicated to give a patient a lube diuretic right they don't form urine so to give them the diuretic is not going to be helpful so that's a important contradiction uh concrete indication that contradiction that you would want to remember untreated dehydration or electrolyte disturbances we kind of talked about that so hopefully that you understand why and then important to remember too is sulfa allergy lube diuretics they're chemically related to sulfonamide antibiotics so the literature kind of indicates a small risk and it's it's unlikely but it's important to remember that there is the chance so someone who has a sulfa allergy we'd be careful giving them a loop diuretic side and adverse effects electrolyte disturbances most commonly again you're going to want to remember really important is the hypokalemia right that's low potassium so signs and symptoms they would have maybe leg cramps tingling numbness nausea vomiting abdominal cramping these are all just signs and symptoms of hypokalemia that you should be aware of and then dehydration hypotension and dizziness so hopefully this makes sense right if our patient is volume depleted they're dehydrated we don't have as much volume exerting against those arterial walls so our blood pressure decreases that's hypotension so maybe if we overshot with the medication their blood pressure is lower than it should be so if they don't have enough circulating volume and we're not circulating volume to our brain that's going to make us dizzy okay so that's why they have those symptoms nursing action so when you understand the mechanism of action hopefully the nursing actions make sense okay it just kind of all goes together so if we're giving a medication that is going to make the patient urinate and it's going to lower the blood pressure what things do you think we're going to monitor well we're going to monitor their blood pressure and we're going to monitor their eyes and o's that's input and outtake right so we want to know what's going in what's coming out okay we want to look at their electrolytes potassium magnesium potassium especially we also want to look at renal function and uh that's the bun and creatinine okay so that gives us an idea of renal function and that's important to watch to you so we're going to just make sure we're monitoring their fluid volume status okay daily weights again remember we're going to talk to the patient about daily weights important key fact to remember okay you want to make sure you're telling your patient to change position slowly due to dizziness why because they have volume loss so they're going to have blood pressure changes so it's important with diuretics in general that we should be educating our patients that way okay examples of drug in the clothes so the only prototype you need to remember for a loop diuretic is furosemide okay you want to remember furosemide is has a very having very potent diuresis because it's a loop diuretic and that hypokalemia is the most commonly uh seen side effect with the use of furosemide okay it's going to lower that potassium level