Diuretics Lecture

Overview of Diuretics

• Diuretics are medications that stimulate the kidneys to produce urine, reducing excess body fluid.
• Types:
  • Loop diuretics
  • Thiazide diuretics
  • Potassium-sparing diuretics
  • Osmotic diuretics
• Common use: Treat heart failure by reducing fluid retention and edema.

Indications for Diuretics

• Heart Failure: Fluid retention due to a weakened heart.
  • Fluid backs up, causing edema.
  • Diuretics reduce fluid and decrease edema.
• Hypertension (High Blood Pressure): More fluid volume increases pressure.
• Chronic Kidney Disease (CKD): Kidneys fail to excrete excess fluid and potassium.

Types of Diuretics

Loop Diuretics

• Suffix: "-mide" or "-nide"
  • Examples: Furosemide (Lasix), Bumetanide, Torsemide
• Mechanism of Action:
  • Inhibits reabsorption of sodium and chloride across three kidney sites: distal and proximal tubules, and loop of Henle.
  • Potassium-wasting, can cause hypokalemia (low potassium).
• Nursing Considerations:
  • Monitor potassium levels.
  • Replace low potassium orally or intravenously (IV).
  • Oral potassium chloride: Extended release, do not crush/chew.
  • IV potassium: Never IV push, use infusion pump.
  • Administer furosemide slowly to prevent ototoxicity.

Thiazide Diuretics

• Suffix: "-thiazide"
  • Examples: Hydrochlorothiazide, Chlorothiazide
• Mechanism of Action:
  • Inhibits reabsorption of sodium and chloride, acts on the ascending loop of Henle and early distal tubule.
  • Weaker than loop diuretics, potassium-wasting.
• Nursing Considerations:
  • Monitor potassium levels.
  • Avoid in patients with gout or sulfa allergies.

Potassium-Sparing Diuretics

• Common Type: Spironolactone (Aldactone)
• Mechanism of Action:
  • Blocks aldosterone, leading to sodium and water excretion but potassium retention.
• Nursing Considerations:
  • Monitor for hyperkalemia (high potassium).
  • Advise against foods high in potassium and potassium supplements.

Osmotic Diuretics

• Common Agent: Mannitol (Osmitrol)
• Use: Treats cerebral edema and decreases intraocular pressure.
• Nursing Considerations:
  • Administer IV only, check for crystallization.
  • Perform neuro assessments for cerebral edema.

General Nursing Considerations for Diuretics

• Administer diuretics in the morning to prevent nocturia (nighttime urination).
• Educate patients on orthostatic hypotension precautions.
• Suggest a low-sodium diet to reduce water retention.
• Monitor daily weight, intake/output, and potassium levels.

Practice Question Recap

• Question about lab values and spironolactone administration.
• Report high potassium level (hyperkalemia) before administering spironolactone.

Additional Resources

• NCLEX study resources available, including practice questions and study schedule aids.