all right so for thiazide and thiazide like diuretics okay so the mechanism of action it's going to inhibit sodium potassium and chloride reabsorption in the distal tubule um and we have direct dilation of peripheral arterials that actually occurs so it's we have decreased peripheral vascular resistance that way so when i'm referring to arterials arterials are just basically small branches of an artery and that's going to lead into our capillaries so that's what feeds you know oxygen rich saturated blood to different areas of the body okay so therapeutic effects we're gonna have increased excretion of uh water h2o sodium potassium and chloride and um this is all occurs actually without altering the ph and then we have peripheral arterial dilation right so those arterials dilate and by dilating we have less peripheral vascular resistance and we have decreased afterload right so that's less resistance that the left ventricle has to overcome in order to pump and circulate blood um indications we would give this for a patient who has high blood pressure or heart failure or maybe even fluid overload and edema right because it's a diuretic so we're going to pull fluid off so precautions would be impaired renal function um pre-existing dehydration and then pre-existing electrolyte disturbance contraindications would be chronic renal failure and then untreated dehydration or electrolyte disturbances specifically hypokalemia and then for our side and adverse effects we have electrolyte disturbances so this will decrease potassium levels and potentially increase calcium levels most the time though this is related to maybe too high of a dose of medication headache dizziness important to educate our men about the possibility of impotence an important side effect though that i really want you to remember and know for this particular class is it increases lipids glucose and uric acid um the biggest one being in here is glucose why they're not really sure um they're thinking that maybe it can increase insulin resistance um or maybe even inhibit glucose uptake but those are all just possibilities but it's important to remember that it increases glucose and also what's not on here is it decreases excretion of lithium okay decreases excretion of lithium lithium is something that you'll learn about in later units and we give it to patients who patients who have bipolar disorder um and we'll we'll get into that drug specific later but what you want to remember with this particular class is it increases glucose and decreases excretion of lithium okay important important so nursing action so what are we going to do for getting the medication that's going to decrease blood pressure we're going to monitor their blood pressure right if we're giving a medication that's going to pull off fluids we're going to monitor the intake and output eyes and o's we want to look at renal function which is their bun and creatinine look at potassium mag and calcium levels example of drugs in the class so the only one that you will have to remember is the hydrochlorothiazide and the um metallazone the metallizone um you don't really see that one as often but the hydrochlorothiazide you see pretty frequently actually so those are the two prototypes that you'll need to remember for this particular class