Diuretics Lecture Notes

Overview of Diuretics

• Types of Diuretics: Loop, Thiazide, Potassium Sparing, Osmotic
• Function: Act on kidneys to stimulate urine production, reducing body fluid
• Memory Trick: Diuretics = "dry inside"

Uses of Diuretics

• Heart Failure: Reduces fluid retention and edema
• Hypertension: Less fluid means less pressure in vessels
• Chronic Kidney Disease (CKD): Helps kidneys excrete fluid and lower potassium levels

Types of Diuretics

Loop Diuretics

• Common Drugs: Furosemide (Lasix), Bumetanide, Torsemide
• Mechanism: Inhibits reabsorption of sodium and chloride, acts on three kidney sites (distal tubules, proximal tubules, loop of Henle)
• Effects: Potassium wasting, risk of hypokalemia
• Nursing Considerations:
  • Monitor potassium levels
  • Administer potassium as needed (oral or IV)
  • Administer furosemide slowly to prevent ototoxicity
  • Educate patients on not crushing/orally altering potassium tablets

Thiazide Diuretics

• Common Drugs: Hydrochlorothiazide, Chlorothiazide
• Mechanism: Inhibits sodium and chloride reabsorption, less potent than Loop Diuretics
• Effects: Potassium wasting, risk of hypokalemia
• Nursing Considerations:
  • Avoid in patients with gout (increases uric acid)
  • Avoid in patients with sulfa allergies

Potassium Sparing Diuretics

• Common Drug: Spironolactone (Aldactone)
• Mechanism: Blocks aldosterone, retains potassium
• Effects: Risk of hyperkalemia
• Nursing Considerations:
  • Monitor for hyperkalemia, educate on avoiding high potassium foods

Osmotic Diuretics

• Common Drug: Mannitol
• Mechanism: Increases kidney filtrate thickness, used for cerebral edema and eye pressure, not typical fluid retention
• Nursing Considerations:
  • Administer IV only
  • Check for crystallization before use
  • Monitor neurological status

General Nursing Considerations for All Diuretics

• Administer in the morning to prevent nocturia
• Warn about orthostatic hypotension (slow position changes)
• Educate on low sodium diet to prevent fluid retention
• Monitor daily weights, intake/output, and potassium levels
• Report acute weight gains (2-3 lbs)

Practice Question Review

• Scenario: Patient with CHF on spironolactone
• Lab Values: Monitor potassium (5.3 mEq/L is too high)
• Rationale: Spironolactone can cause hyperkalemia

Additional Resources

• NCLEX Study Notebook: Offers practice questions and key NCLEX topics
• Next Steps: Watch anti-hypertensives video for more information

Happy studying, future nurses!