Diuretic Drugs

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Diuretic Drugs
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2014-05-10 11:38:48
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pharm final
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Ch 28
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  1. types of diuretic drugs
    • carbonic anhydrase inhibitors (CAIs)
    • loop diuretics
    • osmotic diuretics
    • potassium-sparing diuretics
    • Thiazide and thiazide-like diuretics
  2. carbonic anhydrase inhibitors (CAIs) indications
    • - adjunct drugs in the long term mgmt of open-angle glaucoma
    • - used with miotics to lower intraocular pressure before ocular surgery in certain cases
    • - also treat: edema, epilepsy, high-altitude sickness
    • - Acetazolamide is used in mgmt of edema secondary to HF when other diuretics are not effective
    • - CAIs are less potent diuretics than loop diuretics or thiazides
  3. carbonic anhydrase inhibitors (CAIs) mechanism of action
    • - enzyme carbonic anhydrase helps make H+ available for exchange with Na+ and H2O in proximal tubules
    • - CAIs block action of carbonic anhydrase thus preventing exchange 
    • - inhibit carbonic anhydrase reduces H+ ion concentration in renal tubules
    • as result, there is increased excretion of bicarbonate, Na+, H2O, K+
    • reabsorption of water is decreased, and urine volume is increased
  4. carbonic anhydrase inhibitors (CAIs) examples
    • acetazolamide (Diamox)
    • methazolamide (Neptazane)
  5. carbonic anhydrase inhibitors (CAIs) adverse effects
    • - hypokalemia, drowsiness, paresthesias, urticaria
    • -  metabolic acidosis, anorexia, hematuria, photosensitivity, melena
  6. Loop Diuretics Indications
    • - edema associated with HF or hepatic renal dz
    • - control HTN
    • - increase renal excretion of Ca+ in pts with hypercalcemia
    • - in cases of HF resulting in diastolic dysfunction
  7. Loop Diuretics mechanism of action
    • - act directly on ascending limb of loop of Henle to inhibit chloride and sodium resorption 
    • - increase renal prostaglandins, resulting in dilation of blooc vessels and reduced peripheral vascular resistance
  8. Loop Diuretics effects
    • - potent diuresis and subsequent fluid loss
    • - decreased fluid volume causes a reduction in BP, pulmonary vascular resistance, systemic vascular resistance, central venous pressure, left ventricular end-diastolic pressure
    • - potassium and sodium depletion
  9. Loop Diuretics examples
    • bumetanide (Bumex)
    • furosemide (Lasix)
    • torsemide (Demedex)
  10. Loop Diuretics adverse effects
    CNS
    GI
    Hematologic
    Metabolic
    CNS: dizziness, headache, tinnitus, blurred vision

    GI: N&V, diarrhea

    Hematologic: agranulocytosis, neutropenia, thrombocytopenia

    Metabolic: hypokalemia, hyperglycemia, hyperuricemia
  11. Osmotic Diuretics Indications
    • - treatment for early oliuric phase of ARF (acute renal failure?)
    • - promote excretion of toxic substances
    • - reduce intracranial pressure
    • - treat cerebral edema
    • - NOT for peripheral edema
  12. Osmotic Diuretics Mechanism of Action
    • - work mostly in proximal tubule
    • - nonadsorbable, producing osmotic effect
    • - pul water into renal tubules from surrounding tissues
    • - inhibit tubular resorption of water and solutes, thus producing repaid diuresis
  13. Osmotic Diuretics drug effects
    • - increase glomerular filtration rate and renal plasma flow-helps prevent kidney damage during acute renal failure
    • - reduce excessive intraocular pressure
  14. Osmotic Diuretics examples
    • mannitol (Osmitrol) - IV only. 
    • may crystalize when exposed to low temps (use of filter required)
  15. Osmotic Diuretics adverse effects
    • - convulsions
    • - thrombophlebitis
    • - pulmonary congestion
    • - headache, chest pains, tachycardia, blurred vision, chills, fever
  16. Potassium Sparing Diuretics Indications
    • spironolactone and triamterene:
    • - hyperaldosteronism
    • - HTN
    • - reversing K+ loss caused by potassium-losing drugs
    • - certain cases of HF

    amiloride: treat HF
  17. Potassium Sparing Diuretics mechanism of action
    • - work in collecting ducts and distal convoluted tubules
    • - interfere with sodium-potssium exchange
    • - competitively bind to aldosterone receptors
    • - block resorption of sodium and water usually induced by aldosterone
  18. Potassium Sparing Diuretics drug effects
    • - prevent potassium  from being pumped into the tubule, thus preventing its secretion
    • - competitively block aldosterone receptors and inhibit their action
    • - promote excretion of Na+ and H2O
  19. Potassium Sparing Diuretics Examples
    • amiloride (Midamor)
    • spironolactone (Aldactone)
    • triamterene (Dyrenium)
    • aka aldosterone-inhibiting diuretics
  20. Potassium Sparing Diuretics adverse effects
    CNS
    GI
    Other
    Spironolactone
    • CNS: dizziness, headache
    • GI: cramps, N&V, diarrhea
    • Other: polyuria, weakness, hyperkalemia
    • Spironolactone: gynecomastia, amenorrhea, irregualr menses, postmenopausal bleeding
  21. Thiazide and Thiazide-like Diuretics indications
    • - HTN (one of the most prescribed group of drugs for this)
    • - edematous states
    • - idiopathic hypercalciuria
    • - diabetes insipidus
    • - HF due to diastolic dysfunction
    • - adjunct drugs in treatment of edema related to HF, hepatic cirrhosis, or corticosteroid or estrogen therapy
  22. Thiazide and Thiazide-like Diuretics Mechanism of Action
    • - inhibit tubular resorption of Na+, Cl-, K+
    • - actions primarily in the distal convoluted tubule
    • - result: water, sodium, chloride are excreted
    • - potassium is also excreted to a lesser extent
    • - dilate the arterioles by direct relaxation
  23. Thiazide and Thiazide-like Diuretics drug effects
    • - lowered peripheral vascular resistance
    • - depletion of Na+, H2O, K+
    • - Thiazides should not be used if creatinine clearance is <30-50mL/min (normal is 125 mL/min)
    • - Metolazone remains effective to a creatinine clearance of 10 mL/min
  24. Thiazide Diuretics examples
    • hydrochlorothiazide (Esidrix, HydroDiuril)
    • chlorothiazide (Diuril)
    • trichlormethiazide (Metahydrin)
  25. Thiazide-like Diuretics
    metolazone (Mykrox, Zaroxolyn)
  26. Thiazide and Thiazide-like Diuretics adverse effects
    CNS
    GI
    GU
    Integ
    Metabolic
    CNS: headache, dizziness, blurred vision, paresthesias, decreased libido

    GI: anorexia, N&V, diarrhea

    GU: impotence

    Integ: urticaria, photosensitivity

    Metabolic: hypokalemia, glycosuria, hyperglycemia, hyperuricemia
  27. Thiazide and Thiazide-like Diuretics Nursing Implications
    • - take meds in morning to avoid interference with sleep
    • - monitor serum K+ lvs
    • - eat more K+ rich foods when taking non-K+ sparing drugs
    • - hypokalemia signs: muscle wekaness, constipation, irregular pulse rate, lethargy
    • - monitor for reduction of edema, HF, HTN, intraocular pressure normalize

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