#potassium-sparing

Diuretics 

Osmotic Diuretics

Inhibits reabsorption of water and Na. Increase the osmolarity of blood and renal filtrate.

Uses: renal failure, excretion of toxic substances and cerebral edema

Ex: mannitol (Osmitrol)

Action: increases osmotic pressure and pulls fluid into the renal tubules and reduces cerebral edema

Interactions: none significant

Contraindications: severe renal disease, pulmonary edema (use loop diuretics instead), intracranial bleed

Adverse effects: cause seizures, thrombophlebitis

Loop Diuretics

Uses: edema (heart failure), HTN, renal failure, hypercalcemia, pulmonary edema

Ex: furosemide (Lasix), torsemide (Demadex)

Action: potent diuretics that block chloride and sodium reabsorption in the loop of Henle in the Kidney

Interactions: vancomycin (can cause ototoxicity), digoxin (can cause hypokalmeia), NSAIDs (decrease diuretic activity)

Adverse Effects: dizziness, N/V/D, tinidus, hypokalemia, hyperglycemia,

Make sure kidney OK before administration Gets rid of potassium

Potassium-sparing Diuretics

Uses: HTN, and used with loop diuretics to prevent K loss, heart failure

Ex: amiloride (Midamor), spironolactone (Aldactone)

Action: block aldosterone receptors, causing Na and H2O excretion (weak diuretic effect)

Interactions: lithium, ACE inhibitors or K-supplements can result in significant hyperkalemia!!

Adverse effects: dizziness, headache, cramps, N/V/D, hyperkalemia!!

Contraindications: high potassium, severe renal failure

Thiazide and Thiazide-like Diuretics

Uses: High BP, heart failure and edema; commonly prescribed because relatively cheap

Ex: metolazone (zaroxolyn) hydrochlorothiazide (hydrodiuril)

Action: inhibit reabsorption of Na, Cl and K in the distal tubule

Interactions: steroids (can increase potassium lvl), digoxin(increase of dig toxicity), oral hypoglycemics (increase sugar level)

Adverse effects: N/V/D, hypokalemia, hyperglycemia, increased uric acid 

Interactions: steroids (can increase potassium lvl), digoxin(increase of dig toxicity), oral hypoglycemics (increase sugar lvl)

Implementation for Diuretics

Administer in the morning/not nice (because they’d be up all night urinating)

VS

Assess electrolytes

I&O

Watch constipation

Daily weights

Have patient change positions slowly

Videos

Mike Linares (SimpleNursing) YouTube: Search Diuretics

EmpoweRN: Pharmacology Tips Loop Diuretics Lasix