10 L E C

Pharmacology 25
Ms. Gelianne Alba-Loquez 21 O2
DIURETICS

OUTLINE REVIEW ON FUCTION OF THE KIDNEY

I Diuretics
II Review on Function of the Kidney Review on function of the Kidney
III Diuretics
A Thiazide Diuretics
B Loop Diuretics
C Osmotic Diuretics
D Potassium Sparing Diuretics
IV Comparison of Diuretics
V Drug of Choice For Specific Condition
A Thiazide Diuretics
B Loop Diuretics
C Osmotic Diuretics
D Potassium Sparing Diuretics
VI Interventions for DIURETICS
The cells of the kidneys are called nephrons.
REFERENCES

“PROF’S PPT ON VIDEO LECTURE”

DIURETICS
DIURETICS
- It will induce the excretion of fluids from
the body. Like making someone urinate
Food Sources
 Potassium rich foods: banana, avocado,
broccoli, dried fruits, oranges nuts, potato, From the vessels, there will be filtration inside
prunes, tomato the Bowman’s capsule and eventually resulting to
 Sodium rich foods: buttermilk, margarine, more products inside the capsular space while it is
canned goods, processed foods, fast foods, going down there.
preserved foods, tomato ketchup.
 Calcium rich foods: broccoli, dairy & milk
products, seafoods, spinach

When your glomerulus is done filtrating it will

go through this loops, the tubules will then eventually

BSN-2B TRANSCRIBED BY: GROUP #1 1

reach to loop of Henle. But before it reaches here,
there will be absorption or reabsorption will already
start when the fluid is already going down.
Only 20 % will be reabsorbed, the rest of the
fluid will go to the Bowman’s capsule and to the loop
of Henle.
DIURETICS
Diuretics
 Produces increased urine flow by inhibiting
sodium and water reabsorption from the
kidney tubules.
If you want to secrete water, you have to
release sodium because when sodium goes
water follows
2 main purposes:
 To decrease hypertension
When sodium is released inside the body, it
can cause increased in blood pressure, so to
counter that we have to give diuretics to lower
the blood
Pressure by lowering the sodium and even the
water inside the body
 To decrease edema
BSN-2B TRANSCRIBED BY: GROUP #1
INDICATIONS:
 Congestive heart failure (CHF)
Whether right sided or left sided heart failure.
Sa right sided kasi, if the right side of your heart
has failed already, so hindi nasiya nakaka pump
ng blood and received ng blood. There will be
congestion sa system mo. Like for example; if
your blood is supposed to come to the right
side, but since you have a heart problem at the
right side then the fluid will not be able to flow
in properly. Causing congestion at the rest of
the body. Sa left naman, from the lungs. The
blood is supposed to come back and enter to
the left chamber. But if the left side of your
heart fails to work properly. There will be
congestion sa lungs. Therefor diuretics is also
used for pulmonary edema
 Pulmonary edema
 Liver failure and cirrhosis
For example, if the liver has failure or cirrhosis
the blood cannot pass through properly or
cannot enter properly to the liver, causing
portal hypertension or portal vein
hypertension and congestion sa system before
that kung saan siya ng galling. So if merong
congestion pwede gamitin si diuretics
 Renal diseases
In acute renal cases and measurable renal
cases, pwd gamitin si diuretics to help the
kidney function properly in order for your body
to secrete fluids properly. But diuretics are not
to be used for severe renal disease
 Hypertension (HPN)
 Glaucoma
Diuretics are usedin glaucoma Especially your
carbonic anhydrase diuretics. Sa glocoma kasi
ma increased din yan siya ng pressure,
intraocular pressure. So your aquize humour is
actually increased, so you have to relieved that
by the used of diuretics. To relived the
intraocular pressure
CONTRAINDICATIONS:
 Allergy
Not to patient who is allergic to it, kasi nga nag
sesecreate tayo ng fluids inside the body it may
cause decreased in fluid and elecrolytes. So if
the patient already has fluids ad electrolyte
imbalance, then wag niyo ibigay kai lalong
bababa yung levels
 Fluid & Electrolyte imbalances
2
  Severe renal diseases
Bawal ang chronic renal disease kasi hindi na
siya nag wowork properly yung diuretics kasi
sobrang sir ana yung kidneys
 Systemic Lupus Erythematous (SLE)
It is an auto immune disease and people with
sle are photo sensitive. Sensitive sila sa light.
We do nut give diuretics to patient with lupus
because diuretics can also cause post photo
sensitivity. So we do not want to worsen the
condition of the patient with lupus so we do
not give diuretics
 DM
There are diuretics that worsen diabetes,
especially dyazide diuretics. The reason for
that it because dyazide can casue futher impair
sa glucose tolerance. It may lead to increased
glucose level.
I. Thiazide Diuretics
-Mode Of Action: increase sodium (Na) & water
excretion by inhibiting Na reabsorption in the distal
tubule of the kidney
 Do not allow reabsorption on a specific part
which result to increase in the secretion of
fluids in the body
** not effective for immediate diuresis
 Does not work immediately
-Uses: mild- moderate hypertension (HPN), edema
associated with CHF, cirrhosis with ascites
-Warning: decrease potassium (K), renal/ hepatic
dysfunction, gout
-Drug Interactions:
 + lithium = lithium toxicity
 + digoxin = digoxin toxicity
-Signs and Symptoms: bradycardia, nausea and
vomiting (N/V), visual changes
 + corticosteroids, amphotericin, ticarcillin =
hypokalemia
-Potassium wasting
 + sulfonamides = cross sensitivity
-Side Effects / Adverse Effects:
hypokalemia, hyponatremia, hypomagnesemia,
hypotension, bicarnonate loss, hypercalcemia,
hyperglycemia, hyperuricemia, N/V, constipation,
rashes, dizziness, weakness, increase LDL,
photosensitivity, H/A, dehydration, blood dyscrasias
-Examples: Generic Name (Brand Name)
 chlorothiazide (Diuril)
 chlorthalidone ( Thalitone)
 hydrochlorothiazide ( Hydrodiuril)
 indapamide ( Lozol)
 metolazone ( Zaroxolyn)
-Nursing Responsibilities:
 Monitor BP, wt OD, urine output, edema
-To check for effectivity and adverse reactions
-Diuretics can cause weight loss
 Monitor K, Na, Ca, blood glucose, LDL,
triglycerides
 Change position slowly
 No alcohol
 Take with meals preferably in AM
 Eat foods high in K
-banana, avocado, broccoli, dried fruits,
oranges, nuts ,potato, prunes, tomato
 Manage photosensitivity
-Signs of hypokalemia (muscle weakness,
cardiac dysrhythmias, cramps, dizziness, N/V,
tingling sensation, “U” wave on the ECG (3.5 –
5.1 mEq/L)
-Mnemonics:
T-ake time to check VS
H-yperglycemia, hypokalemia, hyperuricemia
monitoring
I-nstruct to weigh in daily
A-void sudden position changes
Z-ugar monitoring
I- &O monitoring
D-iuresis is expected: I&O
E-at potassium rich foods
II. Loop Diuretics
-Mode of Action: inhibits sodium Na & chloride Cl
absorption from the loop of henle and distal tubules,
causes rapid diuresis, little effect on glucose
-Uses: hypertension HPN, edema associated with CHF,
cirrhosis with ascites, hypercalcemia
-Drug Interaction: same with thiazides
-Side Effect / Adverse Effect: hypokalemia (potassium
wasting), hyponatremia, hypocalcemia,
hypomagnesemia, hypochloremia, hyperuricemia,
orthostatic hypotension, constipation, nausea and
vomiting N/V, decrease platelet (must be monitored),

BSN-2B TRANSCRIBED BY: GROUP #1 3

ototoxicity (give IV bumetanide), dehydration, -Nursing Responsibilities:
photosensitivity, thiamine deficiency, hyperglycemia  Monitor VS, wt, urine output, serum NA, K, Cl,
(burn with glycogenolysis), elevated BUN & creatinine Ca
-Example: Generic Name (Brand Name)  Watch for rapid inc in BP & rapid sympathetic
 furosemide (Lasix) over-activity ( inc HR, tremor, agitation)
 torsemide (Demadex)
 Assess lung and heart sounds
 ethacrynic acid (Edecrin): Common in US
*it can cause pulmonary edema as an adverse
 bumetanide (Bumex)
effect*
-Nursing Responsibilities:
 Monitor VS, edema, urine output, serum K, Na,  Check skin turgor, Level of consciousness,
Ca, Cl, thiamine, blood glucose & platelet manifestations of decrease intracranial
levels, Mx of digoxin & lithium toxicity pressure
-Can decrease platelet count  Mannitol: check bottle or vial for
-Mixing may trigger lithium toxicity crystallization, warm bottle & shake vigorously
 Potassium rich foods to dissolve crystals, if it doesn’t dissolve= DO
 Give slow IVTT (for 2 mins) to prevent hearing NOT administer
loss  use IV line with filter
-It can cause ototoxicity (bumetanide)  infuse for 30- 60 minutes
 With food, in AM -Nursing Responsibilities:
-Mnemonics:  O- liguria, edema, inc. ICP(indication)
 C-heck for weight gain / weight changes
 S - tops reabsoprtion of water
 E-nsure VS prior to administration
 M - annitol
 I-& O monitoring
 O- utput of urine, electrolytes - monitor
 L-aboratory values assessment
 T - issue dehydration
 I-nstruct to rise slowly
 I - ncreased frequency/volume of urination
 N-octuria prevention
 C - irculatory overload
-Tell patient to drink diuretics in the morning
and not drink plenty of water before sleeping
IV. Potassium Sparing Diuretics
 G-ive it with meals
-MOA: acts on the distal tubule to promote Na and
water excretion & prevent potassium excretion; AKA:
III. Osmotic Diuretics
Aldosterone antagonist
-MOA: increase osmotic pressure in the glomerular
*so the distal tubule, these drugs promote the
filtrate, preventing reabsorption of water &
excretion of water and sodium but sparing
electrolytes
potassium*
-USES: increase ICP, edema, prevention of renal failure,
-USES: Hypertension, edema = CHF (Congestive Heart
oliguria, inducing diuresis during chemotherapy
Failure), nephrotic syndrome to counteract
-CI: anuria
hypokalemia caused by other diuretics
-DI: increase hypokalemia which may increase digoxin
*pag may nephrotic syndrome, meron din
toxicity
potassium wasting effect*
*hindi pwedeng isabay sa digoxin kasi
-CI: severe renal disease, severe hyperkalemia
magkakaroon ng digoxin toxicity*
*sa lahat ng diuretics, ito lang ang pasado na
-Side Effect/ Adverse Effect: pulmonary edema d/T
pwedeng ibigay sa patient na may severe renal
rapid fluid shifting, NV, tachycarida, decrease Na, K, Cl,
diseases*
Ca, dehydration
-DI:
-Examples:
 + lithium = lithium toxicity
 mannitol (Osmitrol)
 + ACE inhibitor = hyperkalemia
 urea (Ureaphil)
 + digoxin = digoxin toxicity
 glycerin ( Osmoglyn) = dec IOP
 + K supplements (eg kalium durule) =
 *For cases na may increased intraocular
hyperkalemia
pressure like glaucoma, ginagamit ang
glycerin* isosorbide (Ismotic)

BSN-2B TRANSCRIBED BY: GROUP #1 4

-SE/AE: hyperkalemia, N/V, diarrhea, dry mouth, rash, 1. Loop Diuretics
dizziness, weakness, bluish colored urine (triamterene) - Furosemide
hypotension, increase potassium level result in peaked - Ethecrynic acid
T wave on ECG DOC:
-AE: HA, photosensitivity, anemia, decrease platelet - Edema
-Examples: 2. Thiazides
 spironolactone (Aldactone) - Thiazide
 triamterene (Dyrenium) DOC:
 amiloride (Midamor) - Hypertension (1st Line)
*common are spironolactone and amiloride* 3. Potassium Sparing Diuretics
-Nursing Responsibilities: - Spironolactone
• Monitor VS, urine output, serum K level - Triamterene
• Inform client that hypotensive effects may not be DOC:
seen for 2 weeks - Liver Disease
*slow acting/ hindi agad-agad nakikita yung result* - Patients taking cardiac glycosides in
Congestive Heart Failure (CHF)
• Avoid potassium rich foods
*cardiac glycosides may cause hypokalemia*
• Manage photosensitivity
4. Osmotic Diuretics
*kung lalabas, maglong sleeve or wag mag pa araw*
- Mannitol
• Avoid salt substitutes
- Urea
• Take with meals DOC:
• Bluish colored urine is harmless - Patients with Increased Intracranial Pressure
• Administer in Am - Stroke
5. Carbonic Anhydrase Inhibitors
COMPARISON OF DIURETICS - Zolamide
DOC:
- Glaucoma

INTERVENTIONS FOR DIURETICS

D - iet: decrease sodium intake
*gusto natin I secrete ang water*
I - ntake & output monitoring
U - ndesirable effects
*we have to make the patient aware as to what to
watch out for*
R - eduction of edema
E - lectrolytes review
T - ake early in the day; with meals
I - nteractions:digoxin
DRUG OF CHOICE FOR SPECIFIC CONDITION *watch out for toxicity*
C - ause/aggravate diabetes
S - ensitivity to sunlight

BSN-2B TRANSCRIBED BY: GROUP #1 5