DIURETICS -L00? DIURETICS How it works “ Action” Diuretics work by altering the reabsorption or excretion of electrolytes and alter fluid volume Loop diuretics: inhibit the reabsorption of sodium chloride in the proximal and distal convoluted tubules and the loop of henle . This site increase their effectiveness Why do we give it? “Reason” Hypertension Used with antihypertensives, To reduce edema Glaucoma Seizures Renal disease. eeooee Adverse Effects Neuro: dizziness, headache, encephalopath lightheadedness, weakness, fatigue EENT: hearing loss, tinnitus Yi orthostatic hypotension GU: electrolyte imbalances, glycosuria GI: anorexia, nausea, vomiting Derm: rash, photosensitivity Endo: hyperglycemia, hyperuricemia. F & E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypokalemia, metabolic alkalosis MS:arthralgia, muscle cramps, myalgia. Contraindications a Hypersensitivity % Electrolyte imbalances % severe kidney or liver dysfunction * — Anuria. Mannitol: active intracranial bleeding except during craniotomy 2? ° Generic Trade Bumetanide Bumex Furosemide: Lasix Torsemide Demadex Nursing management Monitor BP and pulse frequently Monitor intake and output ratios and daily weight. — Donot stop the drugs abruptly unless you speak with the HCP. If GI upset occurs then take the med with food or milk. Take early in the morning. Do not reduce fluid intake. Avoid alcohol and non prescription drugs. Notify the healthcare provider if: muscle cramps , weakness, dizziness, diarthea, restlessness, excessive thirst, general weakness, rapid pulse, increased heart rate or pulse, gi distress. Weigh yourself weekly. These drugs may cause hypokalemia, monitor serum potassium levels ° eos oe Interactions — Cisplatin/aminoglycosides: increased risk of ototoxicity Anticoagulant/thromboti bleeding lis: increase risk of arrhythmia Lithium: increased risk of lithium toxicity Hydantoins: decreased diuratic effect Nsaid: decreased Diuretics effect * (creased risk of, eos Simple Nur: 1g Brain bits Taking this medication early in the day can prevent injury r/t getting out of bed at night for the client. Safe dose Route 0.5- 2 mg/day given in PO 1-2 doses 20-80 mg/day as a PO, IM, IV single dose 2.5- 5 mg once daily PO SimpeNursingDIURETICS -THIADIDES How it works “ Action” Nursing management Diuretics work by altering the reabsorption 4 Monitor BP and pulse frequently . or excretion of electrolytes and alter fluid ° Monitor intake and output ratios and volume . daily weight. Thiazide Diuretics: Inhibit reabsorption in the — Donot stop the drugs abruptly ascending portion of the loop of henle and early unless you speak with the DR. distal tubule, Excrete sodium, chloride, and H,O % If Glupset occurs then take the med with food or milk. Why do we give it? “Reason” # Take early in the morning. & Hypertension Do not reduce fluid intake. © — Used with antihypertensives ‘Avoid alcohol and non prescription *% — Toreduce edema drugs. & Glaucoma % Notify the healthcare provider if: @ Seizures muscle cramps , weakness, & Renal disease. dizziness, diarrhea, restlessness, excessive thirst, general weakness, Adverse Effects rapid pulse, increased heart rate or , pulse, gi distress. Neuro: Dizziness, headache, encephalopathy, Weigh yourself weekly lightheadedness, weakness, fatigue © Thee droga fray caiee EENT: Hearing loss, tinnitus hypokalemia, monitor serum CV: Orthostatic hypotension Peraseii levels GU: Electrolyte imbalances, glycosuria @ May cause in serum and urine = an eean! ceca glucose in diabetic patients. May a a cause angin serum bilirubin, calcium, Endo: Hyperglycemia, hyperuricemia. Guntivino and nfoadd. E.& E: Dehydration, hypocalcemia, hypochloremia, israel hypokalemia, hypomagnesemia, hyponatremia, interactions hypokalemia, metabolic alkalosis ¢ Siceario * ete a visk ‘ MS: Arthralgia, muscle cramps, myalgia. \ypersensitivity to allopurinol 3 psi myaia} Anesthetics: increased anesthetic f.: J effects Contraindications Antineoplastic drugs: extended Hypersensitivity leukoperia. # Electrolyte imbalances © Antidiabetic drugs: hyperch Severe kidney or liver dysfunction pe rug et nyperglycoms: ° Anuria. Mannitol: active intracranial bleeding except Simple Nursing Brain bits during craniotomy — Thiazide and Loop: liver disease, lupus, ) diabetes, a cross sensitivity may occurs » with thiazides and sulfonamides C Yellow dye may cause allergic reactions , or bronchial asthma with thiazides. Generic Trade Safe dose Route Hydrochlorothiazide Microzide 12.5- 100 mg/day in 1- PO 2 doses Metolazone | Zaroxolyn PO QsmpenursingFRETLCS -POTASSIUM SPARING How it works “ Action” Diuretics work by altering the reabsorption or excretion of electrolytes and alter fluid volume . Potassium Sparing Diuretics: reduce the excretion of potassium, block the reabsorption of sodium into the kidney. And thereby increasing sodium and h20 in the urine and reduces excretion of K+ Why do we give it? “Reason’ Hypertension Used with antihypertensives To reduce edema Glaucoma Seizures Sooo ee Adverse Effects Neuro: Dizziness, headache, encephalopathy, lightheadedness, weakness, fatigue EENT: Hearing loss, tinnitus CV: Orthostatic hypotension GU: Electrolyte imbalances, glycosuria GI: Anorexia, nausea, vomiting Derm: Rash, photosensitivity Endo: Hyperglycemia, hyperuricemia. E.&E: Dehydration, hypocalcemia, hypochloremia, hyperkalemia, hypomagnesemia, hyponatremia, hypokalemia, metabolic alkalosis MS: Arthralgia, muscle cramps, myalgia. Contraindications Hypersensitivity Electrolyte imbalances, hyperkalemia Severe kidney of liver dysfunction Anuria. Mannitol: active intracranial bleeding except during craniotomy Sooee Generic Trade Spironolactone Aldactone Nursing management Monitor BP and pulse frequently Monitor intake and output ratios and daily weight. “ — Donotstop the drugs abruptly unless you speak with the HCP. * — If Gl upset occurs then take the med with food or milk. Take early in the morning * —Donot reduce fluid intake Avoid alcohol and non prescription drugs. + Notify the healthcare provider if: muscle cramps , weakness, dizziness, diarrhea, restlessness, excessive thirst, general weakness, rapid pulse, increased heart rate or pulse, Gl distress. Weigh yourself weekly. These drugs may cause hyperkalemia, monitor serum potassium levels. oe oe Interactions * Angiotensin converting enzyme/potassium supplement: Increased risk of hyperkalemia * — Nsaids/anticoagulants: decreased diuretic effect Simple Nursing Brain bits Avoid foods high in potassium Avocado, Acorn squash, Spinach, ‘Sweet potato, Wild-caught salmon, Dried apricots, Pomegranate Coconut water, White beans, Banana Safe dose Route 25- 400 mg/day PO as a single doseDIUR How it works “ Action” “Diuretics work by altering the reabsorption or excretion of electrolytes and alter fluid volume. Carbonic anhydrase inhibitors: sulfonamides without bacteriostatic action, inhibit CAH enzyme thus results in excretion of Nat K* HCO, and H,0 Why do we give it? “Reason” Hypertension Used with antihypertensives To reduce edema Glaucoma Seizures Renal disease Seeees Adverse Effects Neuro: dizziness, headache, encephalopathy, lightheadedness, weakness, fatigue EENT: hearing loss, tinnitus CV: orthostatic hypotension GU: electrolyte imbalances, glycosuria GI: anorexia, nausea, vorniting Derm: rash, photosensitivity Endo: Hyperglycemia, hyperuricemia. F & E: Dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypokalemia, metabolic alkalosis MS: Arthralgia, muscle cramps, myalgia. Cont ications Hypersensitivity to sulfonamides Electrolyte imbalances severe kidney or liver dysfunction Anuria. Mannitol: active intracranial bleeding except during craniotomy So eee Generic Trade Acetazolamide Diamox Methazolamide Neptazane -CARBONTC ANIYDRASE INWIBITORS Nursing management Monitor BP and pulse frequently Assess for allergy to sulfonamides Monitor intake and output ratios and daily weight. Do not stop the drugs abruptly unless you speak with the DR. If GI upset occurs then take the med with food or milk Take early in the morning Do not reduce fluid intake Avoid alcohol and non prescription drugs ‘Notify the healthcare provider if: muscle cramps , weakness, dizziness, diarrhea, restlessness, excessive thirst, general weakness, rapid pulse, increased heart rate or pulse, gi distress. e te + eee + — Weigh yourself weekly These drugs may cause hypokalemia, monitor serum potassium levels and electrolytes. ° Interactions * — Primidone: decreased effectiveness of primidone * — Barbiturates & aspi decrease diuretic effectiveness tricyclic antidepressants: can lead to toxicity Simple Nursing Brain bits + Ifactient has an allergy to sulfonamides this drug should not be given. Safe dose Route 250- 1000 mg/day in PO 1-4 divided doses 50- 100 mg 2- 3 times PO daily. ©smpenursina 9DIURETICS How it works “ Action” Diuretics work by altering the reabsorption or excretion of electrolytes and alter fluid volume . Osmotic Diuretics: increase the density of the filtrate in the glomerulus preventing selective reabsorption of h20 and it passes as urine. Why do we give it? “Reason” Toxic overdose. GU irrigant During transurethral procedures (2.5- 5% solution only). ‘Adjunct in the treatment of: Acute oliguric renal failure + Edema Increased intracranial or intraocular pressure + + Adverse Effects CNS:confusion, headache. EENT; blurred vision, rhinitis, CV: transient volume expansion, chest pain, HF, pulmonary edema, tachycardia. GI: nausea, thirst, vomiting. GU: renal failure, urinary retention. Eand E; dehydration, hyperkalemia, hypernatremia, hypokalemia, hyponatremia. Local: phlebitis at IV site. Contraindications + Mannitol: active intracranial bleeding except during craniotomy + Hypersensitivity * Anuria Dehydration ‘Severe pulmonary edema or congestion. Generic Trade Mannitol Osmitrol -QSMOTIC Nursing management Monitor BP and pulse frequently Monitor intake and output ratios and daily weight * Assess patient for anorexia, muscle weakness, numbness, tingling, paresthesia, confusion, and excessive thirst. Report signs of electrolyte imbalance. * Avoid alcohol — Hypokalemia, monitor serum potassium levels and electrolyte levels Interactions * Digoxin: Hypokalemia increases the risk of dig toxicity Simple Nursing Brain Bits ‘Symptoms of fluid and electrolyte imbalance include dry mouth, thirst, weakness, lethargy, drowsiness, restlessness confusion, muscle pain or cramps, confusion, gastrointestinal disturbances, hypotension, oliguria, tachycardia, and seizures. Safe dose Route 50-100 g as a 5- 25% v solution4 HOW DO THEY WORK? “AOLON” In addition to contraception, estrogen is most commonly used in HAT (or estrogen replacement therapy (ERT) in postmenopausal women. INDICATIONS Changes to aging tissues can be lessened when estrogens are used for the following: ‘& Relief of moderate to severe vasomotor symptoms of menopause (ushing, sweating) @ Treatment of atrophic vaginitis @ Treatment of osteoporosis in women past menopause @ Palliative treatment of advanced prostatic carcinoma (in men) © Selected cases of advanced breast carcinoma (Ford 516) CONTRATNDICATIONS breast cancer (except for metastatic atop dependent poplar ame ‘and thromboembolic disorders. T ote impaired liver function. * Ford 518) Both the estrogens and progestins are Classified as pregnancy category X drugs and are contraindicated during pregnancy. oes eee ° eeeeseeoes Lundiagnosed abnormal genital bleeding he progestins also are contraindicated in patients with cerebral hemorrhage or ADVERSE REACTIONS Headache, migraine Dizziness, mental depression Dermatitis, pruritus ‘Chloasma (pigmentation of the skin) or melasma (Giscoloration ofthe skin), which may continue when se ofthe drugis discontinued Nausea, vomiting ‘Abdominal bloating and cramps Breakthrough bleeding, withdrawal bleeding, ‘spotting, changes in menstrual fow Dysmenonthea, premenstrua-ike syndrome, ‘amenorrhea Vaginal candidiasis, cervical erosion, vaginitis ‘Steepening of comeal curvature Intolerance to contact lenses Edema, rhinitis, changes in libido Breast pain, enlargement, and tenderness Reduced carbohydrate tolerance Venous thromboembolism, pulmonary embolism Weight gain or oss Generalized and skeletal pain Increased tisk of endometrial cancer, gallbladder disease, hypertension, liver adenoma , thromboembolic disease, hypercalcemia URINARY SYSTEM DRUGS: ESTROGENS Seie. INTERACTIONS © Oral anticoagulants: Decreases anticoagulant effect, © Tricyclic antidepressants: increased ‘offectivaness of antidepressant ‘Rifampin: Increased risk of ‘breakthrough bieeding 4 — Hydantoins: Incroased risk of breakthrough bleeding and pregnancy HERBAL CONSIDERATIONS Black cohosh, an herb reported to be beneficial in ‘managing symptoms of menopause, is generally regarded as safe when used as directed. Black ccohosh fs a member of the buttercup family. Black Cohosh tea is not considered as effective as other forms. Boling the root releases only a portion of the therapeutic constituents. The benefits of black Cohosh (not to be confused with blue cohosh) indude: Reduction in physical symptoms of ‘menopause: # hot flashes, night sweats, headache & heart palpitations, dizziness, vaginal atrophy, and tinnitus (ringing in the ears) Decrease in psychological symptoms of ‘menopause: ‘@ insomnia, nervousness, initabilty, and depression @ Improvement in menstrual cycle regulary by balancing the hormones ‘and reducing uterine spasms, Black Cohosh is contraindicated during pregnancy. Toxic effects include dizziness, headache, nausea & impaired vision, and vomiting ‘This herb is purported tobe an alternative to HRT. (Ford 518)gp MEN HOW DO THEY WORK? * “ACTION” peripherally acting, ata-adrenergic blockers that exert their action primarily on the smooth muscle ofthe prostate and the bladder neck. By blocking norepinephrine, the muscles relax and this allows urine to flow trom the bladder. Adrenergic blockers can be uroselective ; therefore, the ata-adrenergic blockers exert their action (nthe bladder with minimal action on the vascular system. ‘androgen hormone inhibitors prevent the conversion of testosterone into the androgen 5-a-dihydrotestosterone (DHT). ‘The growth ofthe prostate gland depends fon DHT. The lowering of serum levels of DHT reduces the effect of this hormone on the prostate gland, resulting in a decrease in the siz ofthe gland and the symptoms associated with prostatic gland enlargement. (Ford 519) INDICATIONS , ‘Treatment and symptom * control of BPH * ADVERSE REACTIONS ‘A: adrenergic blockers: % weight gain, fatigue, dizziness, ‘and transient orthostatic hypotension. ‘Androgen hormone inhibitors © impotence, decreased libido, © decreased volume of ejaculate. ‘Changes to breast tissue ,pain or tenderness, nipple discharge, or ‘eniargement Ford 520) cy SYSTEM DRUGS: CONTRAINDICATIONS Uncontrolled angle-closure glaucoma Intestinal obstruction or stony Urinary retention. Both a-adrenergic blockers and. ‘AHI drugs should be used with caution in patients with hepatic or renal disease. Caution the patient with hypertension when using both beta (B) and a blockers that hypotensive symptoms may be increased. (Ford 520) INTERACTIONS antibiotics/antifungals: Decreased effectiveness of ant-infective drug 8 blockers: Increased hypotension Phosphodiesterase type 5 Inhibitors: Increased hypotension BPH DRUGS © __ NURSING MANAGEMENT ‘Monitor voiding pattern and intake and output ratios @ assess abdomen fer bladder distention prior to and periodicaly during therapy. © Catheterization may be used to assess ostvoid residual & —Cystomety is usually performed to diagnose type of bladder dysfunction prior to prescription of oxybutynin @ Gori: Assess geriatric patients for anticholinergic effects (sedation and weakness) HERBAL CONSIDERATIONS ‘Saw palmetto is used to relieve the symptoms of [BPH (urinary frequency, decreased flow of urine, ‘and nocturia). The herb is believed to reduce inflammation and the hormone DHT (responsible for prostate enlargement). Saw palmetto does rot cause impotence, yeti can aggravate GI disorders such as peptic ulcer disease. Men report reduction in urinary symptoms in 1 to 3 ‘months when 160 mg twice daly is taken. tis not recommended as a tea, because the active constituents are not water soluble. Itis usually recommended thatthe herb be taken for 8 ‘months, followed by evaluation by a primary health care provider (Bent, 2006). (Ford 520) 1-5 malday orally Hypertension: 1-8 mg orally dally; ‘BPH: 1-16.mg orally dallyea URINARY SYSTEM DRUGS {ERECTILE DYSFUNCTION DRUGS HOW DO THEY WORK? “ACTION” Phosphodiesterase type § inhibitors are oral drugs that facilitate the enzyme that allows blood flow into the penis, resulting in an erection. = CONTRATNDICATIONS ® Drugs for ED should not be taken by men who use nitrates (eg. for anginal pain). Because P NURSING MANAGEMENT ‘Viagra: Determine erectile dysfunction before administration. Sidenafil has no effect in the abeence of sexual stimulation. Revatio: Monitor hemodynamic parameters and exercise tolerance prior to and Poriodicaly during therapy. Instruct patient to take sidenafil as directed. For erectile dysfunction, take approximately 1 hour betore sexual activity and not more than ‘once per day. If taking sidenafllfor pulmonary arterial hypertension, take missed doses as these drugs affect smooth muscle, patients with pre-existing cardiac problems, especially those using drugs to lower biood pressures Medical attention should be sought for erections soon as remembered unless almost time for next dose; do not double doses. ‘Advise patient that Viagra is not indicated for INDICATIONS = sustained for more than 4 hours. oe & allows blood low nto the penis, resulting in ‘an erection fe ADVERSE REACTIONS ® headache, fushing, Gl upset, nausea, and runny nose or ‘congestion ° Cerny Pulmonary veno-occiusive disease (Chronic use not recommended for pulmonary hypertension due to lack of efficacy INCREASED tisk of death. INTERACTIONS Antiretrovirals; Increased ‘ffectivoness of ED drug Antihypertensives: Increased ‘effectiveness of antinypertensive Caution patient not to take sildenafil concurrently witnalpha-adrenergic blockers (unless on a stable dose) or nitrates. I chest pain occurs after taking sidenall instruct patient to seek immediate medical attention. ‘Advise patient taking sildenafil for pulmonary arterial hypertension to natty health care professional ofall Rx or OTC medications, vitamins, or herbal products being taken and ‘to consult with health care professional before ‘taking other medications. Instruct patient to notify health care professional prompt if erection lasts longer ‘than 4 hr or if experience sudden or decreased vision loss in one or both eyes or loss or decrease in hearing, ringing in the fears, or dizziness, Inform patient that sidenafl offers no protection against sexually transmitted diseases. Counsel patient that protection against sexually transmitted diseases and HIV infection should be considered. idenafi Viegs Erectile dysuncton Erectile dysfunction, BPH Erect dyshinction