Class: Loop Diuretics

Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions

Furosemide (Lasix) Heart Failure Hypovolemia PO 60 minutes Increase ototoxicity
Bumetanide (Bumex) Renal Failure Anuria with aminoglycosides.
Hepatic disease Increase bleeding
Torsemide (Demadex)
Hypertension Severe electrolyte IV 5 minutes with anticoagulants.
Hypercalcemia (increases imbalances Increase digoxin
renal excretion of calcium) Hepatic coma toxicity with digoxin
FVE and hypokalemia

Mechanism of Action

Causes diuresis, but also will cause vasodilation to trap blood out in the arms and legs which reduces preload and afterload.

Advantages/Disadvantages
Side Effects Adverse Effects

Rapidly removes fluid to help clients in acute Nausea Diarrhea Severe dehydration Gout
heart failure or pulmonary edema. Vertigo Constipation Marked hypotension
Weakness Headache Hyperglycemia
Potassium-wasting Electrolyte imbalances Hearing loss
Should not be used if a thiazide could Abdominal cramping Renal failure
alleviate body fluid excess. Constipation Thrombocytopenia

Nursing Interventions Client Education

Assess vital signs, UOP, electrolytes. Advise to take in the morning and not in the evening to
Daily weight prevent sleep disturbance and nocturia.
Monitor potassium levels. Observe for signs of hypokalemia. Rise slowly from lying or sitting to standing.
Monitor digoxin levels if taking digoxin. Take with food to avoid nausea.
Administer IV dose over 1-2 minutes to prevent hypotension and ototoxicity. Eat foods high in potassium.

Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Osmotic Diuretic
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Mannitol (Osmitrol) Early stage acute Hypersensitivity IV 1 hour May decrease
renal failure Severe dehydration effectiveness of
Reduction of Lithium
Active intracranial
intracranial pressure
Reduction of bleed
intraocular pressure
seen with glaucoma

Mechanism of Action

Inhibits reabsorption of electrolytes and water by affecting pressure of glomerular filtrate.

Advantages/Disadvantages
Side Effects Adverse Effects

Used in emergency, trauma, critical Headache Fluid and electrolyte imbalance

care and neurosurgical settings to treat Dry mouth Dehydration
cerebral edema and decreased increased Hypotension Rebound increased intracranial or
ICP intraocular pressure
Very irritating to veins May crystallize when exposed to low
temperatures.

Nursing Interventions Client Education

Administer through a filter. Reason for medication

Assess neuro status Rise slowly from lying or sitting position.
Monitor lab values (electrolytes and serum osmolality) Report signs of electrolyte imbalance, confusion, pain at injection
I&O site, hearing loss, blurred vision.
Daily weight
Change IV every 24 hours
Monitor for orthostatic hypotension

Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Potassium-Sparing Diuretics
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Spironolactone Hypertension Severe kidney or hepatic PO Unknown Do not take with
(Aldactone) Hyperaldosteronism disease ACE inhibitors
Triamterene (Dyrenium) Reverse potassium or ARBS as
loss from diuretic
induced hypokalemia
hyperkalemia is
more likely.

Mechanism of Action

Acts in the renal tubules and late distal tubule to promote sodium and water excretion and potassium retention. Aldosterone
antagonist.
Advantages/Disadvantages
Side Effects Adverse Effects

Potassium supplements not needed. Mild Photosensitivity Hyperkalemia

diuretic. GI upset
Headache
Can lead to hyperkalemia Dizziness

Nursing Interventions Client Education

Monitor UOP (at least 600 mL/day) for adequate renal perfusion. Avoid sodium substitutions, K+ supplements, and foods
Monitor electrolytes high in potassium.
Daily weight Teach signs of hyperkalemia.
Observe for signs of hyperkalemia (N/V, diarrhea, abdominal cramps, leg Avoid exposure to direct sunlight.
cramps, tingling hands and feet, peaked t-wave.

Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Thiazide Diuretics
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Hydrochlorothiazide Hypertension HCTZ: contraindicated PO 2 hours Increase dig toxicity
(HydroDiuril, HCTZ Diabetes Insipidus with known sensitivity to with digoxin if
Edema associated with hypokalemia present.
sulfonamides or thiazides.
steroid use, estrogen Increase renal toxicity
therapy, heart disease Renal failure with anuria with ASA. Decrease
or liver disease. absorption with
NSAIDS

Mechanism of Action

Action is on the renal distal tubules, promoting sodium, potassium and water excretion ad decreasing preload and cardiac output.
Also decreases edema. Acts on arterioles, causing vasodilation, thus decreasing blood pressure.
Advantages/Disadvantages
Side Effects Adverse Effects

Dizziness Hyperglycemia Severe dehydration

Vertigo Constipation Hypotension
Weakness Nausea/Vomiting Gout
Not effective for immediate diuresis Diarrhea Abdominal pain Hypokalemia
Should only be given with adequate Photosensitivity Shock
renal perfusion. Aplastic Anemia

Nursing Interventions Client Education

Monitor vital signs, UOP, Electrolytes, glucose, uric acid. Teach s/s of hypokalemia
Daily weight Take medication in the morning to avoid sleep disturbance and
Assess peripheral extremities for edema. nocturia.
Observe for s/s of hypokalemia (muscle weakness, leg cramps, How to take BP
cardiac dysrhythmias). Safety precautions
Rise slowly from lying or sitting to standing position.
Use sunblock when in direct sunlight for photosensitivity.

Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.