Drug Class: Loop (high

ceiling) diuretic
Trade names: Lasix,
Fumide, Furomide
‡ Presence of severe electrolyte imbalances
‡ Hypovolemia
‡ Anuria
‡ Hypersensitivity to sulfonamides
‡ Hepatic Coma
‡ To treat fluid retention/fluid
overload caused by heart
failure, renal dysfunction,
cirrhosis, hypertension; acute
pulmonary edema
‡ Inhibition of sodium and water
reabsorption from the loop of
Henle and distal renal tubules;
potassium, magnesium, and
calciumalso may be exerted
‡ Nausea, diarrhea, electrolyte
imbalances, vertigo,
cramping, rash, headache,
weakness, ECG changes,
blurred vision,
photosensitivity
‡Severe dehydration, marked
hypotension, life-threatening: renal
failure, thrombocytopenia,
agranulocytosis
Physiologic Changes Possible Effects of Loop ( High
Ceiling) Diuretics
HYPOTENSION
Postural (orthostatic)
hypotension can result
because of ECFV deficit.
Physiologic Changes Possible Effects of Loop ( High
Ceiling) Diuretics
OTOTOXICITY
Hearing impairment,
although rare, may occur. It
is more common with use of
ethacrynic acid. Diuretics in
other categories are not
considered ototoxic.
Caution: Avoid taking a loop
diuretic with a drug that can
be ototoxic, such as an
aminoglycoside.
Laboratory Changes Possible Effects of Loop
Diuretics
Hypokalemia,
Hypomagnesemia
, Hyponatremia,
Hypocalcemia,
Hypochloremia
Potassium, magnesium,
sodium, calcium, and
chloride are lost from the
body from increases urine
excretion. Chloride anion,
is attached to the cations
potassium and sodium,
thus, chloride is lost along
with potassium and
sodium.
Laboratory Changes
Possible Effects of Loop
Diuretics
Hyperglycemia
Increase glycogenolysis
may contribute to an
elevated blood sugar
level. Clients with
diabetes should closely
monitor their blood
glucose levels when
taking a loop diuretic
Diuretics: Diuretics:
Generic (Brand) Uses and Considerations
LOOP
Bumetanide (Bumex)
Treatment of renal
disease and hypertension
and edema associated
with heart failure.
Similar effects as
furosemide
Generic (Brand) Uses and Considerations
LOOP
Ethacrynic Acid
(Edecrin)
For severe edema
(pulmonary and
peripheral). Potent
diuretic with rapid
action. Also used for
hypercalcemia.
Moderate to high
doses may cause
ototoxixity.
Generic (Brand) Uses and Considerations
OSMOTICS
Mannitol For oliguria and decreasing
Intracranial Pressure. To
prevent acute renal failure.
Used in narrow angle
glaucoma for reducing Intra-
ocular Pressure. Clients
should have effective renal
function
Generic (Brand) Uses and Considerations
OSMOTICS
Urea
(Ureaphil)
Same uses as
mannitol. Not the
drug of choice. Used
during prolonged
surgery to prevent
acute renal failure
Generic (Brand) Uses and Considerations
CARBONIC
ANHYDRASE
INHIBITORS
Acetazolamide (Diamox)
For edema, treating
abscence (petit
mal)seizures,and open-angle
glaucoma. May cause
hyperglucemia,
hyperuricemia, nad
hypercalemia. Metabolic
acidosis can result
Generic (Brand) Uses and Considerations
CARBONIC ANHYDRASE
INHIBITORS
Dichlorphenamide(Daranid
e,Oratol)
Treatment of open-angle
glaucoma by reducing the
intraocular pressure and for
narrow-angle glaucoma
before surgery.
Metazolamide (Neptazane) Similar to
Dichlorphenamide
‡ Increase the osmolality
(concentration) and sodium
rearbsorption in the proximal
tubule and loop of Henle
‡ Increase the osmolality
(concentration) and sodium
rearbsorption in the proximal
tubule and loop of Henle
‡ Fluid and electrolyte imbalance,
pulmonary edema from the rapid shift
of fluids, nausea, vomiting, tachycardia
from rapid fluid loss, and acidosis
‡ Fluid and electrolyte imbalance,
pulmonary edema from the rapid shift
of fluids, nausea, vomiting, tachycardia
from rapid fluid loss, and acidosis
‡ CONSIDERATION:
Crystallization of Mannitol
in the vial may occur when the
drug is exposed to a low
temperature. The vial should
be warmed to dissolve the
crystals. The mannitol
solution should not be used for
iv infusion if crystals are
preseent and have not been
dissolved.
‡ CONSIDERATION:
Crystallization of Mannitol
in the vial may occur when the
drug is exposed to a low
temperature. The vial should
be warmed to dissolve the
crystals. The mannitol
solution should not be used for
iv infusion if crystals are
preseent and have not been
dissolved.
‡ Mannitol should be given
with extreme caution to
clients who have heart
disease and heart failure. It
should be immediately
discontinued if the client
develops HF or renal failure.
‡ Mannitol should be given
with extreme caution to
clients who have heart
disease and heart failure. It
should be immediately
discontinued if the client
develops HF or renal failure.
‡ The carbonic anhydrase inhibitors,
acetazolamide, dichlorphenamide,
ethoxzolamide, and methazolamide
block the action of the enzyme
carbonic anhydrase which is needed
to maintain the body¶s acid-base
balance(hydrogen and bicarbonate
ion balance)
‡ The carbonic anhydrase inhibitors,
acetazolamide, dichlorphenamide,
ethoxzolamide, and methazolamide
block the action of the enzyme
carbonic anhydrase which is needed
to maintain the body¶s acid-base
balance(hydrogen and bicarbonate
ion balance)
Acetazolamide can cause fluid and electrolyte
imbalance, metabolic acidosis, nausea,
vomiting, anorexia, confusion, orthostatic
hypertension, and crystalluria. Hemolytic
anemia and renal calculi can also occur.
These drugs are contraindicated during the 1
st
trimester of pregnancy
‡ Weaker than thiazides and loop diuretics,
are used as mild diuretics or in
combination with another diuretic.
Continuous use of potassium wasting
diuretics requires a daily oral potassium
supplement because the kidneys excrete
potassium, sodium and body water. However,
potassium supplements are not used when a
client takes a potassium-sparing diuretic.
In fact, serum potassium excess called
heperkalemia, results when a potassium
supplement is taken with a potassium
sparing diuretic.
‡ Weaker than thiazides and loop diuretics,
are used as mild diuretics or in
combination with another diuretic.
Continuous use of potassium wasting
diuretics requires a daily oral potassium
supplement because the kidneys excrete
potassium, sodium and body water. However,
potassium supplements are not used when a
client takes a potassium-sparing diuretic.
In fact, serum potassium excess called
heperkalemia, results when a potassium
supplement is taken with a potassium
sparing diuretic.
‡ The maIn sIde effect of these drugs
Is hyperkaIemIa. CautIon must be
used when gIvIng potassIum-sparIng
dIuretIcs to a cIIent wIth poor renaI
functIon, because the kIdneys
excrete ßû% to 9û% of potassIum.
UrIne output shouId be atIeast
6ûûmI per day. CIIents shouId not
used potassIum suppIements unIess
the serum potassIum IeveI Is Iow.
‡ The maIn sIde effect of these drugs
Is hyperkaIemIa. CautIon must be
used when gIvIng potassIum-sparIng
dIuretIcs to a cIIent wIth poor renaI
functIon, because the kIdneys
excrete ßû% to 9û% of potassIum.
UrIne output shouId be atIeast
6ûûmI per day. CIIents shouId not
used potassIum suppIements unIess
the serum potassIum IeveI Is Iow.
Drug Class: Potassium-sparing
diuretic
Trade name: Dyrenium
Contraindications: Severe kidney or
hepatic disease,severe hyperkalemia
Caution: Renal or hepatic
dysfunction,diabetes mellitus
Therapeutic Effects/Uses: To
increase urine output; to treat fluid
retention/overload associated with
heart failure. Hepatic cirrhosis, or
nephrotic syndrome
Mode of Action: Acts on
distal renal tubules to promote
sodium and water excretion and
potassium retention
Nausea
vomiting
diarrhea
rash
dizziness
headache
weakness
dry mouth
photosensitivity
Adverse Reaction:
Life-threatening: Severe
hyperkalemia,thrombocytopenia,
megaloblastic anemia
Generic(Brand) Uses and
considerations
Single Agents
Amiloride HCl
(Midamor)
For diuretic-induced
hypokalemia; used for
hypertension, heart
failure,and cirrhosis of
the liver. Secrum
potassium level should
be monitored to detect
hyperkalemia.
Generic(Brand) Uses and
considerations
Eplerenone (inspra) For hypertension or
chronic heart failure
post MI. Also
classified as a selective
aldosterone receptor
blocker. Serum
potassium should be
monitored to detect
hyperkalemia
Generic(Brand) Uses and
considerations
Combinations
Amiloride HCL and
hypochlorothiazide
(Moduretic)
Combinations contain
potassium-wasting and
potassium-sparing
diuretics. Drugs are to
control hypertension and
edema. They are used to
prevent the occurrence of
hypokalemia.
Generic(Brand) Uses and
considerations
Spironolactone and
hypochlothiazide
(Aldactazide)
Same as Moduretic

‡ Presence of severe electrolyte imbalances ‡ Hypovolemia ‡ Anuria ‡ Hypersensitivity to sulfonamides ‡ Hepatic Coma

‡ To treat fluid retention/fluid overload caused by heart failure, renal dysfunction, cirrhosis, hypertension; acute pulmonary edema

magnesium. potassium. and calcium also may be exerted .‡ Inhibition of sodium and water reabsorption from the loop of Henle and distal renal tubules.

weakness. cramping. rash. ECG changes.‡ Nausea. vertigo. diarrhea. headache. blurred vision. electrolyte imbalances. photosensitivity .

‡Severe dehydration. life-threatening: renal failure. thrombocytopenia. marked hypotension. agranulocytosis .

.Physiologic Changes HYPOTENSION Possible Effects of Loop ( High Ceiling) Diuretics Postural (orthostatic) hypotension can result because of ECFV deficit.

such as an aminoglycoside. although rare. It is more common with use of ethacrynic acid. may occur. Caution: Avoid taking a loop diuretic with a drug that can be ototoxic.Physiologic Changes  OTOTOXICITY Possible Effects of Loop ( High Ceiling) Diuretics  Hearing impairment. Diuretics in other categories are not considered ototoxic. .

is attached to the cations potassium and sodium. thus. Hypocalcemia. chloride is lost along with potassium and sodium. and chloride are lost from the body from increases urine excretion. magnesium. Hypochloremia sodium. calcium. . Hyponatremia. Hypokalemia.Laboratory Changes Possible Effects of Loop Diuretics  Potassium. Hypomagnesemia . Chloride anion.

Laboratory Changes Possible Effects of Loop Diuretics Hyperglycemia Increase glycogenolysis may contribute to an elevated blood sugar level. Clients with diabetes should closely monitor their blood glucose levels when taking a loop diuretic .

Similar effects as furosemide .Diuretics: Generic (Brand) Uses and Considerations LOOP Bumetanide (Bumex) Treatment of renal disease and hypertension and edema associated with heart failure.

Potent diuretic with rapid action. . Moderate to high doses may cause ototoxixity. Also used for hypercalcemia.Generic (Brand) Uses and Considerations LOOP Ethacrynic Acid (Edecrin) For severe edema (pulmonary and peripheral).

Generic (Brand) Uses and Considerations OSMOTICS Mannitol For oliguria and decreasing Intracranial Pressure. To prevent acute renal failure. Used in narrow angle glaucoma for reducing Intraocular Pressure. Clients should have effective renal function .

Used during prolonged surgery to prevent acute renal failure .Generic (Brand) Uses and Considerations OSMOTICS Urea (Ureaphil) Same uses as mannitol. Not the drug of choice.

May cause hyperglucemia. hyperuricemia.and open-angle glaucoma. nad hypercalemia. Metabolic acidosis can result .Generic (Brand) Uses and Considerations CARBONIC ANHYDRASE INHIBITORS  For edema. treating Acetazolamide (Diamox) abscence (petit mal)seizures.

Oratol) glaucoma by reducing the intraocular pressure and for narrow-angle glaucoma before surgery.Generic (Brand) CARBONIC ANHYDRASE INHIBITORS Uses and Considerations Dichlorphenamide(Daranid Treatment of open-angle e. Metazolamide (Neptazane) Similar to Dichlorphenamide .

‡ Increase the osmolality (concentration) and sodium rearbsorption in the proximal tubule and loop of Henle .

pulmonary edema from the rapid shift of fluids. nausea. tachycardia from rapid fluid loss. and acidosis . vomiting.‡ Fluid and electrolyte imbalance.

. The vial should be warmed to dissolve the crystals. The mannitol solution should not be used for iv infusion if crystals are preseent and have not been dissolved.‡ CONSIDERATION: Crystallization of Mannitol in the vial may occur when the drug is exposed to a low temperature.

It should be immediately discontinued if the client develops HF or renal failure. .‡ Mannitol should be given with extreme caution to clients who have heart disease and heart failure.

ethoxzolamide. acetazolamide.‡ The carbonic anhydrase inhibitors. and methazolamide block the action of the enzyme carbonic anhydrase which is needed to maintain the body¶s acid-base balance(hydrogen and bicarbonate ion balance) . dichlorphenamide.

vomiting. anorexia. nausea. These drugs are contraindicated during the 1st trimester of pregnancy . Hemolytic anemia and renal calculi can also occur. confusion. and crystalluria.Acetazolamide can cause fluid and electrolyte imbalance. metabolic acidosis. orthostatic hypertension.

In fact. However. sodium and body water. potassium supplements are not used when a client takes a potassium-sparing diuretic. . results when a potassium supplement is taken with a potassium sparing diuretic. Continuous use of potassium wasting diuretics requires a daily oral potassium supplement because the kidneys excrete potassium. serum potassium excess called heperkalemia.‡ Weaker than thiazides and loop diuretics. are used as mild diuretics or in combination with another diuretic.

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Drug Class: Potassium-sparing diuretic Trade name: Dyrenium Contraindications: Severe kidney or hepatic disease.diabetes mellitus .severe hyperkalemia Caution: Renal or hepatic dysfunction.

or nephrotic syndrome Mode of Action: Acts on distal renal tubules to promote sodium and water excretion and potassium retention .Therapeutic Effects/Uses: To increase urine output. Hepatic cirrhosis. to treat fluid retention/overload associated with heart failure.

Nausea vomiting diarrhea rash dizziness headache weakness dry mouth photosensitivity .

thrombocytopenia. megaloblastic anemia .Adverse Reaction: Life-threatening: Severe hyperkalemia.

and cirrhosis of the liver. Secrum potassium level should be monitored to detect hyperkalemia.Generic(Brand) Single Agents Amiloride HCl (Midamor) Uses and considerations For diuretic-induced hypokalemia. used for hypertension. . heart failure.

Also classified as a selective aldosterone receptor blocker. Serum potassium should be monitored to detect hyperkalemia .Generic(Brand) Eplerenone (inspra) Uses and considerations For hypertension or chronic heart failure post MI.

They are used to prevent the occurrence of hypokalemia. . Drugs are to control hypertension and edema.Generic(Brand) Uses and considerations Combinations Amiloride HCL and Combinations contain potassium-wasting and hypochlorothiazide potassium-sparing (Moduretic) diuretics.

Generic(Brand) Spironolactone and hypochlothiazide (Aldactazide) Uses and considerations Same as Moduretic .

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