DIURETICS

PRESENTED BY: MS. SUMIT KUMARI

NURSING TUTOR
SION
DEFINITION
Diuretics, also called water pills, are medications
designed to increase the amount of water and salt
expelled from the body as urine.
TYPES
 THIAZIDE DIURETICS

 LOOP DIURETICS

K+ SPARING DIURETICS

CARBONIC ANHYDRASE INHIBITORS

OSMOTIC DIURETICS
THIAZIDE DIURETICS
 Thiazides are the most commonly prescribed
diuretics.
They’re most often used to treat high blood pressure.
 These drugs not only decrease fluids, they also cause
your blood vessels to relax.
 Thiazides are sometimes taken with other
medications used to lower blood pressure
THIAZIDE DIURETICS
Examples of thiazides include:
 Chlorthalidone
 Hydrochlorothiazide (Microzide)
Metolazone
 Indapamide
 Thiazide diuretics increase the elimination of sodium
and chloride in approximately equivalent amounts.
They do this by inhibiting the reabsorption of sodium
and chloride in the distalconvoluted tubules in the
kidneys.
LOOP DIURETICS
Loop diuretics are often used to treat heart failure.
Examples of these drugs include:
 Torsemide (Demadex)
 Furosemide (Lasix)
 Bumetanide
LOOP DIURETICS
Loop diuretics are the most potent diuretics as they
increase the elimination of sodium and chloride by
primarily preventing re-absorption of sodium and
chloride.
 The high efficacy of loop diuretics is due to the
unique site of action involving the loop of Henle (a
portion of the renal tubule) in the kidneys.
POTASSIUM-SPARING DIURETICS
 Potassium-sparing diuretics reduce fluid levels in
your body without causing you to lose potassium, an
important nutrient.
 The other types of diuretics cause you to lose
potassium, which can lead to health problems such as
arrhythmia.
 Potassium-sparing diuretics may be prescribed for
people at risk of low potassium levels, such as those
who take other medications that deplete potassium
POTASSIUM-SPARING DIURETICS
 In the distal tubule, potassium is excreted into the
forming urine coupled with the re-absorption of
sodium.
 Potassium-sparing diuretics reduce sodium re-
absorption at the distal tubule, thus decreasing
potassium secretion.
 Potassium-sparing diuretics when used alone are
rather weak, hence they are used most commonly in
combination therapy with thiazide and loop diuretics
POTASSIUM-SPARING DIURETICS
 Potassium-sparing diuretics don’t reduce blood
pressure as well as the other types of diuretics do.
 Therefore, prescribe a potassium-sparing diuretic with
another medication that also lowers blood pressure.
 Examples of potassium-sparing diuretics include:
 Amiloride
 Triamterene (Dyrenium)
 Spironolactone (Aldactone)
Eplerenone (Inspra)
CARBONIC ANHYDRASE INHIBITORS
 Carbonic anhydrase inhibitors inhibit the enzyme
carbonic anhydrase which is found in the proximal
convoluted tubule.
 This results in several effects including bicarbonate
accumulation in the urine and decreased sodium
absorption.
 Carbonic anhydrase inhibitors work by increasing the
excretion of sodium, potassium, bicarbonate and water
from the renal tubules
 Drugs in this class include acetazolamide and
methazolamide
OSMOTIC DIURETICS
 Osmotic diuretics are low-molecular-weight substances that
are filtered out of the blood and into the tubules where they are
present in high concentrations.
Osmotic diuretics (e.g. mannitol) are substances that increase
osmolarity but have limited tubular epithelial cell permeability.
 They work primarily by expanding extracellular fluid and
plasma volume, therefore increasing blood flow to the kidney,
particularly the peritubular capillaries. This reduces medullary
osmolality and thus impairs the concentration of urine in the
loop of Henle
 They work by preventing the reabsorption of water, sodium
and chloride
INDICATIONS
Diuretics are used with other types of medications (adjunctive
therapy) in edema associated with
 Congestive heart failure(CHF),
 Cirrhosis of the liver,
 Corticosteroid and estrogen therapy.
Diuretics also are useful in edema caused by renal dysfunction
CAUSED BY
 Nephrotic syndrome,
 Acute glomerulonephritis
 Chronic renal failure Diuretics are used to lower urinary calcium
excretion, making them useful in preventing calcium- containing
kidney stones.
INDICATIONS
 Diuretics are used as the sole therapeutic agents to
treat hypertension.
 Diuretics can also be used in combination with other
antihypertensive drugs to treat more severe forms of
hypertension.
 Diuretics (specifically the carbonic anhydrase
inhibitors) are used as adjunctive treatment of chronic
simple (open-angle) glaucoma and secondary
glaucoma
INDICATIONS
 Thiazide diuretic uses for osteoporosis in
postmenopausal women. They can be given alone or in
combination with calcium or estrogen.
 Thiazide diuretics also used for treating diabetes
insipidus
 Osmotic diuretics used in the treatment of incearsed
ICP , cerebral oedema, head injury
SIDE EFFECTS
Dry mouth
 Thirst
 Weakness
 Lethargy
 Drowsiness
 Restlessness
 Muscle pains or cramps
 Confusion
Seizures
 Muscular fatigue
 Hypotension
 Oliguria
Tachycardia
 Gastrointestinal (GI) disturbances
SERIOUS SIDE EFFECTS
 In rare cases, diuretics may cause serious side effects. These
can include:
 Allergic reaction
 Kidney failure
 Irregular heartbeat
 Extremely low levels of sodium caused by thiazide diuretics
have been associated with death and neurologic damage in
elderly patients.
 Thiazide diuretics are associated with increase uric acid
levels which may cause gout
DRUG INTERACTIONS
 Thiazide diuretics given concurrently with antidiabetic
drugs causes a decreased blood level of antidiabetic drugs,
hence doses of antidiabetic drugs may need to be increased.
 Among patients taking digoxin (Lanoxin), low levels of
potassium caused by concurrent digoxin and diuretics
(thiazide & loop diuretics) may cause weakness, cramps, and
irregular heartbeats.
 Lithium given concurrently with diuretics (thiazides and
loop diuretics) may induce lithium toxicity due to decreased
renal elimination of lithium.
 Lithium levels should be monitored to ensure safety
DRUG INTERACTIONS
 Potassium-sparing diuretics given with angiotensin converting
enzyme (ACE) inhibitors or nonsteroidal anti- inflammatory drugs
(NSAIDs) have been associated with severely elevated levels of
potassium (hyperkalemia).
 Severe hyperkalemia may present as muscle weakness, fatigue and
slow heart rate (bradycardia).
 It is important to monitor potassium blood levels and to have an
electrocardiogram performed.
 Diuretics are often prescribed with other medications for high blood
pressure and heart disease.
 This may increase the effects of these medications, potentially
causing electrolyte abnormalities (such as reduced levels of
potassium).
NURSING MANAGEMENT
 Potential Nursing Diagnoses
 ■ Fluid Volume, Excess
 ■ Fluid Volume, Deficient, Risk for
 ■ Urinary Elimination, Impaired, related to diuretic
use
ASSESSMENT
Prior to administration:
 ■ Obtain a complete health history (mental and physical),
including data on recent surgeries or trauma.
 ■ Obtain vital signs; assess in context of client’s baseline
values.
 ■ Obtain client’s medication history, including nicotine
and alcohol consumption and use of herbal supplements or
alternative therapies to determine possible drug allergies
and/or interactions.
 ■ Obtain blood and urine specimens for laboratory
analysis
THANK YOU