Thiazides

Action: Act on distal convoluted tubule to promote Na, Cl, and water excretion and lose K+

Contraindicated: in renal failure

Used in HTN

Abnormal Chem: Hypokalemia, Hypercalcemia, Hyperuricemia, Hyperglycemia, Hyperlipidemia

Drug interaction: Digoxin, Lithium

Suggest taking in the morning, make slow position changes, check blood glucose reg., use sun block, K+ rich foods.

(Mannitol)

Pulls water into the vasculature and renal tubules, therefore excretion of sodium, potassium, and water.

Used in early stages of kidney failure, however, must still have kidney function for drug to work.

Must be administered through a filter d/t tendency of med to crystalize, and must be stored in a warmer.

Hypokalemia, pulmonary edema-> auscultate lungs

Used also for intraoccular pressure (glaucoma)

Thiazide

Loop

Osmotic

Carbonic Anhydrase Inhibitor

(Lasix)

Acts on the loop of Henle to prevent reabsorption of Na.

Whereever Na goes so goes the water.

Lab changes: hypocalcemia, hyperglycemia, thrombocytopenia, leukopenia, BUN, creatinine

Careful if allergy to Sulfa drugs

Give IVP slowly ! ototoxicity-cranial nerve 8

push 40mg/2min

used to treat pulmonary edema

(Aldactone)binds to Aldosterone receptors, therefore blocking reabsorption of sodium and water.

Sodium is excreted  and potassium is retained (will increase K+)

Adeverse: hyperkalemia (Na is excreted)

Ace inhibitors cause to retain K+ (could be deadly)

Nursing: monitor for signs of hyperkalemia, may need to reduce dietary intake of K+, beware of salt substitutes.

Carbonic anhydrase: enzyme in kidneys and eyes, plays a part in the exchange of sodium for hydrogen ions.  In order for sodium and water to be reabsorbed hydrogen must be exchanges for it. this medication inhibits this action, resulting in diuresis

Indicated for: open-angle glaucoma, edema

Adverse: metabolic acidosis, hypokalemia, elevated glucose

(Acetazolamide)