furosemide (Lasix)

"Loop diuretics"

Routes and Pharmacokinetics

PO onset 60 mins, duration 8 hrs

IM rarely used

IV onset 5-10 mins, duration 2 hrs

Metabolized in liver, excreted in kidney

furosemide (Lasix)

Uses

Pulmonary edema

CHF

Edema fro hepatic, cardiac or renal origins

HTN (adjunct therapy)

*note-can be used in the presence of renal impairment even tho it works in the kidney- does not change GFR

furosemide (Lasix)

Adverse Effects

HYPOnatremia

HYPOchloremia

*HYPOkalemia* look at BMP

Dehydration (tugor, weight, I&O)

HYPOtension

Ototoxicity- can NOT give more than 20mg/min or pt will experience tinnitus

furosemide (Lasix)

Drug Interactions

digoxin (Lanoxin)- can lead to digtoxicity in otherwise safe doses

Ototoxic drugs- additive effect

Potassium sparing diuretics- will balance out potassium levels when pt needs more lasix drugs

Anithypertensive drugs- additive effect

furosemide (Lasix)

nursing interventions

Monitor I & O, hydration (thirsty, lips dry), daily weights

Monitor BUN (kidney function and hydration), Creatinine (kidney fnx)

Monitor BP

Monitor lytes ESP K⁺

Schedule oral doses early in day to prevent nocturia- risk for falls

IV doses give slowly at a rate not to exceed 20mg per minute in adults

IV piggyback 4mg per min

furosemide (Lasix)

Teaching

hydrochlorothiazide (HCTZ)

"Thiazide diuretics"

hydrochlorothiazide (HCTZ)

routes & pharmacokinetics

oral ONLY - onset 2 hrs, duration 6-12 hrs

dose 12.5-25 mg average

hydrochlorothiazide (HCTZ)

Uses

essential HTN (first line drug)

edema in mild CHF

hydrochlorothiazide (HCTZ)

adverse effects

hyponatremia

hypocholermia

hypokalemia

dehydration 

(^ same as lasix but less impact on BP, BMP, and I&O)

hypergylcemia in DM pts

hyperuricemia (gout pts)

caution with pregnancy and lactation

*dont take at night (especially elderly), can take with food

hydrochlorothiazide (HCTZ)

drug interactions

digoxin (lanoxin)- can lead to digtoxicity in otherwise safe dose

ototoxic drugs- additive effect

potassium sparing diurectics- will balance out potassium levels when pt needs more

(^same as lasix)

NSAIDs may blunt diuretic effect

*natural licorice causes potassium loss*

hydrochlorothiazide (HCTZ)

nursing interventions

monitor glucose in DM pts

Monitor uric acid levels

monitor for s/s gout, gouty arthritis

*may take with food to reduce GI upset

spironolactone (Aldactone)

"Potassium- Sparing Diuretics"

uses

cause modest increase in UOP & substantial decrease in potassium excretion

this diuretic specifically works as an aldosterone antagonist (blocks aldosterone)

Used to treat certain patients with hyperaldosteronism (body produces too much aldosterone), low potassium levels, & in patients with edema caused by including heart, liver, or kidney disease. Spironolactone is used alone or with other medications to treat high blood pressure.

spironolactone (Aldactone)

MOA

blocks action of aldosterone in distal nephron therefore retention of K and increase excretion of NA

scanty diuresis as it mostly occurs in loop

spironolactone (Aldactone)

routes & pharmacokinetics

only oral: onset 24-48 hours duration 48-72 hours

spironolactone (Aldactone)

uses

HTN

Edema

CHF

primary hyperaldosteronism

spironolactone (Aldactone)

Adverse effects

hyperkalemia- watch that electrolytes dont get high

spironolactone (Aldactone)

contraindications

renal failure/hyperkalema- already have high K

pregnancy/lactation/children

spironolactone (Aldactone)

drug interaction

potassium supplements/salk substitues (made with KCl)

caution with ACE inhibitors

digoxin- increase effect

spironolactone (Aldactone)

nursing intervention/teaching

monitor I&O, daily weights

MONITOR K!!!!!

monitor BP

may take with food to reduce GI upset

mannitol (Osmitrol)

"osmotic diuretics"

freely filtered at glomerulus with minimal reabsorption

not metabolized to a significant degreee

acts by creating osmotic force within lumen of nephron w/out effect on electrolytes

mannitol (Osmitrol)

route & pharmacokinetics

IV ONLY

onset 30-60 mins, duration 6-8 hrs

excreted intact in urine

prophylaxis of renal failure

reduction of ICP (pulls fluid out of brain tissue)

reduction in IOP (for eye surgery)

edema (extravascular)

transient volume expansin

electrolyte imbalances

dehydration

use filter needle and inline filter for admin

monitor IV site

monitor fluid status (I&O, weights)

monitor VS, ICP, central venous pressure readings

monitor for eye pain, change in vision

monitor BUN and electrolytes

potassium chloride

oral form?

can NOT be crushed

potassium chloride

when should it be held?

hyperkalemia- CALL DOC!

Sodium polystyrene sulfonate (Kayexalate)

what is it used for?

resin that gets rid of too much K

Sodium polystyrene sulfonate (Kayexalate)

where does it work?

exchanges sodium for potassium

Sodium polystyrene sulfonate (Kayexalate)

what route?

oral or rectal (may cause diarrhea)

Sodium polystyrene sulfonate (Kayexalate)

contraindications?

CHF pts, if potassium isnt high

Sodium polystyrene sulfonate (Kayexalate)

precautions?

telemetry- watch EKG

Sodium polystyrene sulfonate (Kayexalate)

Adverse effects

may alter other drugs absorption

cant use if pt has fecal impactions

diarrhea, causes GI effects