1 / 39

Diuretics

Diuretics. Blood Pressure Review. Definition. Per Davis’s Drug Guide for Nurses: “Enhance the selective excretion of various electrolytes and water Different classes of diuretics work on different parts of the nephron: the proximal tubule, the loop of Henle , and the distal tubule.

kyoko
Download Presentation

Diuretics

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diuretics

  2. Blood Pressure Review

  3. Definition • Per Davis’s Drug Guide for Nurses: • “Enhance the selective excretion of various electrolytes and water • Different classes of diuretics work on different parts of the nephron: the proximal tubule, the loop of Henle, and the distal tubule.

  4. Diuretics • A nephron is the functioning unit in the kidney that filters the blood. There are at least 1 million nephrons in each kidney. • One of the nephron’s primary jobs is to excrete and reabsorb sodium. • Sodium reabsorption in the distal tubule of the nephron is dependant on the action of aldosterone

  5. Aldosterone • Aldosterone, is a steroid hormone produced by the adrenal gland, and acts on the kidney nephron to conserve sodium, increase water retention, secrete (get rid of) potassium, and increase blood pressure.

  6. Nephron

  7. Diuretics • General Information/Nursing Responsibilities: • Monitor clients taking Digoxin closely, as diuretics may contribute to Digoxin toxicity • Client Teaching- • Best to take diuretics in the morning or at least not at night • Daily weights should be recorded at home • Notify physician for s/s of Dig toxicity • Visual disturbance, bradycardia, nausea, vomiting, and anorexia

  8. MEDICATIONS

  9. Antihypertensive Medications • Onset of action- begins when drug enters the plasma • Peak of action- highest serum concentration • Half-life – time required for drug concentration in the body to be reduced by one half

  10. Safe Medication Administration • OSBN Nurse Practice Act • LPN Scope of Practice • “The licensed practical nurse has the authority and responsibility to question any order which is not clear, perceived as unsafe, contraindicated for the client, or not within the [nurse’s] scope of practice.” [ paraphrase]

  11. Diuretics • THIAZIDE DIURETICS • Increase sodium and water excretion by inhibiting Na+ reabsorption in the distal tubule of kidneys • Not effective for immediate diuresis • Contraindicated in clients with renal failure Use with caution in clients taking lithium  lithium toxicity • Also use with caution in clients taking digoxin, corticosteroids, and hypoglycemic medications

  12. Diuretics • Examples: • Chlorthiazide (Diuril) • Hydochlorothiazide (HCTZ)(Hydrazide, HydroDiuril) • Metolazone(Zaroxolyn) • Nursing: • Monitor labs (electrolytes, glucose, calcium, BUN, Cr, uric acid levels) • Monitor VS, checks for edema • Pt. teaching: diet, meds, BP self-checks, change positions slowly

  13. Diuretics • LOOP DIURETICS • Inhibit Na+ and Cl⁻ reabsorption from loop of Henle and distal tubule in kidneys • More potent than Thiazide diuretics  rapid diuresing  decreased vascular fluid volume, cardiac output, and BP Use with caution in pt. taking lithium, digoxin, aminoglycosides, anticoagulants

  14. Diuretics • Loop (cont.) • Examples: Bumex, Lasix (furosemide) • Nursing: • Observe for s/sxhypokalemia, hyponatremia, hypocalcemia, hypomagnesemia • Observe for orthostatic hypotension • Monitor labs, s/sxdigoxin or lithium toxicity • Pt. teaching

  15. Diuretics • OSMOTIC DIURETICS • Increase osmotic pressure of the glomerular filtrate inhibiting reabsorption of water and electrolytes • Used for oliguria and to prevent renal failure • Example: Mannitol (Osmitrol) • Nursing: • Monitor: I&O, wt., VS, labs, s/sx dehydration, pulmonary edema

  16. Diuretics • CARBONIC ANHYDRASE INHIBITOR • Inhibition of this enzyme (carbonic anhydrase)  increased Na+, K+, and bicarbonate excretion • Used to decrease intraocular pressure in open-angle glaucoma, and • Produce Diuresis, manage epilepsy, and treat high-altitude sickness • Examples: Diamox, Naptazane

  17. Diuretics • POTASSIUM-SPARING DIURETICS • Act on the distal tubule of the kidneys to promote Na+ and H20 excretion and retention of K+ • Used for edema and HTN; increase urine output • Contraindicated in severe kidney or liver disease or severe hyperkalemia • Examples: Aldactone (spironolactone); Aldactazide (spironolactone and hydochlorothiazide)

  18. Diuretics • POTASSIUM-SPARING DIURETICS (cont.) • Nursing: • Monitor potassium levels that are > 5.1 mEq/L • Adult Nml Range = 3.5 – 5.5 • Critical values: <2.5 or >6.5 cardiac electrical activity can be seriously altered with development of arrhythmia • Monitor, teach/instruct s/sxhyperkalemia • Monitor VS and urine output • Take med with or after meals to ↓ GI irritation

  19. ACE Inhibitors • Angiotensin Converting Enzyme Inhibitor • Antagonist to the reninangiotensin-aldosterone system • Angiotensin II produces vasoconstriction and stimulation of aldosterone • Prevent Angiotensin I conversion to Angiotensin II  vasodilation, ↓ BP, decreased systemic vascular resistance

  20. Factors Influencing Blood Pressure

  21. Remember . . . • Aldosterone is a steroid hormone produced by the adrenal gland, and acts on the kidney to conserve sodium, secrete potassium, increase water retention, and increase blood pressure.

  22. ACE Inhibitors • Angiotensin Converting Enzyme Inhibitors • Examples (not a comprehensive list) • Lisinopril (Prinivil, Zestril) • Ramipril (Altace) • Captopril (Capoten) • Benzapril (Lotensin) • Side effects • Dry cough • Hypotension, hyperkalemia

  23. ACE Inhibitors • Client Teaching • Notify physician if: *Cough develops • S/S of renal insufficiency or failure • Decreased urine output • Sediment in urine • Blood in urine

  24. ACE Inhibitors • Nursing: Pt. teaching: • Notify MD if: • Cough develops • s/sx renal insufficiency or failure • ↓ urine output • Sediment in the urine • Blood in the urine

  25. Angiotensin II Antagonists • Examples • Candesartan (Atacand) • Irbesartan (Avapro) • Losartan (Cozaar) • Valsartan (Diovan) • Action • Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II • Block vasoconstriction and release of aldosterone • Lower blood pressure

  26. Angiotensin II Receptor Blockers • Side Effects • Hypotension (orthostatic, dizziness) • Upper Respiratory Infection (URI) • Cough is much less prevalent than in ACE inhibitors • Nursing: Client Teaching • Notify physician if • s/s of infection • dizziness

  27. Calcium Channel Blockers Mechanism of action • Interrupts the flow of calcium into cells of cardiac muscle and vascular smooth muscle relaxation of smooth muscle, decreasing cardiac muscle contraction and slowing electrical conduction (decreases heart rate) • Dilate peripheral arterioles and reduce peripheral resistance (systemic vascular resistance)

  28. Calcium Channel Blockers • Examples (not a comprehensive list!) • Amlodipine (Norvasc) • Diltiazem (Cardizem, Tiazac) • Felodipine (Plendil) • Nicardipine (Cardene) • Nifedipine (Procardia) • Verapamil (Calan)

  29. Calcium Channel Blockers • Side effects • Hypotension, bradycardia, worsening heart failure (edema), headaches • Nursing: Client teaching • Check heart rate before taking medication • Notify physician of increased SOB, edema, bradycardia *Watch out for “extended release”* *Do not crush or chew!

  30. Beta-Adrenergic Blocking Agents (Beta Blockers) • Action • Block the release of the catecholamines epinephrine and norepinephrine ↓ heart rate and BP • Decrease the workload of the heart and oxygen demand • Used for angina, dysrhytmias, HTN, migrain headaches, prevention MI, and glaucoma

  31. Beta-adrenergic Blocking Agents • Examples (not comprehensive) • Metoprolol (Lopressor) • Atenolol (Tenormin) • Carvedilol (Coreg) • Labetolol (Normodyne) • Toprol XL • Sotolol (Betapace) • Adverse Effects • Bradycardia, hypotension, bronchoconstriction, fatigue, worsening heart failure (edema) • May also mask the symptoms of hypoglycemia

  32. Beta-adrenergic Blocking Agents • Nursing: Client teaching • Notify physician: • If you are an asthmatic before taking this medication • Increased SOB and/or edema • Check heart rate before taking medication and notify physician of bradycardia *Watch out for extended release* *Do not crush or chew!

  33. Peripherally Acting Alpha-Adrenergic Blockers (Alpha Blockers) • Examples • Doxasosin(Cardura) • Prazosin(Minipress) • Terasosin (Hytrin) • Action • Decrease sympathetic vasoconstriction by reducing the effect of norepinephrine vasodilation and ↓ BP • Used to treat HTN

  34. Peripherally Acting Alpha- Adrenergic Blockers • Adverse effects: • hypotension (orthostatic, dizziness), drowsiness, Na+ and H20 retention edema • Nursing: • Client teaching: • Change positions from lying to standing slowly • First dose after any change should be taken at night and then avoid hazardous activities for 12 hours • Avoid OTC meds • Monitor VS, s/sx edema, orthostatic hypotension

  35. Centrally Acting Sympatholytics (Adrenergic blockers) • Examples • Clonidine (Catapres) • Methyldopa (Aldomet) • Guanfacine(Tenex) • Action: • Stimulate alpha-receptors in the CNS to inhibit vasoconstriction  reduced peripheral resistance • Contraindicated in impaired liver function

  36. Centrally Acting Adrenergic Blockers • Adverse effects • Hypotension (orthostatic, dizziness), dry mouth, sedation/drowsiness • Client Teaching • Change positions slowly • Take at bedtime if drowsiness occurs • Do not stop taking suddenly (Risk of rebound hypertension) • Take with food to slow absorption

  37. Peripheral Vasodilators • Examples • Hydralazine (Apresoline) • Minoxidil (Loniten) • Action • Directly dilates peripheral arterioles  ↓ peripheral resistance  ↑ blood flow • Used in peripheral vascular disorders of arteries and veins • Sodium retention (minoxidil)

  38. Peripheral Vasodilators • Side Effects • Orthostatic Hypotension, tachycardia, lightheadedness, dizziness, paplitations • Nursing: • Client Teaching • Notify physician if: Dizziness, Preexisting CAD or Renal insufficiency • Monitor blood flow to LE • Instruct to not smoke • Change positions slowly • Avoid aspirin an aspirin-like products

  39. Nursing Diagnosis • Fluid Volume, risk for deficient • Check Orthostatic Blood Pressures!! • Teach client about appropriate fluid intake • Normally there are not restrictions for HTN, but follow restrictions if ordered • Teach s/s of dehydration and advise client to have more intake if having these s/s

More Related