1. Diuretics Remove sodium & water
tx hypertension, CHF, pulmonary edema, kidney disease
nursing diagnosis - fluid volume excess

2. Renal Physiology
Urine formation occurs in nephron where blood plasma is processed into urine
ADH – released when osmolality of extracellular fluid increases which increases water reabsoprtion
Acid-base regulation
Usual urine production is less than 2L/day

3. Carbonic Anhydrase Inhibitor
Enzyme (carbonic anhydrase) acts to promote reabsorption of sodium and bicarbonate
Diamox (acetazolamide)
Agents used more for glaucoma than as diuretic
may cause false positive urine protein test
take with meals

4. Loop Diuretics
Inhibit reabsorption of sodium and chloride in the ascending loop of Henle
effective even with impaired GFR
watch for hypokalemia
Lasix (furosemide) - may raise glucose level, push slowly with IV, store oral solution in refrigerator

5. Osmotic Diuretics
These agents are filtered by glomerulus but have limited capability of being reabsorbed
Used primarily with increased intracranial pressure but also may be used with ARF
mannitol (Osmitrol) - IV, if crystals form, warm sol. then cool to body temp., IV set must have filter, infiltration may result in tissue necrosis

6. Thiazide Diuretics Safest diuretic
Structurally related to antibacterial sulfonamides
inhibit sodium and chloride reabsorption in early portion of distal tubule
watch for hypokalmia
adverse effects - hyperglycemia and hyperuricemia)
HydroDIURIL (hydrochlorothiazide)

7. Potassium-sparing Diuretics
The drugs in this class have different modes of action
Dyrenium (triamterene) & Midamor (amloride) blocks sodium reabsorption in distal tubule
Aldactone (spironolactone) - inhibits action of aldosterone, adverse effect is gynecomastia for male clients
Generally used with potassium-depleting diuretic

8. Combination Diuretics
Combines potassium sparing diuretic with hydrochlorothiazide (HCTZ) (thiazide diuretic)
Aldactozide (spirolactone & HCTZ)

9. Nursing Implications Monitor I&O, weights
Monitor potassium, chloride, glucose, uric acid
Give early in day
Watch for Digoxin toxicity for clients on Digoxin

10. Critical Thinking
Ms. Jones is admitted with CHF. She is started on HydroDIURIL. What type of diuretic is this?
What lab data would you check prior to giving this medication?
What are the adverse effects you will be monitoring for?
What do you expect to see if Ms. Jones has a therapeutic response?

11. Critical Thinking (cont)
Ms. Jones is having difficulty breathing. The physician orders Lasix IV.
Is impaired renal function a contraindication?
What primary electrolyte imbalance will you monitor for?
What precautions will you take when administering Lasix IV?