8 Murphy N305 Diuretics

Front 1

Ahoy there!!

Back 1

Here, we be learning 'bout Diuretics.
AARRRR!!
These slides be informational. Be sure to repeat the information out loud while going through the slides to help your noggin retain the info.

Front 2

(Fill in the blank)
Functions for Diuretics:
________ urinary output
Therapeutic uses:
HTN aka ____________
Removal of _________ fluid
Prevent _____ failure

Back 2

Functions for Diuretics:
INCREASE urinary output
Therapeutic uses:
HTN aka HYPERTENSION
Removal of EDEMATOUS fluid
Prevent RENAL failure

Front 3

General information on DIuretics:
The site of action that produces the greatest diuresis (65%) is at the Proximal tubule. This is the first part of the Kidney.

Back 3

General information on DIuretics cont:
Most diuretics block Na and Cl reabsorption.

Front 4

Adverse effects for Diuretics:
Most of these are quite obvious. Think about it, if you are losing fluids, what could happen?? 5 are listed on the next slide.

Back 4

Adverse effects:
1.) Hypovolemia
2.) Acid-base imbalance
3.) Electrolyte imbalances, natremia, chloremia, kalemia
4.) Hypotension
5.) Ototoxicity

Front 5

We'll be learning about 4 drugs. Each drug works at different sections of the kidney.

Back 5

High ceiling (loop) diuretics: Furosemide [Lasix]
Thiazide diuretics: Hydrochlorothiazide [HydroDIURIL; Oretic]
Potassium sparing diuretics: Spironolactone [Aldactone]
Osmotic diuretics: Mannitol [Osmitrol]

Front 6

Furosemide [Lasix] *Most commonly given
Loop Diuretic
Site of Action: Loop of Henle
RAPID onset

Back 6

Furosemide:
Tx: Pulmonary edema, edema unresponsive to other drugs, HTN
This diuretic has high strength and can work even when there is low renal blood flow and low GFR.

Front 7

There are quite a few adverse effects. Once again, most of them are quite obvious.Be sure to really remember the 1st, 3rd, and 9th one.

Back 7

Adverse effects:
1.) Hypotension
2.) Electrolyte imbalance (e.g. hypokalemia, hyponatremia, and hypochloremia)
3.) Ototoxicity
4.) Hyperglycemia
5.) Hyperuricemia
6.) Hyperlipidemia
7.) Dehydration
8.) Danger in pregnancy (Category C)
9.) Multiple DDIs (Digoxin if low K, ototoxic drugs, other diuretics, lithium if low Na, anti-HTN agents)

Front 8

Hydrochlorothiazide [HydroDIURIL]
Thiazide Diuretic
ALWAYS for Stage 2 HTN
Site of Action: distal convoluted tubule
Effects are less then high-ceiling agents (non emergency setting)

Back 8

DEPENDENCY on kidney function:
Not effective w/scant urine flow, Doesn't work well with renal damage
Peaks 4-6 hours
Used in: HTN, edematous states, and diabetes insipidus (excessive urination related to ADH action)
SEs similar to loop diuretics WITHOUT OTOTOXICITY

Front 9

Spironolactone [Aldactone]
Potassium Sparing Diuretic (aldosterone antagonist)
Site of Action: distal nephron to cause retention of K, and increased excretion of Na
Produces only modest increase in urine

Back 9

Tx Spironolactone:
May take up to 48 hours to work
Hypertension or edema (commonly given + TZD or loop diuretic)
Severe heart failure
Primary hyperaldosteronism

Front 10

Side Effects:
HYPERKALEMIA,
ENDOCRINE EFFECTS including gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening voice
**Know these distinct side effects!*

Back 10

DDI:
**Beneficial interaction with thiazide and loop diuretics to counteract potassium loss
**Never give with drugs that increase potassium
e.g. ACE inhibitors

Front 11

Mannitol [Osmitrol]
Osmotic Diuretic
Site of Action: Osmotic force in lumen of nephron that prevents passive water reabsorption and increases urine output
FAST ACTING esp given IV

Back 11

It is a:
Six-carbon sugar that is freely filtered at glomerulus; minimal reabsorption; not metabolized significantly; basically inert

Front 12

Tx:
1.) *Prophylaxis of Renal failure
2.) *Reduction of intracranial pressure b/c except CNS
3.) *Reduction of intraocular pressure b/c except CNS

Back 12

SE:
**Can leave vascular system at capillary beds (except CNS) and lead to edema; caution with heart disease

Front 13

Great Job Guys!
Make sure to go over the information again.

Back 13

All things starred (ex: **) are important so attempt to remember these little pieces of data for each drug.