What is an example of a loop diuretic?

furosemide

Where does furosemide work?

in the ascending Loop of Henle (tubule in nephron)

What does furosemide do?

decreases Na/Cl reabsorption

How would you describe furosemide as a diuretic?

VERY STRONG (and can be titrated for an increased effect)

What would you use furosemide for in patients?

acute pulmonary edema, heart failure, edema/ascites in hepatic diseases, renal diseases, and for lower glomerular filtration rate.

What is the onset, peak, and duration for furosemide?

Onset: 30 - 60 minutes

Peak: 1-2 hours

Duration: 6-8 hours

Can you name any adverse effects of furosemide?

HYPOnatremic, HYPOkalemic, ototoxic, and increased fluid loss.

What patients are contraindicated for furosemide?

sulfonamide allergic and pregnant

What is an example of a thiazide diuretic?

Hydrochlorothiazide

Thiazides are also known as?

Potassium losing drugs

Where does hydrochlorothiazide work?

in the distal convoluted tubule between the Loop of Henle and the collecting tubule (H)

What does hydrochlorothiazide do?

decreases reabsorption of Na, H2O, Cl, and HCO3

How would you describe hydrochlorothiazide as a diuretic?

Very weak and slow

What would you use hydrochlorothiazide for in patients?

long term management of heart failure edema and HYPERtension

What is the onset, peak, and duration for hydrochlorothiazide?

Onset: 2 hours

Peak: 4-6 hours

Duration: 6-24 hours

Can you name any adverse effects of hydrochlorothiazide?

hearing impairment, tinnitus, dizziness, and ototoxicity

What patients are contraindicated for hydrochlorothiazide?

sulfonamide sensitivity, renal failure, anuric, and pregnant.

What does hydrochlorothiazide have?

a ceiling threshold

In order to give hydrochlorothiazide, what is needed in the patient?

adequate urine flow

What is an example of potassium (K) sparing diuretic?

Spironalactone, Triamterene

Where does spironalactone work?

in the distal convoluted tubule between the Loop of Henle and the collecting tubule (S)

What does spironalactone do?

it competes with aldosterone for Na/K channel to inhibit Na/H2O reabsorption and K excretion (spares K)

What would you use spironalactone for in patients?

heart failure, ascites, HYPOkalemia, HYPERtension, HYPERaldosteronism

What is the onset, peak, and duration for spironalactone?

all between 24-48 hours (needs a long time for results)

Can you name any adverse effects of spironalactone?

dizziness, headaches, abdominal cramping, diarrhea, *AFFECTS ANDROGEN/STEROIDS RECEPTORS (= deep voice, gynecomastia, menstrual irregularities, testicular atrophies)

What patients are contraindicated for spironalactone?

renal failure (may cause HYPERkalemia bc of decreased aldosterone and retention of K), hepatic disease, first trimester of pregnancy, digoxin toxicity, lithium toxicity

What is spironalactone known as?

Aldosterone antagonist

What would you tell a patient if they are prescribed spironalactone?

AVOID foods high in K bc of potential K toxicity

What is spironalactone's BBW?

tumorigenic with chronic toxicity

What is an example of an osmotic diuretic?

Mannitol

Where does mannitol work?

in the blood stream

What does mannitol do?

it increases osmotic pressure (solute load) of glomerular filtrate (pulling H2O into bloodstream), increasing blood volume and decreasing reabsorption of H2O/electrolytes in renal tubules

What would you use mannitol for in patients?

it decreases intracranial pressure for neurosurgery, decreases intraocular pressure for ophthalmic surgery, excretes toxic substances, manages olig/anuria, and prevents acute renal failure

What is mannitol's onset, peak, and duration?

IV

onset: 1-3 hours (15-30 minutes to decrease intracranial pressure)

What are some combination drugs for diuretics?

(Thiazides)

Aldactazide, Dyazide, Maxzide, Moduretic

Combination drugs for diuretics are used for initial therapy for edema and HYPERtension. (T/F)

False

What do combination drugs prevent when used with potassium sparing diuretics?

K imbalance (thiazides are K wasting, K sparing are...well, K sparing. IT EVENS OUT)

Why is a loop-thiazide diuretic combination synergistic?

loop diuretics block Na reabsorption in Loop of Henle, so Na delivery increases at distal convoluted tubule (increasing excretion of Na)

What are adverse effects of a loop-thazide diuretic combination?

increased diuresis with severe Na, K, and volume depletion (only use with hospitalized patients so you can keep track of em)