Diuretics (thiazide) Thiazide diuretics –
hydrochlorothiazide, chlorothiazide,
Indapamide, metolazone
MOA: Inhibits reabsorption of Na, K, CI resulting
in osmotic water loss. Relaxes arterioles (decreases
afterload) Not effective for immediate diuresis
Indication: HTN (First line), edema, HF, liver
cirrhosis, kidney disease, lowers bp 2-4 weeks
Contraindications: Drug allergy, hepatic coma,
anuria, kidney failure
Adverse effects: Electrolyte disturbance (decreases
K, elevated Ca, lipids, glucose, uric acid),
dizziness, GI disturbances, thrombocytopenia,
pancreatitis, cholecystitis, headache, impotence,
metabolic alkalosis, constipation
Interaction: NSAIDS may decrease the
antihypertensive effect
Nursing consideration: Monitor VS, orthostatic
hypotension, hypokalemia, taking supplements
with rich K+ foods, I&O, weight, renal function
Sparing diuretic- Spironolactone, triamterene
MOA: Spironolactone acts primarily through
competitive binding of receptors at the
aldosterone-dependent sodium-potassium
exchange site in the distal convoluted renal tubule.
Spironolactone causes increased amounts of
sodium and water to be excreted, while potassium
is retained.
Indication: HTN, edema for pt with HF, liver
dysfunction
Adverse/side effects: Hyperkalemia,
hyperglycemia, hyperuricemia, hypotension, renal
impairment, hypersensitivity, and gynecomastia
increase risk for lithium toxicity
Consideration: Monitor I&O(30ml) = report,
caution with renal impairment, liver pts.
Administer in the morning to avoid nocturia. Cause
orthostatic changes. Avoid salt substitutes that
have high levels of potassium
Loop diuretics- Furosemide
MOA: Loop diuretics inhibit absorption of sodium
and chloride in the loop of henle and proximal and
distal tubules, thus causing fluid loss, along with
sodium, potassium, calcium, and magnesium
losses. Loop diuretics are very potent diuretics and
are used when a patient has an exacerbation of
fluid overload.
Indication: Edema, HTN(first line) , IV
furosemide is used to urgently treat pulmonary
edema,
Considerations: Onset is 1-hour, peak effect
within 1st or 2nd hour. Duration effect 6-8. Should
be administered in the morning, evening doses
should be avoided
Asses: For dehydration electrolyte imbalance,
hypotension, tachycardia, arrhythmias GI
disturbances. Hypokalemia if used with digoxin
(digoxin toxicity)
Adverse/side effects: dry mouth, weakness,
lethargy, drowsiness, restlessness, muscle pain or
cramps,
Alpha-2fatigue,
agonisthypotension,
– Clonidine,oliguria.
ctapress
MOA: Clonidine stimulates the alpha-adrenergic
receptors, resulting in vasodilation and decreased
blood pressure, thus decreasing peripheral
resistance, increased blood flow to the kidneys,
and decreased afterload. Stimulate alphas-2
adrenoceptors in the CNS(brain & spinal cord)
SNS the part in the nervous system increases HR,
BP, BR, & pupil size.
Indication: HTN, ADHD, opioid dependence,
alcohol addiction menopause
Consideration: Monitor BP, PR, dosage is
adjusted to pts BP because it can cause
hypotension, bradycardia, sedation. Rebound
hypertension if stopped abruptly
Adverse effects: Hypotension, bradycardia,
sedation, depression, orthostatic hypotension,
constipation, dry mouth, impotence