Diuretics

1. PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING
ARSI UNIVERSITY,ASELLA,ETHIOPIA,
SOUTH EAST AFRICA.

2.  The diuretics act by inhibiting
tubular reabsorption.

5.  Furosemide : 20-80 mg/day (oral/IM/IV )
 Bumetanide : 1mg IV loading dose
 0.5-2mg/day PO divided q 12 h ( oral/IV)
 Piretanide
 Ethacrynic acid
 Torsemide : 2.5-5 mg/day
 Azosemide

7.  Frusemide acts by inhibiting NaCl
reassorption in the thick ascending
limb of the henle’s loop.

8.  It blocks the Na, K, Cl in the thick
ascending limb of the henle’s loop
because of which it is called is a
loop diuretic.

9.  It greatly increases the excretion of
Na and Cl in the urine .
 As a large amount of NaCl is
absorbed in this segment, loop
diuretics are highly efficacious.

10.  Diuretic response increases with
dose and over increased treatment
can cause dehydration.

11.  Acute CHF
 Acute pulmonary edema
 Edema associated with CHF
 Hypertension
 Acute renal failure
 Cerebral edema
 Acute hypercalcemia and hyperkalemia

12.  Anuria
 Severe renal failure
 Hepatic coma
 Pregnancy and lactation

13.  Hypotension and volume depletion
 Dose related toxicity
 Hypersensitivity reactions
 GI disturbances.

15.  Administer drug at day time to avoid
sleep disturbances.
 Monitor serum electrolytes, liver and
renal function.
 Administer pottassium rich diet to
patient.

17.  To weight regularly
 To eat pottassium rich diet

19.  Thiazides act on the early distal
tubule.
 Thiazides have a moderate efficacy
because 90% of the filtered sodium
is already reabsorbed before
reaching the distal tubule.

20.  This group of drugs block Na/Cl
cotransport system in the early distal
tubule.
 Thiazides enhance excretion of Mg and
K.
 But they inhibit excretion of Ca and uric
acid resulting in hypercalcemia and
hyperuricemia.

21.  Thiazides : (Benzothiadiazines) –
 Chlorothiazide (adult -0.5-1g)(10-
20ML/day) ( oral / IV)
 Hydrochlorothiazide (adult-25-100mg/day
(oral)
 Polythiazide
 Bendroflumethiazide
 Cyclopenthiazide

22.  Thiazide related agents –
 Chlorthalidone
 Clopamide : 10-60 mg/day (oral/IV)
 Indapamide : 2.5-5mg/day (oral/IV)
 Metolazone : 5-10 mg/day (oral/IV)
 Xipamide : 20-40 mg/day (oral/IV)

23.  Edema
 Hypertension
 Diabetes insipidus
 Hypercalciurea
 Liver cirrhosis

24.  Allergy to thiazides
 Fluid or electrolyte imbalance
 Renal disease
 Liver disease
 Anuria

26.  Reduce dose of other antihypertensives
by at least 50% if given with thiazides.
 Readjust dosages as blood pressure
responds.
 Measure and record weights to monitor
fluid changes.

28.  potassium sparing diuretics act as
aldostrone antagonist by reduce Na
reabsorption and reduce K secretion in the
distal part of the nephron.
 These are not potent diuretics when used
alone.

29.  They are primarily used in
combination with other diuretics.
 It enhances the excretion of calcium
by a direct action on the renal
tubules.

30.  It is an enzyme that catalyzes the
formation of carbonic acid, which
spontaneously ionizes to H and
Hco3 .
 This Hco3 combines with Na and is
reabsorbed.

31.  carbonic anhydrase inhibitors block
sodium bicarbonate reabsorption
and cause Hco3 diuresis.
 carbonic anhydrase is present in the
nephron, eyes, gastric mucosa,
pancreas etc.

32.  Potassium sparing diuretics
 Triamterene : child 5mg/oral
 Amiloride : Adult : 100mg /oral
 Spironolactone : Adult : 25-
200mg/oral

33.  Carbonic anhydrase inhibitors
 Acetazolamide : 250mg/oral
 Methazolamide
 Dorzolamide

34.  Glaucoma
 To alkaline urine
 Epilepsy
 Hyperphosphatemia

36.  Electrolyte level
 Vital signs
 Weight of the patient
 Signs of metabolic acidosis

37.  Osmotic diuretics
 Mannitol : 10%, 20% IV
 Urea
 Glycerol : 0.5-1.5g/kg as oral
solution

38.  Methylxanthines
 Theophylline : it have mild diuretic
effect.

39.  Primary aldosteronism
 Edema associated with CHF, nephrotic
syndrome, hepatic cirrhosis
 Prevention of hypokalemia
 Cardiac arrhythmias
 Hypertension in combination of other
drugs.

40.  Allergy
 Hyperkalemia
 Renal disease
 Anuria
 Pregnancy and lactation

42.  Measure and record regular weight
to monitor mobilization of edema
fluid.
 Regular evaluation of serum
electrolytes and blood urea nitrogen.
 Avoid foods rich in pottassium.

44.  It causes water to be retained in the
proximal tubule and descending
limb of henle’s loop by osmotic
effect resulting in water diuresis.
 There is some loss of sodium.

45.  Increased intracranial or intraocular
tension.
 Acute renal failure to maintain GFR.

46.  Assess electrolytes level
 Check vital signs
 Weight of the patient