Download Ch. 22-Drugs Used for Diuresis

Chapter
22
Drugs Used for Diuresis






Diuresis means the increased formation and
excretion of urine
Diuretic: a drug that promotes the formation and
excretion of urine
Diuretics increase the flow of urine
Purpose is to increase the loss of water from the
body, the do this by increasing the excretion of
sodium
Used in treatment of hypertension and heart failure
Used to treat cerebral edema, glaucoma and liver
disease

Ascites: abnormal accumulation of fluid in the
peritoneal cavity (fig 22-1)
 Peritoneum is a 2 layer membrane that lines the
abdomen, the peritoneal cavity is the space between
them

SEE BOX 22-1 (pg. 284) for a review of
urinary system
Delegation Guidelines
Drugs Used for Diuresis:
Some drugs used for diuresis are given
parenterally- by intramuscular or intravenous
injection. Because you do NOT give parenteral
dose forms, they are NOT included in this
chapter. Should a nurse delegate the
administration of such to you, you must:
- remember that parenteral dosages are often
very different from dosages other routes
-Refuse the delegation. Make sure to explain why.
Do NOT just ignore the request. Make sure the
nurse knows that you cannot give drug and why

Loop Diuretics:

Loop of Henle is u-shaped part of renal tubule (fig 22-3)

has thin descending limb and a thick ascending limb

loop diuretics inhibit the re-absorption of sodium and
chloride from the ascending loop of Henle

goals of therapy:
◦ promote diuresis
◦ reduce edema
◦ improve symptoms related
to excess fluid in tissues
drugs used for diuresis
bumetanide (Bumax):
◦ strong diuretic
◦ inhibits sodium and chloride re-absorption in the ascending
loop of Henle
◦ increases blood flow to the glomeruli
◦ diuretic activity begins in 30-60 minutes after
administration, peaks within 1-2 hours and lasts 4-6 hours
◦ drug is used to treat edema from heart failure and kidney
disease
Assisting With the Nursing Process
bumetanide (Bumex)
ASSESSMENT: measure: vital signs, weight daily, intake/output,
observe alertness and orientation to person, time and place,
observe for : confusion, muscle strength, tremors, ask about muscle
cramps, nausea, measure blood glucose if person has diabetes
PLANNING: oral dose form: 0.5, 1, and 2mg tablets
IMPLEMENTATION: initial adult dose is 0.5 to 2mg given as a
single, daily dose. additional doses may be given at 4-5 hour
intervals. max daily dose is 10mg. Give drug with food/milk. Give
before mid-afternoon, prevents nocturnia
EVALUATION: report and record:
- oral irritation, dry mouth: give oral hygiene as directed by the
nurse/care plan, if nurse allows give hard candy or ice chips
- orthostatic hypotension, dizziness, weakness, fainting: BP is
measured daily (supine/standing), provide for safety
- stomach irritation, abdominal pain: give drug with food/milk
- changes in alertness and orientation to person, time, place..
- confusion , nausea, muscle cramps: may signal dehydration or
electrolyte imbalance (potassium, sodium and chloride)
drugs used for diuresis cont…
ethacrynic acid (Edecrin):
◦ inhibits sodium and chloride re-absorption in the
ascending loop of Henle
◦ diuretic activity begins in 30 minutes
◦ peaks in 2 hours and lasts 6-8 hours
◦ used: to treat edema from heart failure, liver
disease, kidney disease and cancer
Assisting With the Nursing Process
ethacrynic acid (Edecrin)
ASSESSMENT: measure: vital signs, weight daily, intake/output, observe
alertness and orientation to person, time and place, observe for :
confusion, muscle strength, tremors, ask about muscle cramps, nausea,
measure blood glucose if person has diabetes
PLANNING: oral dose form: 25 and 50mg tablets
IMPLEMENTATION: initial adult dose is 50-100mg, followed by 50200mg daily. Max daily dose is 400mg/day. give with food or milk, give
before mid-afternoon to prevent nocturia
EVALUATION: report and record:
 orthostatic hypotension, dizziness, weakness, fainting: BP is measured daily
(supine/standing), provide for safety
- changes in alertness and orientation to person, time, place..
- confusion , nausea, muscle cramps: may signal dehydration or electrolyte
imbalance (potassium, sodium and chloride)
- “coffee ground” vomitus: dark tarry stools: signal GI bleeding
- changes in hearing/balance, deafness, tinnitus: person with impaired kidney
function may have these symptoms
- diarrhea: may become severe: dehydration and electrolyte imbalance are
risks
- hyperglycemia: may occur with person who has or is at risk for diabetes
drugs used for diuresis cont…
furosemide(Lasix):
◦ acts on ascending loop of Henle to prevent
sodium and chloride re-absorption
◦ acts on proximal and distal portions of the tubule
to prevent sodium and chloride re-absorption
◦ maximum effect from oral dose forms occurs in 12 hours, lasts 4-6 hours
◦ this drug is one of the strongest and most effective
diuretics currently available
◦ the drug is used to treat edema from heart failure
and liver and kidney diseases, hypertension
◦ used alone or with other anti-hypertensives
Assisting With the Nursing Process
furosemide (Lasix):
ASSESSMENT: measure: vital signs, weight daily, intake/output, observe alertness
and orientation to person, time and place, observe for : confusion, muscle
strength, tremors, ask about muscle cramps, nausea, measure blood glucose if
person has diabetes, observe for signs of hearing loss
PLANNING: oral dose form: 20, 40, 80mg tablets, 10mg/mL and 40mg/5mL oral
solution
IMPLEMENTATION: persons allergic to sulfonamides (ch. 34) may also be
allergic to furosemide. Adult dose is 20-80mg given as single dose. If 2nd dose
needed it is given 6-8 hours later. Dose is increased 20-40mg per day, usually
given in morning. Give drug with food/milk
EVALUATION: report and record:
- oral irritation, dry mouth. Give oral hygiene as directed by nurse/care plan. Nurse
may allow for hard candy or ice chips
 orthostatic hypotension, dizziness, weakness, fainting: BP is measured daily
(supine/standing), provide for safety
- changes in alertness and orientation to person, time, place.
- confusion , nausea, muscle cramps: may signal dehydration or electrolyte
imbalance (potassium, sodium and chloride)
- hyperglycemia: may occur with person who has or is at risk for diabetes
- hives, rash, itching: may signal allergic reaction, tell nurse at once. Do not give next
dose unless approved by nurse
drugs used for diuresis cont…
torsemide (Demadex):
◦ acts on ascending loop of Henle to prevent
sodium and chloride re-absorption
◦ maximum effect from oral dose forms occurs in 1
-2 hours, lasts for 6-8 hours.
◦ drug is used to treat edema from heart failure and
liver and kidney diseases, and hypertension
◦ used alone or with other anti-hypertensive agents
Assisting With the Nursing Process
torsemide (Demadex):
ASSESSMENT: measure: vital signs, weight daily, intake/output, observe
alertness and orientation to person, time and place, observe for :
confusion, muscle strength, tremors, ask about muscle cramps, nausea,
measure blood glucose if person has diabetes, observe for signs of hearing
loss
PLANNING: oral dose form: 5, 10, 20, 100mg tablets
IMPLEMENTATION: persons allergic to sulfonamides (ch. 34) may
also be allergic to torsemide (Demadex). Adult dose is 5-20mg once/day.
Dose may be doubled until the desired response is achieved.
EVALUATION: report and record:
 oral irritation, dry mouth. Give oral hygiene as directed by nurse/care
plan. Nurse may allow for hard candy or ice chips
 orthostatic hypotension, dizziness, weakness, fainting: BP is measured daily
(supine/standing), provide for safety
 changes in alertness and orientation to person, time, place.
 confusion , nausea, muscle cramps: may signal dehydration or electrolyte
imbalance (potassium, sodium and chloride)
 hyperglycemia: may occur with person who has or is at risk for diabetes
 hives, rash, itching: may signal allergic reaction, tell nurse at once. Do not
give next dose unless approved by nurse
drugs used for diuresis cont…
Thiazide Diuretics:
◦ act on distal tubules to block the re-absorption of sodium and chloride
◦ sodium and chloride that are not re-absorbed take water with the, this
results in diuresis
◦ used in treatment of edema from:







heart failure
kidney disease
liver disease
pregnancy
obesity
pre-menstrual syndrome
administration of cortico-steroids (ch 28)
◦ thiazides also have anti-hypertensive effects, cause vaso-dialation of
peripheral arterioles
◦ goal of therapy:




promote diuresis
reduce edema
improve symptoms related to excess fluid in tissues
reduce BP
Assisting With the Nursing Process
thiazides:
ASSESSMENT: measure: vital signs, weight daily, intake/output, observe
alertness and orientation to person, time and place, observe for :
confusion, muscle strength, tremors, ask about muscle cramps, nausea,
measure blood glucose if person has diabetes, observe for signs of hearing
loss
PLANNING: see 22-1 and 22-2 (pg 288) for “Oral Dose Forms”
IMPLEMENTATION: see 22-1 and 22-2 (pg 288) for “Adult Dosage
Range”, give drug before mid-afternoon, prevents nocturia. For
hypertension: most of the diuretics listed are given in divided doses. For
edema: most listed are given in single daily doses
EVALUATION: report and record:
 orthostatic hypotension, dizziness, weakness, fainting: BP is measured daily
(supine/standing), provide for safety
 stomach irritation, nausea, vomiting, constipation: give drug with food/milk
 changes in alertness and orientation to person, time, place.
 confusion , nausea, muscle cramps: may signal dehydration or electrolyte
imbalance (potassium, sodium and chloride)
 hyperglycemia: may occur with person who has or is at risk for diabetes
 hives, rash, itching: may signal allergic reaction, tell nurse at once. Do not
give next dose unless approved by nurse
drugs used for diuresis cont…
Potassium-Sparing Diuretics:
◦ excrete sodium but retain potassium
◦ examples:
 amiloride (Midamor)
 spironolactone (Aldactone)
 triamterene (Dyrenium)
drugs used for diuresis cont…
amiloride (Midamor):
◦ acts on distal renal tubule to retain potassium and
excrete sodium
◦ diuresis is mild
◦ drug has weak anti-hypertensive effects
◦ used with other diuretics to treat hypertension or
heart failure
◦ goals of therapy:
-reduce edema
-improve symptoms related to excess fluid
in tissues
Assisting With the Nursing Process
amiloride (Midamor)
ASSESSMENT: measure: vital signs, weight daily,
intake/output, observe alertness and orientation to person,
time and place, observe for : confusion, muscle strength,
tremors, ask about muscle cramps, nausea
PLANNING: Oral Dose Form is 5mg tablets
IMPLEMENTATION: initial dose is 5mg daily, dosages may be
increased by 5mg to achieve a max daily dose of 20mg, give
drug with food/milk, give drug before mid-afternoon, this
prevents nocturia
EVALUATION: report and record:
 anorexia, nausea, vomiting, flatulence: should be mild if drug
is given with food
 headache: measure BP
 changes in alertness and orientation to person, time, place.
 confusion , nausea, muscle cramps: may signal dehydration or
electrolyte imbalance (potassium, sodium and chloride)
drugs used for diuresis cont…
spironolactone (Aldactone):
◦ blocks the sodium-retaining properties of
aldosterone (ch. 19)
◦ it blocks potassium and magnesium excretion
caused by aldosterone
◦ sodium and water are excreted
◦ drug is useful in relieving edema and ascites that
do not respond to usual diuretics
◦ may be given with other diuretics
◦ goals of therapy:
 reduce edema
 improve symptoms related to excess fluid in tissues
 improve symptoms from heart failure
Assisting With the Nursing Process
spironolactone (Aldactone):
ASSESSMENT: measure: vital signs, weight daily, intake/output, observe alertness
and orientation to person, time and place, observe for : confusion, muscle
strength, tremors, ask about muscle cramps, nausea
PLANNING: Oral Dose Forms are 25, 50, 100mg tablets
IMPLEMENTATION: initial dose is 50-100mg daily, maintenance dose is 100-
200mg daily, some persons need up to 400mg daily. Give drug with food/milk.
Give drug before mid-afternoon, prevents nocturia
EVALUATION: report and record:





confusion: provide for safety
headache: measure BP
diarrhea: note the number and consistency of stools
changes in alertness and orientation to person, time, place, confusion ,
nausea, muscle cramps: may signal dehydration or electrolyte imbalance
(potassium, sodium and chloride)
breasts may enlarge in men: breast tenderness and menstrual irregularities
in women. These reverse when therapy is discontinued
drugs used for diuresis cont…
triamterene (Dyrenium):
◦ mild diuretic
◦ blocks the exchange of potassium for sodium in
the distal tubules
◦ potassium is retained
◦ sodium and water are excreted through urine
◦ goals of therapy:
 cause diuresis
 improve symptoms related to excess fluid in
tissues
Assisting With the Nursing Process
triamterene (Dyrenium):
ASSESSMENT: measure: vital signs, weight daily,
intake/output, observe alertness and orientation to person,
time and place, observe for : confusion, muscle strength,
tremors, ask about muscle cramps, nausea
PLANNING: Oral Dose Forms are 50 and100mg tablets
IMPLEMENTATION: initial dose is 50-150mg daily, 2x/day
EVALUATION: report and record:
 changes in alertness and orientation to person, time, place,
confusion , nausea, muscle cramps: may signal
dehydration or electrolyte imbalance (potassium, sodium
and chloride)
 hives, rash, itching: may signal an allergic reaction. Tell nurse at
once, do NOT give next dose unless approved by nurse
drugs used for diuresis cont…
Combination Diuretic Products:
◦ low potassium (hypokalemia) is a common
problem with thiazide diuretics
◦ several products contain a potassium-sparing
diuretic with a thiazide diuretic (table 22-3 p.
290)
◦ the goal is to promote diuresis and antihypertensive effects while maintaining normal
potassium levels
◦ persons receiving a combination product are at
risk for side effects from each of the drugs in
product
◦ high potassium and low sodium levels have been
reported