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Pharmacology Diuretics Chp 33

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All about loops, thiazides, and K+ sparing!

Good morning everybody so this is going to be a lecture on diuretics i’m going to share my screen with you and we are going to get started so here and this would be in your pharmacology book chapter 33 and it’s all about diuretics and i know we call them water pills um and we call them that because makes people urinate but we’re nurses so we’re gonna call them

Diuretics so we’re gonna get started and um just to understand they treat edema for one thing and edema is just an accumulation of excess water or fluid in the body an edema that’s associated with heart failure right-sided heart failure people would have edema in their body in other words their feet their ankles will swell if they have left-sided heart failure that

Would be pulmonary edema so that’s edema fluid that accumulates in the lungs other reasons for edema corticosteroids estrogen therapy cirrhosis of the liver can also cause edema but for intensive purposes right now we’re going to focus on cardiac okay so what are the meds you have to know you have to know loop diuretics and those there’s two of them that you need

To know furosemide and bumetanide that’s lasix and bumx they are potassium depleting in other words they can cause hypokalemia and lasix can cause ototoxicity in other words damage your hearing and one of the first signs of ototoxicity is tinnitus ringing or buzzing in the ear so you would instruct your patient if you hear ringing or buzzing in the ear stop the

Drug call the doctor can also cause nephrotoxicity in other words damage to the kidneys so tell the patient if you notice there’s a change in your urinary habits or your urine looks really dark or concentrated or you’re not urinating as much as you normally do call the doctor and also it’s a sulfa-based drug so if the patient’s allergic to sulfa sulfonomides they

Should not have lasix then your potassium sparing diuretics there’s only one spironolactone and the big problem here is hyperkalemia it can cause hyperkalemia and then your thiazides and the ones that you need to know are hydrochlorothiazide and chlorthalidone and they also can cause hypokalemia so what are we using to treat like i said edema that’s associated

With heart failure hypertension if we’ve tried things like lifestyle modifications lose weight stop smoking stay away from salt and that’s not working usually the first line of defense from a medication perspective is hydrochlorothiazide a low dose see if that works so it’s used to treat hypertension uh diuretics are used for some renal diseases cerebral edema

Which is edema in the brain acute glaucoma and increased intraocular pressure in other words if there’s a fluid buildup and pressure build up behind the eye use diuretics also used for short-term management of abdominal ascites interactions you need to know the ones that i have listed here because digoxin is one of the ones that’s important to know i’m gonna

Take a quick break for one second i will be back okay i am back let’s go back to sharing the screen again and continue on with diuretics okay so interactions drug drug interactions when we’re talking about loop diuretics and thiazides so furosemide bumatinide hydrochlorothiazide chlorthalidone interactions with dig people if they’re on digoxin digoxin toxicity

The risk of that increases with hypokalemia well loop diuretics and thiazides can cause hypokalemia anticoagulants there’s a risk there for bleeding lithium phenytoin and seds and salicylates so with lithium there’s an increased risk for lithium toxicity because secondary to hyponatremia because remember when you think lithium you think salt diuretics you’re

Losing fluid you’re losing sodium as well and so you’re going to be at risk for lithium toxicity if the patient’s on phenytoin which is an anti-seizure medication there is a possibility the diuretic won’t be quite as effective same thing with nsaids and salicylates okay so salicylates to refresh your memory need to know this forever aspirin nsaids ibuprofen

Naproxen sodium meloxican celecoxib okay make sure you know that all important stuff and then the potassium sparing diuretic only one spironolactone that’s the only one potassium sparing which means they’ll hang on to potassium the interaction here if they’re on an ace inhibitor an angiotensin ii receptor blocker aldosterone antagonist which is a plaridone or

A potassium supplement they’re going to be at an increased risk for hypercalamia because spironolactone can cause hyperkalemia and so can all of those drugs it’s pretty straightforward before you administer diuretics you’re always going to make sure daily weights daily weights daily weights not every other day not weekly daily because a weight gain of two to

Three pounds in a day or three to five pounds in a week is fluid you did not eat too much at the all you can eat buffet it is fluid okay you must always look at the laboratory results especially potassium sodium yeah you’re going to look at nag and calcium you’re going to look at renal function are their kidneys okay bun should be 10 to 20 creatinine 0.2 to 1.4

Know those numbers one more time know those numbers okay and if a patient has edema whether it’s pulmonary in the lungs peripheral feet legs abdominal you have to document specifically what was the edema before they started the treatment what does it look like after in other words is the treatment working right that’s the question and remember with daily weights

Weigh the patient at the same time every day the same scale the same location after you wake after you pee before you eat right just keep saying that over and over again there are some nursing diagnoses in here risk for deficient fluid volume risk for injury because their blood pressure will drop um what do you need to know to implement you know weigh the patient

Daily like i said before make sure that’s very important because if we’re giving them a drug to reduce edema is it working they should be losing waterway and always blood pressure pulse respiratory weight rate and if they have edema in the extremities let gravity help elevate the extremities above the level of the heart to help get some of that fluid moving

Right patients with hypertension if they’re using hydrochlorothiazide to treat high blood pressure always monitor their blood pressure that’s pretty much common sense and always if you know regardless of whether it’s furosemide bumetanide hydrochlorothiazide chlorthalidone those are potassium depleting or spironolactone potassium sparing all of the diuretics will

Affect potassium so the patient’s going to be at risk for either hypo or hyperkalemia so you should always be monitoring their certain potassium levels and fyi hyperkalemia we can give them k excellent and k excellate will literally draw that high potassium out of their blood and they’ll excrete it in their feces and if their potassium is low well we can just

Give them some potassium it’s pretty straightforward so this is really really important if a patient’s on a diuretic even if it’s a bid or twice daily dose it should never be given later than 12 or 1 o’clock in the afternoon let me say that again you should never have a person take a diuretic after 1 pm why because it’s going to make them pee and for older folks

They read the label it says okay furosemide take one tablet twice a day they’ll take it in the morning and then they’ll take another one in the evening and then in the middle of the night they’ll have to pee and then they will try to jump out of the bed and then they will fall and then they will either break a hip or crack their head open so because of the high

Risk for falls it gives them urinary urgency when they have to pee they have to pee right then and there so you never give the drug if the patient’s at home never give it past one o’clock in the afternoon make sure you know that monitor their pulse you know rate and rhythm their blood pressure if they feel light-headed make sure that you get them assistance for

Ambulation and transfers and always instruct them to change positions slowly so don’t try to jump out of the chair or the bed and you know get your day started when you move from a lying position to a sitting position sit there for a minute you know let your blood pressure kind of catch up so you don’t fall down and then um educating the patient about the drug

You know don’t reduce their fluid intake because a lot of times what will happen is the patient will oh well it makes me pee so i just don’t drink you can’t do that now you can’t drink a lot of fluid usually people with heart failure will be on a fluid restriction usually some somewhere around 1500 mils a day is pretty typical but they cannot just stop drinking

Because they don’t want to have to go run and pee right that’s not good they can wind up in a severe state of dehydration okay and you know make sure they don’t drink alcohol stay away from over-the-counter non-prescription drugs without talking to the physician be careful if they’re driving and you know they should report if they’re feeling weak or dizzy when

They’re taking this men okay it’s very important um photosensitivity is important to note too that they can um if they’re exposed to the sunlight especially in the middle of the day they can get burned they should wear sunscreen and people who are diabetic and take the loops of the thiazides they need to watch their blood sugar because loops and thiazides only

With diabetic patients can increase blood glucose levels that’s important to know um here’s more important stuff i know this is a lot so if the patient’s taking potassium sparing diuretic in other words there’s only one spironolactone they have to avoid foods that are high in potassium and they should never use salt substitutes they can use mrs dash black pepper

Garlic other herbs and spices but they cannot use salt substitutes a salt substitute that looks like salt is potassium and they’re going to wind up hyperkalemic okay so it’s very important to know and you know again did it work and that’s diuretics so remember the meds you need to know furosemide bumetanide hydrochlorothiazide chlorthalidone and spironolactone

The end all right i am going to stop this video and if you have questions you know where to find me until next time peace

Transcribed from video
Pharmacology Diuretics Chp 33 By Ms. Mary RN Nursing School SUCCESS