diuretics & anticholinergics

how do diuretics work
applications for usage?

- increase urine output

- htn, edema r/t hf, liver and kidney disease, renal failure prevention

priorities pre-admin

- complete list of home meds

- obtain electrolytes, baseline vitals, weight, history of bph

- pt access/ability to urinate, toilet, call light

priorities post-admin

- vitals q8hrs, i&o, electrolytes, weight

- monitor for OH

pt education for diuretics

- take med as prescribed

- report s/s of OH/HOTN

- daily weights

when to call hcp about weight gain

> 2lbs in one day

> 5lbs in a week

intended responses of diuretics

- more urine output

- diluted color

- decreased blood volume → decreases BP

types of diuretetics

- osmotic

- loop

- thiazide

- potassium sparing

thiazide diuretics
drugs?
moa?

Hydrochlorothiazide (HCTZ), Metolazone

increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule

thiazide adverse effects

- hypokalemia: cardiac changes mostly; dysrhythmias, palpitations, and increased thirst/dry mouth

- hyponatremia: neuro changes mostly, confusion, irritiability, convulsions, muscle cramps

- hyperuricememia: gout, kidney stones

thiazide nursing considerations

- monitor BP

- monitor s/s of adverse effects

- check apical for irregular HR/rhythm

- see if they have potassium supplements ordered and see if they are taking them; if not ordered, call the provider

- ensure morning labs are drawn every morning and call the provider if they are weren’t and are needed

thiazide pt teaching

- s/s of adverse effects

- how to check pulse

- take K+ supplements

loop diuretics

drugs?
moa?

bumetanide: 40x more potent & furosemide: works in 5mins and lasts 2hrs if iv, have urinal ready

- blocks sodium and chloride reabsorption, prevents passive reabsorption of water

- effective even when low gfr

when are loop diuretics used

- hepatic probs

- pink frothy sputum/pulmonary edema

- HF

what are the most powerful diuretics and can cause profuse diuresis if IV

loop

loop adverse effects

- hypokalemia

- hypocalcemia: bone pain, weakness, very thirsty - urinating more, upset stomach, pain, and constipation, and affect your heart (heart racing, irregular beats)

- ototoxicity

nursing considerations loop

- low k: increases risk for digoxin toxicity, ventricular arrythmias?

- monitor if they’re on vancomycin, aminoglycosides, or aspirin because they are ototoxic as well. It can cause permanent hearing loss if given together or if you IV push it too quickly. Ototoxicity can be reversible if caught early.

- increases lithium toxicity? - HYPERkalemia does this

- can be used w thiazides

loop pt education

- check blood sugar regularly may increase it

- take in morning, make sure to take K+ supp

- all s/s of effects

potassium sparing
drugs?
moa?

Spironolactone

- inhibits sodium reabsorption while saving k

potassium sparing adverse effects

- hyperkalemia

considerations potassium sparing

- given w loops or thiazides

- watch for s/s of hyperkalemia and watch potassium. 

potassium sparing education

No potassium supplements, salt substitutes, or foods high in potassium. 

osmotic diuretics

drugs?

moa?

Mannitol

- increases osmotic pressure in glomerular filtrate, inhibits passive reabsorption of water

- pulls fluid off brain tissue (used w tbi, and increased icp, cva)

osmotic side effects

- h/a

- altered electrolytes

- decreased bp

osmotic nursing considerations

- trangent vol expanders: pulls fluid from extravascular to intravascular-doesnt matter unless heart or kidney prob PT (monitor)

- only given IV and takes 60 minutes to start working and lasts for 6 hours

- monitor for dehydration

overactive bladder

- sudden invol contraction of bladder, urgent need to urinate, detrusor contracts before full

- embarassment, decreased qol

- teach kegels and bladder training

urinary antispasmodics

drugs?
moa?
intended response?

 Mirabegron, oxybutynin, solifenacin, tolterodine

- moa: relax detrusor

- intended response: decreased frequency, feeling of always having to go, and incontinence.

urinary antispasmodics adverse effects

- dry mouth

- constipation

- blurred vision

- dry eyes

- urinary retention

urinary antispasmodics education

- teach about s/s because the dose may need to be lowered

- watch for heat stroke, stay in ac and cool environment (cant sweat)

- no alcohol

- report weight increase/monitor daily weight

- watch and keep track of i and o

- Oxybutynin has a transdermal patch - teach how to care for it/use it.