Drugs Affecting the Kidney

Diuretics

DIURETICS

alter the volume and composition of body fluids.

DIURETICS PHARMACODYNAMICS

• Increases the rate of urine flow.

• Block the sodium ion reabsorption in the nephron, thus sending more sodium to the urine.

• Blocking the reabsorption of Na will increase the volume of urination.

DIURETICS INDICATION

✓ Hypertension

✓ Heart Failure

✓ Pulmonary Edema

✓ Diseases characterized by accumulation of fluid

DIURETICS 4 types

LOOP

THIAZIDES

POTASSIUMSPARING

OSMOTIC

Loop Diuretics PHARMACODYNAMICS

block the reabsorption of sodium chloride and water

⇧ Excretion of Potassium

Loop Diuretics INDICATION

Acute Congestive Heart Failure

Loop Diuretics DRUG EXAMPLES

▪ Furosemide (Lasix)

▪ Bumetanide (Bumex)

▪ Torsemide

Loop Diuretics NURSING CONSIDERATIONS

Pediatrics – administer with caution

Geriatrics – require lower dose

Thiazide Diuretics PHARMACODYNAMICS

Act on the early distal tubule to block the reabsorption of sodium chloride and water.

⇧ Excretion of Potassium

Thiazide Diuretics INDICATION

▪ Mild to Moderate Hypertension

▪ Heart Failure

▪ Liver Failure

▪ Renal Failure

Thiazide Diuretics DRUG EXAMPLE

SHORT ACTING

Hydrochlorothiazide

INTERMEDIATE ACTING

Metolazone

Bendroflumethiazide

LONG ACTING

Chlorthalidone

Indapamide

Methylclothiazide

Potassium-Sparing Diuretics PHARMACODYNAMICS

• Act on the late distal tubule and collecting ducts to block the reabsorption of sodium and reduce the secretion of potassium.

• Sodium-Potassium exchange.

• ⇩ Excretion of Potassium

Potassium-Sparing Diuretics DRUG EXAMPLES

▪ SPIRINOLACTONE

▪ AMILORIDE

▪ EPLERENONE

▪ TRIAMTERENE

Osmotic Diuretics

• Act on the proximal tubule and loop of Henle to create an osmotic force that pulls water into the nephron.

• ⇧ excretion of all electrolytes.