PathoPharm: Module 6 Medications

Diuretics: Loop-Furosemide (Lasix)

• Patho

  • Directly inhibit sodium + chloride reabsorption from the loop of Henle + the distal tubule

  • First line for uncomplicated HTN

• Why

  • More potent than thiazides

  • Cause rapid diuresis, decrease overall volume (including preload), cardiac output + BP

  • Used for hypertension, heart failure, renal disease, edema, pulmonary edema

• Side effects

  • Electrolyte Imbalances: Potassium (3.5-5.0 K), Sodium, Calcium, Magnesium

    • Usually lower due to increased excretion

  • Hyperglycemia + gout

  • Photosensitivity

  • Hypotension

  • Dehydration

• Caution

  • Administer slowly, ototoxicity (hearing loss)

  • Give in morning so don’t have to pee all night

Diuretics: Thiazide Diuretics: Hydrochlorothiazide (HCTZ)

• Patho

  • inhibit reabsorption of sodium + chloride

  • Excretion of sodium, chloride, and water

• Why

  • Used for hypertension, peripheral edema, cirrhosis

  • Not for immediate diuresis + used with normal functioning 

• Side effects

  • Electrolyte Imbalances: Calcium, Potassium, Sodium

  • Hyperglycemia

  • Hypovolemia + hypotension

  • Photosensitivity

• Pearls

  • Monitor urine output (UOP)

  • Give with meals to decrease GI upset

  • Replace K as needed <3.5 mEq/L

  • Monitor renal function + weigh daily

Diuretics: Potassium Sparing: Spironolactone

• Patho

  • Act on distal tubule to promote sodium + water excretion + potassium retention

  • Blocks aldosterone (salt water hormone)

• Why

  • Hypertension, edema, Heart Failure, ascites, hyperaldosteronism

  • Not as powerful as loop (weaker diuretic)

• Side effects

  • Hyperkalemia (Potassium >5 mEq/L)

  • NVD

  • Dizziness, weakness, HA

  • Dry mouth

  • Gynecomastia

• Contraindicated

  • Severe kidney/liver disease

  • Avoid foods high in potassium: green leafy veggies, melons, bananas

Diuretics: Osmotic: Mannitol

• Patho

  • Pull water into the renal tubule without sodium loss

  • Very intense diuresis (given at the hospital)

• Why

  • Cerebral edema, acute renal failure, shock

• Side effects

  • Sudden drop in fluids: hypoTN, lightheadedness, confusion, HA

• Caution

  • Renal disease, anuria, intracranial bleeding, dehydration

  • Only given IV

  • Perform neuro assessment + LOC

Carbonic Anhydrase Inhibitors: Acetazolamide (Diamox)

• Patho

  • Block the effects of carbonic anhydrase

  • Slow down movement of hydrogen ions

  • More sodium + bicarbonate lost in urine

• Why

  • Used as adjunct for more intense diuresis

  • Edema with Heart Failure, acute pulmonary edema, liver disease, renal disease

• Side effects

  • Electrolyte Imbalance: metabolic acidosis, hypokalemia, confusion

• Contraindicated

  • allergy, pregnancy, renal+ hepatic disease

• Drug

  • Salicylates + lithium

ACE Inhibitors: Lisinopril

• Patho

  • Inhibits RAAS system

  • ACE converts Angiotensin I to II

  • Powerful vasoconstrictor

  • Inhibits conversion

  • Decrease in constriction + BP

• Why

  • Hypertension, Heart Failure

• Side effects

  • dry persistent cough

  • angioedema

  • Hyperkalemia

• Pearls

  • Monitor for hypotension + move slowly

  • Monitor K+ levels

  • Assess for angioedema

  • Not suddenly stop = rebound hypertension

  • Teratogenic