NRSG 2700 unit 8

fluid and electrolyte balance

Different types of diuretics

loop, thiazides, potassium-sparing, osmotic, carbonic anhydrase inhibitors, and combo meds

Furosemide class and MOA

loop diuretic, prevents reabsorption of Na+ in the loop of henle and water follows

Furosemide TE

decreases in fluid retention/removes fluid, approved for HTN but not preferred, and increases urine output even when there is renal failure

Furosemide con

hypersensitivity, anuria/no urine output, hepatic coma, or severe electrolyte depletion

Furosemide SE

profound diuresis aka water and electrolyte depletion (BBW), hypovolemia aka OH, electrolyte imbalances (tachycardia, n/v, dysrhythmias), increased blood glucose, hyperuricemia aka gout, and ototoxicity

Furosemide inter

can cause dysrhythmias w digoxin, other K+ depleting drugs (corticosteroids and amphotericin B), toxicity in other meds like lithium

Furosemide NC/T

monitor for TE and SE, electrolytes and vital signs (bp, weight, lung sounds, peripheral edema), glucose in diabetics, do daily weights, watch bp, report weight gain or loss, eat K+ rich foods, avoid too long sun exposure aka photosensitivity 

Hydrochlorothiazide class and MOA

thiazide diuretic, Blocks Na+ reabsorption of Na+ in the distal tubule

Hydrochlorothiazide TE

HTN management, treats ascites, edema, HF, and nephrotic syndrome. The most prescribed diuretic

Hydrochlorothiazide con

hypersensitivity, anuria, hepatic coma/liver failure

Hydrochlorothiazide SE

same SE as furosemide but thiazide diuretics are not a potent so lower incidence, hypovolemia, hypotension, headache, electrolyte imbalance, hyperuricemia

Hydrochlorothiazide inter

ctn w other meds that increase potassium loss, decreases lithium excretion so watch for toxicity in meds and monitor for serum levels, can lead to toxicity w digoxin

Hydrochlorothiazide NC/T

reduces bp by 10-20, decreases calcium excretion, monitor glucose levels in pt w diabetes, eat K+ rich foods, avoid prolonged sun exposure, daily weights, watch bp, report weight gain or loss

Spironolactone class and MOA

potassium-sparing diuretic (sodium ion channel inhibitor and aldosterone antagonist), competes w aldosterone for receptor sites in the distal renal tubules and increases diuresis without lowering serum K+

Spironolactone TE

mild HTN in pts w hypokalemia, edema and sodium retention associated w HF nephrotic syndrome and liver disease, used off label for PCOS, useful in treating edema or ascites in pt with hepatic cirrhosis 

Spironolactone con

CKD, pregnancy, hyperkalemia, lactic acidosis

Spironolactone SE

hyperkalemia and associated dysrhythmias, dizzy, headache, n/v, gynecomastia, hirsutism, menstrual abnormalities, impotence, tumors in animals in labs (BBW)

Spironolactone inter

ctn when taking other meds that increase K+ retention, decreases lithium excretion (watch for toxicity in meds with monitored serums)

Spironolactone NC/T

use gloves when handling, monitor K+ levels closely, assess fluid and electrolyte balance, weigh yourself 2-3 times a week and report gain or loss, do NOT take K+ supplements and discontinue high K+ diet, maximum diuretic effect takes a few days

Fludrocortisone class and MOA

Adrenocorticoid (mineralocorticoid), mimics the same action as aldosterone and promotes water and sodium reabsorption and increases urinary potassium excretion

Fludrocortisone TE

replaces hormone in adrenocortical insufficiency, treatment of salt-losing congenital adrenogenital syndrome, off-label treats neurogenic orthostatic pressure

Fludrocortisone con

use ctn where fluid accumulation could be hazardous, do not give to pt with fungal infection

Fludrocortisone SE

sodium and fluid retention causes HTN, edema, and HF. Hypokalemia (n/v, muscle cramps, fatigue, prolonged QT interval), impaired wound healing, hematologic changes

Fludrocortisone inter

hypokalemia with drugs that increase K+ excretion, may decrease blood glucose and control with those with diabetes, ctn with digoxin and androgens

Fludrocortisone NC/T

monitor fluid balance and do daily weights and I/O, monitor bp, monitor for hypokalemia, report signs of hypokalemia, eat foods high in K+, weigh yourself daily and report weight gain, report infections