Upload
henry-morris
View
243
Download
3
Tags:
Embed Size (px)
Citation preview
2
Diuretics
• Increase urine excretion
• Categories– Thiazides– Loop diuretics– Potassium-sparing diuretics– Osmotic agents
3
Thiazides
• Most frequently used• Increase secretion of water, sodium,
chloride, and potassium• Example
– Hydrochlorothiazide
• Uses– Edema, heart failure, cirrhosis
4
Thiazides
• Side effects– Dehydration– Fluid/Electrolyte imbalance– Hypokalemia (K)
• Arrhythmia, muscle weakness, spasms, fatigue/lethargy
– Hypochloremia (Cl)– Postural Hypotension
5
Patient Education
• Diet considerations– Include high K foods (citrus, bananas)– Need for K supplements
• When to notify physician– Sx?
• Administer in the morning– Prevents alteration in sleep pattern
• Rising slowly to prevent postural hypotension
7
Loop Diuretics
• Site of action: Loop of Henle– Inhibits Na and Cl reabsorption
• More effective and rapid than thiazides• Example
– Furosemide (Lasix)– Bumetanide (Bumex)
• Uses– Edema, renal/hepatic dz, CHF, Pulm. Edema,
Ascites, cirrhosis, HTN (if thiazides are ineffective)
8
Loop Diuretics
• Side effects – Dehydration– Fluid/Electrolyte imbalance– Hypokalemia (K)
• Arrhythmia, muscle weakness, spasms, fatigue/lethargy
– Hypochloremia (Cl)– Postural Hypotension
• Contraindications or caution– Cross allergy to sulfa
9
Patient Education
• Diet
• Notification of side effects
• Take with food before 6 P.M.
• Rising slowly
• Avoid alcohol
• Report sudden changes in output
10
Patient Education
• Report abrupt or severe weight loss
• Limit exposure to sunlight (furosemide) - photosensitivity
• Do not take other medications or OTC drugs without physician consultation
11
Potassium-Sparing Diuretics
• Counteract loss of potassium, glucose, and uric acid associated with thiazides
• Rx’d used when K depletion can be too dangerous.
• Drug of choice in cirrhosis• Example
– Spironolactone (Aldactone) – Triamterene (Dyrenium)
12
Potassium-Sparing Diuretics
• Side effects– HYPERkalemia
• Cardiac Arrhythmias
– Dehydration– Fluid/Electrolyte imbalance– Postural Hypotension
13
Patient Education
• Avoid potassium-rich foods and salt substitutes
• Report excess dehydration, GI symptoms (N/V/D) and persistent HA and confusion
• Monitor weight and report sudden, excessive loss
• Rising slowly
14
Osmotic Agents(Parental Only)
• Used to reduce intracranial or intraocular pressure
• Other uses– Renal Failure
• Example– Mannitol and urea
15
Osmotic Agents
• Side effects– Fluid/Electrolyte imbalance– CNS Sx’s: HA, Vertigo, Confusion, N/V– Hypotention
• Extreme caution
• Interactions
16
Patient Education
• Report side effects to physician
• Reassure patient that they will be closely monitored
• Frequent blood work
17
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
Medications for Gout• Gout
– A form of arthritis in which uric acid crystals are deposited in and around joints, causing inflammation and pn.
18
Medications for Gout
• Lower uric acid levels
• Medications1. Uricosuric agents
Ex: probenecid (Benemid)
2. Allopurinol
19
Uricosuric Agents
• When used– Tx for chronic gout (no analgesic or anti-
inflammatory effect)
• How they work– Act on kidney by blocking reabsorption and
promoting urinary excretion of uric acid
• Side effects– Kidney stones if fluid volume not maintained
20
Patient Education
• Increase fluid intake
• Take meds after meals
• Stop meds and report rash immediately
• Avoid alcohol
• Avoid other meds unless prescribed by physician
21
allourinol (Zyloprim)
• Used for chronic gout
• Decreases serum and urine levels of uric acid
• No analgesic/anti-inflammatory effect
• REMEMBER FROM CHAPTER 21:– Tx for acute gout is colchicine
22
Antispasmodics(anti-cholinergic effect)
Block parasympathathetic nerve • When used
– Reduce the strength and frequency of contractions of the bladder
• Pro-Banthine
– Increases the bladder capacity capacity with neurogenic bladders, preventing incontinence
• Cytospaz, Levsin
– Other chemically similar drugs (Detrol/Ditropan) are used for relief of sx’s of frequency, urgency, nocturia and incontinence
23
Patient Education
• Report troublesome side effects– Drowsiness– Urinary retension/Constipation
• Caution when driving or operating machinery
• Avoid alcohol or other sedatives
24
CholinergicsStimulate parasympathetic nerve
• When used– Need to contract bladder– Non-obstructive urinary retention
• Post-Op/Postpartum• Called “pharmacological catherization”
• Side effects– Sweating/Salivation, Urinary Urgency
25
Oral Urinary Analgesics
• When used– Need for local anesthetic effect for urinary tract
mucosa– Relieve pn, burning associated w/ cystitis– Procedures (cytoscopy/surgery)
• Side effects– Orange-Red Urine
26
Patient Education
• Urine will stain orange-red
• Only temporarily effective against discomfort – Not effective for infection
• Diagnosis and treatment of underlying treatment required
27
Benign Prostatic Hypertrophy (BPH)• Anti-androgens
– Action• Reduce size of prostate and associated urinary obstruction• Ex: Proscar, Avodart
– Side effects• Impotence, decreased libido, gynecomastia
– Cautions
• Alpha-blockers– Action
• Relaxes bladder neck and prostate, causing them to relax• Ex: Flomax, Cardura
– Side effects• Dizziness, HA, Nasal Congestion