PHARM EXAM 3
Furosemide: Loop diuretic- loses sodium potassium magnesium and calcium
Action
oInhibits water and sodium reabsorption, potassium, magnesium and calcium are also
excreted
oAct on ascending loop of Helen
Uses
oTreat fluid retention caused by heart failure
oRenal dysfunction
oCirrhosis
oHypertension
oPulmonary edema
Side effects and adverse reactions
oGI distress
oDizziness
oWeakness
oPhotosensitivity
oFluid and electrolyte imbalances
oOrthostatic hypotension, hypotension
oHyperglycemia
oHearing loss – when iv pushing too fast
Contraindications
oSevere electrolyte imbalance
oHypovolemia
oAllergy to sulfa drugs
Caution
oHeart failure
oDiabetes
Interactions
oAnticoagulants (increased bleeding)
oSteroids (increased K loss)
oDigoxin if hypokalemia is present
o
Spironolactone: potassium sparing diuretic- holds onto potassium
Action
oBlocks action of aldosterone
oBecause of blocking aldosterone, the renal tubules promote sodium and water excretion
and potassium retention
oAlso excretes magnesium, calcium – can increase blood glucose
Uses
oheart failure
oHepatic cirrhosis
Side effects/adverse reactions
oGI distress, dizziness, weakness
, oErectile dysfunction
oorthostatic hypotension, Hypotension
oFluid and Electrolyte imbalance
oHyperkalemia
Contraindications
oSevere kidney/renal disease
oHyperkalemia
Interactions
oPotassium supplements
oACE inhibitors and angiotensin 2 receptor blockers
oSalt substitutes containing potassium
Hydrochlorothiazide: thiazide diuretic- loses sodium potassium magnesium and hold on the
calcium
Action
oAction is in the kidneys
oPromotes NA, K, and water excretion
oAct on distal convoluted renal tubule
Uses
oTreat hypertension
oEdema from heart failure
Side effects and adverse reactions
odizziness, headache, weakness (common side effect because we are lower BP)
oGI distress
oPhotosensitivity
oFluid and Electrolyte imbalances
oHypotension, orthostatic hypotension
oHyperglycemia
oHypokalemia, dysrhythmias
Contraindications
oRenal failure don’t give to kidney failure
oElectrolyte depletion
Caution
oHepatic dysfunction
oDiabetes mellitus (have them monitor their blood pressure frequently due to
hyperglycemia)
Interactions
oIncreased digoxin toxicity with hypokalemia
oAnti-diabetic drugs
oSteroids
Mannitol: osmotic (used in emergency situation) potassium wasting
Action
oCauses water, sodium, chloride, potassium to be excreted through the kidneys
Use:
, odecrease Intracranial pressure
odecrease intraocular pressure
oPromote excretion of toxic substances
oUsually used in an emergency situation
Side effects/adverse reactions:
oGi upset
ofluid and electrolyte imbalance
opulmonary edema from rapid shift of fluids
oTachycardia from rapid fluid loss
oRapid fluid loss, acidosis
Extreme caution
oHeart disease and heart failure
oRenal failure
Diuretic
Assessment
oMedication/medical history
oVital signs (because it’s going to lower the blood pressure)
oFluid and electrolyte levels, weight
oRenal/hepatic function
oAllergies (furosemide sulfa base drug)
Interventions
oMonitor I & o, daily weight
oNotify hcp if urine output does not increase
oMonitor vs, watching blood pressure
oAdminister iv furosemide slowly
oFor k wasting watch for s/s of hypokalemia
oFor k sparing watch for s/s of hyperkalemia
oMonitor electrolyte levels
oMonitor glucose periodically
Teaching
oTake bp before dose
oWeigh self-daily – report gain of 2 # overnight or 5 # in week
oTake medication in the morning
oOk to take with food if GI upset occurs
oStay out of sun with photosensitivity
oTeach to get up slowly
oReinforce need for medication and to compliance
oDiet – k wasting – increase potassium, potassium supplement, if patient on digoxin,
especially important
oDiet – k sparing – decrease potassium
oTeach that drugs can increase glucose so hcp will monitor blood glucose
Furosemide: Loop diuretic- loses sodium potassium magnesium and calcium
Action
oInhibits water and sodium reabsorption, potassium, magnesium and calcium are also
excreted
oAct on ascending loop of Helen
Uses
oTreat fluid retention caused by heart failure
oRenal dysfunction
oCirrhosis
oHypertension
oPulmonary edema
Side effects and adverse reactions
oGI distress
oDizziness
oWeakness
oPhotosensitivity
oFluid and electrolyte imbalances
oOrthostatic hypotension, hypotension
oHyperglycemia
oHearing loss – when iv pushing too fast
Contraindications
oSevere electrolyte imbalance
oHypovolemia
oAllergy to sulfa drugs
Caution
oHeart failure
oDiabetes
Interactions
oAnticoagulants (increased bleeding)
oSteroids (increased K loss)
oDigoxin if hypokalemia is present
o
Spironolactone: potassium sparing diuretic- holds onto potassium
Action
oBlocks action of aldosterone
oBecause of blocking aldosterone, the renal tubules promote sodium and water excretion
and potassium retention
oAlso excretes magnesium, calcium – can increase blood glucose
Uses
oheart failure
oHepatic cirrhosis
Side effects/adverse reactions
oGI distress, dizziness, weakness
, oErectile dysfunction
oorthostatic hypotension, Hypotension
oFluid and Electrolyte imbalance
oHyperkalemia
Contraindications
oSevere kidney/renal disease
oHyperkalemia
Interactions
oPotassium supplements
oACE inhibitors and angiotensin 2 receptor blockers
oSalt substitutes containing potassium
Hydrochlorothiazide: thiazide diuretic- loses sodium potassium magnesium and hold on the
calcium
Action
oAction is in the kidneys
oPromotes NA, K, and water excretion
oAct on distal convoluted renal tubule
Uses
oTreat hypertension
oEdema from heart failure
Side effects and adverse reactions
odizziness, headache, weakness (common side effect because we are lower BP)
oGI distress
oPhotosensitivity
oFluid and Electrolyte imbalances
oHypotension, orthostatic hypotension
oHyperglycemia
oHypokalemia, dysrhythmias
Contraindications
oRenal failure don’t give to kidney failure
oElectrolyte depletion
Caution
oHepatic dysfunction
oDiabetes mellitus (have them monitor their blood pressure frequently due to
hyperglycemia)
Interactions
oIncreased digoxin toxicity with hypokalemia
oAnti-diabetic drugs
oSteroids
Mannitol: osmotic (used in emergency situation) potassium wasting
Action
oCauses water, sodium, chloride, potassium to be excreted through the kidneys
Use:
, odecrease Intracranial pressure
odecrease intraocular pressure
oPromote excretion of toxic substances
oUsually used in an emergency situation
Side effects/adverse reactions:
oGi upset
ofluid and electrolyte imbalance
opulmonary edema from rapid shift of fluids
oTachycardia from rapid fluid loss
oRapid fluid loss, acidosis
Extreme caution
oHeart disease and heart failure
oRenal failure
Diuretic
Assessment
oMedication/medical history
oVital signs (because it’s going to lower the blood pressure)
oFluid and electrolyte levels, weight
oRenal/hepatic function
oAllergies (furosemide sulfa base drug)
Interventions
oMonitor I & o, daily weight
oNotify hcp if urine output does not increase
oMonitor vs, watching blood pressure
oAdminister iv furosemide slowly
oFor k wasting watch for s/s of hypokalemia
oFor k sparing watch for s/s of hyperkalemia
oMonitor electrolyte levels
oMonitor glucose periodically
Teaching
oTake bp before dose
oWeigh self-daily – report gain of 2 # overnight or 5 # in week
oTake medication in the morning
oOk to take with food if GI upset occurs
oStay out of sun with photosensitivity
oTeach to get up slowly
oReinforce need for medication and to compliance
oDiet – k wasting – increase potassium, potassium supplement, if patient on digoxin,
especially important
oDiet – k sparing – decrease potassium
oTeach that drugs can increase glucose so hcp will monitor blood glucose
