Furosemide - Loop Diuretic
ACTIONS: inhibits reabsorption of sodium & water in the thick ascending Loop of Henle and the distal
renal tubule, resulting in increased excretion of sodium, water, potassium, calcium and magnesium. Also
increases renal blood flow and decreases BP through vasodilation effects.
USES: Heart failure, renal dysfunction, HTN, nephrotic syndrome, acute pulmonary and peripheral
edema, hypercalcemia
--Potent, fast acting protein binding drug
--SE: hypokalemia, hypochloremia, hyperglycemia, metabolic alkalosis, GI disturbances, photosensitivity,
dizziness, headache, weakness, rash, blurred vision, tingling/prickling sensation, and elevated uric acid
levels
--AR: orthostatic hypotension, hyperglycemia, gout, hearing loss, hypercholesterolemia
--Life threatening: Renal failure, aplastic anemia, thrombocytopenia, agranulocytosis, Stevens-Johnson
syndrome
--Contraindication: presence of severe electrolyte imbalances, hypovolemia, anuria, hepatic coma,
hypersensitivity to sulfonamides
--Caution: HF, DM, hypotension, systemic lupus erythematosus, gout, nephrotoxicity, and patients with
hearing impairment, acute MI, Geriatrics, BPH
--Drug interactions: orthostatic hypotension with alcohol; ototoxicity with aminoglycosides; increased
bleeding with anticoagulants; hypokalemia with steroids and amiodarone; digitalis toxicity and cardiac
dysrhythmia with digoxin and hypokalemia; increased lithium toxicity; increased amphotericin B
ototoxicity and nephrotoxicity; licorice may increase potassium loss; Hawthorn herbal may cause
hypotension; ginseng may decrease diuretic action; and numerous serum electrolyte imbalances
ASSESS/MONITOR: low BP, increased glucose, low K+/Mg++/Na+/Cl- labs
NURSING: Assess orthostatic vitals; teach to sit up first before standing; never give drug until fluid status
is known; assess BUN/CR prior to administration; teach to report dizziness, weight loss, tinnitus, N/V
Hydrochlorothiazide (HCTZ) - Thiazide Diuretic
ACTIONS: acts on the (DCT) distal convoluted renal tubule to promote sodium, water, potassium and
chloride excretion and calcium reabsorption. Also decreasing cardiac output and preload, decreases
edema, ascites on arterioles and causes vasodilation (thus decreasing BP).
USES: Increase urine output, HTN, edema, HF, nephrotic syndrome and ascites
--mildly potent, moderate protein binding with longer action onset than furosemide
--take with K+ supplement. Potassium rich foods: bananas, oranges
--SE: electrolyte imbalances, GI disturbances, photosensitivity, hyperglycemia, dizziness, headache,
weakness, rash, blurred vision, tingling/prickling sensation, and elevated uric acid levels
--AR: orthostatic hypotension, hyponatremia, gout
--Life threatening: severe hypokalemia, aplastic anemia, hemolytic anemia, thrombocytopenia,
agranulocytosis, renal failure, and Stevens-Johnson syndrome
--Contraindication: renal failure, hypersensitivity
--Caution: hepatic/renal dysfunction, DM, hypotension, systemic lupus erythematosus, gout, and
electrolyte imbalance
--Drug interactions: hypokalemia could cause toxicity with Digoxin; renal toxicity with aspirin,
hypokalemia with steroids; decreased diuretic absorption and effects with NSAIDs, cholestyramine, and
colestipol; hypercalcemia, hyperglycemia and increased uric acid levels.
--Herbal interactions: Ginkgo may increase BP, Aloe & Licorice may increase potassium loss, and
Hawthorn may cause hypotension
,Spironolactone - Potassium Sparing Diuretic
ACTIONS: (Weak diuretic) - Acts on distal renal tubules to promote sodium and water excretion and
potassium retention, by interfering with the sodium-potassium pump, which is controlled by
Aldosterone (a mineralocorticoid hormone that promotes Na+ retention and K+ excretion). It helps to
regulate the heart rate.
USES: peripheral and pulmonary edema, circulatory overload, HTN, HF, ascites, and hypokalemia
--SE: N/V, diarrhea, dizziness, headache, weakness and muscle cramps
--AR: electrolyte imbalances, dehydration. Life threatening: Severe hyperkalemia, thrombocytopenia,
agranulocytosis, hepatotoxicity, and Stevens-Johnson syndrome.
Contraindications: Renal failure.
Caution: renal/hepatic dysfunction, DM, HF
Interactions: potassium supplements could increase serum potassium levels; Increased serum
electrolyte levels (except decreased Na+ and Cl levels); Increased effects of antihypertensives and
lithium; LIFE THREATENING: Hyperkalemia if given with ACE inhibitors
Mannitol - Osmotic diuretic
ACTIONS: they are a potent potassium-wasting diuretic that increase the osmolality (concentration) and
sodium reabsorption in the proximal tubule and loop of Henle. Sodium, chloride, water and (to a lesser
degree) potassium are excreted. Major site of action: Glomerulus
USES: Kidney failure prevention, decreases intracranial pressure (ICP, such as in cerebral edema), and
decreases intraocular pressure (IOP, such as in glaucoma), and urologic irrigation.
--*Frequently used in emergency situations, like ICP and IOP)
--*Can be used with cisplatin and carboplatin in cancer chemotherapy
--Diuresis occurs within 1-3 hours after IV administration
--SE: fluid and electrolyte imbalance, N/V, acidosis, headache, blurred vision, dry mouth,
photosensitivity, injection site reaction, and polyuria
--AR: renal failure, tachycardia (rapid fluid loss), pulmonary edema (from rapid fluid shifts)
Contraindications: heart disease, heart failure, and renal failure
Caution:
--Crystallization of drug in vial may occur with low temperatures (1st warm vial to dissolve crystals)
Interactions:
,Diuretics:
Pre-assessment: drug/medical history, baseline vitals, sulfonamide allergies, alcohol use, anticoagulant
use, digoxin use, lithium use
Nursing interventions:
Monitor urine output (alert for retention and/or loss)
Monitor vital signs (alert for low BP)
Monitor peripheral extremities and weight (alert for edema)
Admin IV slow (alert for hearing loss; ototoxicity)
Observe for hypokalemia (muscle weakness, leg cramps, dysrhythmias) with K+ wasting
diuretics
Observe for hyperkalemia (nausea, diarrhea, abdominal cramps, numbness/tingling in hands/feet)
with K+ sparing diuretic
Monitor serum K+ levels (alert for hypokalemia; especially in Digoxin patients)
Monitor blood glucose (in diabetes)
Teaching:
Take as MD prescribed; don’t stop abruptly
Monitor and record BP daily
Take in AM to avoid nocturia and sleep disturbance
Rise and change positions slowly (alert for dizziness, orthostatic hypotension)
Take with food to avoid GI upset
Eat foods rich in potassium and take K+ supplement (HCTZ & Furosemide)
Monitor blood glucose (in diabetes)
Keep out of children’s reach
Photosensitivity (use sunblock)
Consult MD first before taking herbals or OTC’s
Report S/E of hypokalemia (muscle weakness, leg cramps, dysrhythmias
,
ACTIONS: inhibits reabsorption of sodium & water in the thick ascending Loop of Henle and the distal
renal tubule, resulting in increased excretion of sodium, water, potassium, calcium and magnesium. Also
increases renal blood flow and decreases BP through vasodilation effects.
USES: Heart failure, renal dysfunction, HTN, nephrotic syndrome, acute pulmonary and peripheral
edema, hypercalcemia
--Potent, fast acting protein binding drug
--SE: hypokalemia, hypochloremia, hyperglycemia, metabolic alkalosis, GI disturbances, photosensitivity,
dizziness, headache, weakness, rash, blurred vision, tingling/prickling sensation, and elevated uric acid
levels
--AR: orthostatic hypotension, hyperglycemia, gout, hearing loss, hypercholesterolemia
--Life threatening: Renal failure, aplastic anemia, thrombocytopenia, agranulocytosis, Stevens-Johnson
syndrome
--Contraindication: presence of severe electrolyte imbalances, hypovolemia, anuria, hepatic coma,
hypersensitivity to sulfonamides
--Caution: HF, DM, hypotension, systemic lupus erythematosus, gout, nephrotoxicity, and patients with
hearing impairment, acute MI, Geriatrics, BPH
--Drug interactions: orthostatic hypotension with alcohol; ototoxicity with aminoglycosides; increased
bleeding with anticoagulants; hypokalemia with steroids and amiodarone; digitalis toxicity and cardiac
dysrhythmia with digoxin and hypokalemia; increased lithium toxicity; increased amphotericin B
ototoxicity and nephrotoxicity; licorice may increase potassium loss; Hawthorn herbal may cause
hypotension; ginseng may decrease diuretic action; and numerous serum electrolyte imbalances
ASSESS/MONITOR: low BP, increased glucose, low K+/Mg++/Na+/Cl- labs
NURSING: Assess orthostatic vitals; teach to sit up first before standing; never give drug until fluid status
is known; assess BUN/CR prior to administration; teach to report dizziness, weight loss, tinnitus, N/V
Hydrochlorothiazide (HCTZ) - Thiazide Diuretic
ACTIONS: acts on the (DCT) distal convoluted renal tubule to promote sodium, water, potassium and
chloride excretion and calcium reabsorption. Also decreasing cardiac output and preload, decreases
edema, ascites on arterioles and causes vasodilation (thus decreasing BP).
USES: Increase urine output, HTN, edema, HF, nephrotic syndrome and ascites
--mildly potent, moderate protein binding with longer action onset than furosemide
--take with K+ supplement. Potassium rich foods: bananas, oranges
--SE: electrolyte imbalances, GI disturbances, photosensitivity, hyperglycemia, dizziness, headache,
weakness, rash, blurred vision, tingling/prickling sensation, and elevated uric acid levels
--AR: orthostatic hypotension, hyponatremia, gout
--Life threatening: severe hypokalemia, aplastic anemia, hemolytic anemia, thrombocytopenia,
agranulocytosis, renal failure, and Stevens-Johnson syndrome
--Contraindication: renal failure, hypersensitivity
--Caution: hepatic/renal dysfunction, DM, hypotension, systemic lupus erythematosus, gout, and
electrolyte imbalance
--Drug interactions: hypokalemia could cause toxicity with Digoxin; renal toxicity with aspirin,
hypokalemia with steroids; decreased diuretic absorption and effects with NSAIDs, cholestyramine, and
colestipol; hypercalcemia, hyperglycemia and increased uric acid levels.
--Herbal interactions: Ginkgo may increase BP, Aloe & Licorice may increase potassium loss, and
Hawthorn may cause hypotension
,Spironolactone - Potassium Sparing Diuretic
ACTIONS: (Weak diuretic) - Acts on distal renal tubules to promote sodium and water excretion and
potassium retention, by interfering with the sodium-potassium pump, which is controlled by
Aldosterone (a mineralocorticoid hormone that promotes Na+ retention and K+ excretion). It helps to
regulate the heart rate.
USES: peripheral and pulmonary edema, circulatory overload, HTN, HF, ascites, and hypokalemia
--SE: N/V, diarrhea, dizziness, headache, weakness and muscle cramps
--AR: electrolyte imbalances, dehydration. Life threatening: Severe hyperkalemia, thrombocytopenia,
agranulocytosis, hepatotoxicity, and Stevens-Johnson syndrome.
Contraindications: Renal failure.
Caution: renal/hepatic dysfunction, DM, HF
Interactions: potassium supplements could increase serum potassium levels; Increased serum
electrolyte levels (except decreased Na+ and Cl levels); Increased effects of antihypertensives and
lithium; LIFE THREATENING: Hyperkalemia if given with ACE inhibitors
Mannitol - Osmotic diuretic
ACTIONS: they are a potent potassium-wasting diuretic that increase the osmolality (concentration) and
sodium reabsorption in the proximal tubule and loop of Henle. Sodium, chloride, water and (to a lesser
degree) potassium are excreted. Major site of action: Glomerulus
USES: Kidney failure prevention, decreases intracranial pressure (ICP, such as in cerebral edema), and
decreases intraocular pressure (IOP, such as in glaucoma), and urologic irrigation.
--*Frequently used in emergency situations, like ICP and IOP)
--*Can be used with cisplatin and carboplatin in cancer chemotherapy
--Diuresis occurs within 1-3 hours after IV administration
--SE: fluid and electrolyte imbalance, N/V, acidosis, headache, blurred vision, dry mouth,
photosensitivity, injection site reaction, and polyuria
--AR: renal failure, tachycardia (rapid fluid loss), pulmonary edema (from rapid fluid shifts)
Contraindications: heart disease, heart failure, and renal failure
Caution:
--Crystallization of drug in vial may occur with low temperatures (1st warm vial to dissolve crystals)
Interactions:
,Diuretics:
Pre-assessment: drug/medical history, baseline vitals, sulfonamide allergies, alcohol use, anticoagulant
use, digoxin use, lithium use
Nursing interventions:
Monitor urine output (alert for retention and/or loss)
Monitor vital signs (alert for low BP)
Monitor peripheral extremities and weight (alert for edema)
Admin IV slow (alert for hearing loss; ototoxicity)
Observe for hypokalemia (muscle weakness, leg cramps, dysrhythmias) with K+ wasting
diuretics
Observe for hyperkalemia (nausea, diarrhea, abdominal cramps, numbness/tingling in hands/feet)
with K+ sparing diuretic
Monitor serum K+ levels (alert for hypokalemia; especially in Digoxin patients)
Monitor blood glucose (in diabetes)
Teaching:
Take as MD prescribed; don’t stop abruptly
Monitor and record BP daily
Take in AM to avoid nocturia and sleep disturbance
Rise and change positions slowly (alert for dizziness, orthostatic hypotension)
Take with food to avoid GI upset
Eat foods rich in potassium and take K+ supplement (HCTZ & Furosemide)
Monitor blood glucose (in diabetes)
Keep out of children’s reach
Photosensitivity (use sunblock)
Consult MD first before taking herbals or OTC’s
Report S/E of hypokalemia (muscle weakness, leg cramps, dysrhythmias
,
