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Chapter 32 - Drug Therapy for Fluid Volume Excess

Terms in this set (19)

Renal Overview
Primary function of the kidneys is to regulate volume, composition, & pH of body fluids

Anatomy & Physiology of the kidney:
* Nephron: functional unit of the kidney; each kidney contains 1 million nephrons; functions by 3 processes: glomerular filtration, tubular reabsorption, & tubular secretion

* Glomerular filtration: rate is about 180L/day or 125 mL/min; most fld. is reabsorbed

* Tubular reabsorption: movement of substances from the tubule to the blood

* Tubular secretion: movement of substances from the blood to the tubule
Diuretic Sites of Action
Thiazide Diuretics
Hydrochlorothiazide (Esidrix, Oretic) is the prototype

Chemically related to sulfonamides

Not a strong diuretic & only works well when urine flow is adequate

Effects usually occur in 2 hours
Mechanism of Thiazide Diuretics
Acts to decrease absorption of Na, H20, chloride, & bicarbonate
Use of Thiazide Diuretics
Treat mild to moderate HTN & edema associated with heart failure & nephrotic syndrome

NOT established safety & effectiveness in children

Older adults are sensitive to adverse effects

Should NOT be given the MORNING of surgery, may lead to volume depletion
Adverse effects of Thiazide Diuretics
Hypotension
weakness
dizziness
diarrhea
constipation
electrolyte imbalances
hyperglycemia
paresthesia = cause numbness, itching, and a feeling of pins and needles on your skin
erectile dysfunction
Loop Diuretics
Diuretic of choice when rapid effects are required

Furosemide (Lasix) is the prototype

Effects usually occur within 30-60 mins.

Inhibits Na & Chloride reabsorption
Use of Loop Diuretics
treat HTN, acute pulmonary edema, heart failure, & renal/hepatic disease
Adverse effects/Contraindications of Loop Diuretics
Adverse effects
* Fluid & electrolyte imbalances
* Ototoxicity

Contraindications
* Known sensitivity
* Anuria
* Allergy to sulfonamides
Other Drugs in Class of Loop Diuretics
Bumetanide (Bumex)

Torsemide (Demadex)
Potassium-Sparing Diuretic
Spironolactone (Aldactone) is the prototype
Mechanism of K-sparing Diuretic (Spironolactone )
Slow onset; requiring several days before full therapeutic effect

Blocks the affects of aldosterone

Blocks Na-retaining effects of aldosterone
Use of K-sparing Diuretic (Spironolactone )
tx of heart failure
Ascites (abnormal accumulation fluid in the abdominal (peritoneal) cavity)
Hypokalemia
HTN
Hyperaldosteronism
Signs & Symptoms of Hyperkalemia
Signs & Symptoms of Hypokalemia
Adverse effects of K-sparing Diuretic (Spironolactone )
Dizziness
HA
abd. cramping
diarrhea
Deepening of voice
gynecomastia
menstrual irregularities
testicular atrophy
Osmotic Diuretics
Produce rapid diuresis

Mannitol (Osmitrol) is the prototype
Use of Osmotic Diuretics (Mannitol )
Useful in managing oliguria, anuria, & may prevent acute renal failure,

Can be used to decrease intracranial pressure
Combination products
Thiazide diuretics are available in fixed-dose combinations

Nondiuretic anti-HTN& K sparing diuretics

Purpose: increase pt. convenience & compliance; prevent K imbalances

Drugs: aldact-azide, dy-azide, max-zide, & moduretic
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