Understanding the 5 classes of diuretics

Diuretics are medications used to treat hypertension and edema brought on by heart failure, liver failure, certain kidney diseases, and certain drug therapies. Specific classes of diuretics work in another way, acting on different segments of the nephron, except osmotic diuretics, which act on the whole nephron. The most vital thing to recollect is that diuretics affect fluid and electrolyte balance, so it is amazingly essential to rigorously monitor your intake and output, body weight and electrolyte levels – especially potassium -. Let’s take a more in-depth have a look at the classes of diuretics, how they work, and what nurses should know.

Loop diuretics

Loop diuretics act within the ascending limb of the loop of Henle. They are first-line therapy for the acute treatment of pulmonary and peripheral edema brought on by heart failure, but are also used to treat edema related to cirrhosis and renal disease, including nephrotic syndrome. The most famous treatment is. Other drugs on this class include: Many loop diuretics can be found in each oral and intravenous forms.

Loop diuretics are generally well tolerated. Hypokalemia related to using diuretics may result in cardiac arrhythmias in patients with coronary insufficiency or heart failure, and using loop diuretics can be related to dose-dependent ototoxicity (concomitant use with aminoglycosides needs to be avoided).

Thiazides and thiazide-like diuretics

Thiazide diuretics inhibit the reabsorption of sodium chloride within the distal tubule. These are first-line drugs for the treatment of hypertension and are sometimes used along with loop diuretics because of their synergistic diuretic effect in heart failure. They are administered orally.

is an example of a thiazide diuretic. In addition to affecting the renal electrolyte balance, hydrochlorothiazide reduces glucose tolerance and will manifest diabetes in patients liable to impaired glucose metabolism. Hydrochlorothiazide needs to be taken several times a day. The longer-acting thiazide could be taken once every day.

Thiazide diuretics mustn’t be used concurrently with antiarrhythmic drugs that lengthen the QT interval (e.g. quinidine, sotalol) because of the chance of torsades de pointes; this will likely be related to thiazide-induced hypokalemia, which increases the chance of cardiac arrhythmias. Patients also needs to be monitored for symptoms of acute pancreatitis.

Carbonic anhydrase inhibitors

Carbonic anhydrase inhibitors reduce proximal tubular reabsorption of sodium and bicarbonate. Although these drugs are considered diuretics, also they are used to treat glaucoma, idiopathic intracranial hypertension, altitude sickness, and epilepsy, amongst others. is an example of a carbonic anhydrase inhibitor; could be used as adjunctive therapy within the treatment of edema brought on by heart failure. It is offered in each oral and intravenous forms.

Potassium-sparing diuretics

Potassium-sparing diuretics increase nephron reabsorption of potassium by interfering with sodium reabsorption within the collecting duct. They are frequently used together with a thiazide or loop diuretic to reinforce its effect, since potassium-sparing diuretics have weak diuretic and antihypertensive effects when used alone. Examples are: and Unlike other classes of diuretics, the chance of calemia is increased.

Osmotic diuretics

Osmotic diuretics increase urinary flow by osmotic retention of water within the nephron. it’s used to cut back intracranial pressure and cerebral edema. It is given by intravenous injection (intermittent bolus preferred) and preferably through a big central vein due to its blistering effect.

Nursing considerations

As with any medication, it is vital for nurses to be acquainted with the precise diuretic medications the patient is taking, including indications, dosage and approach to administration, contraindications, interactions, and negative effects. Below are some general considerations regarding diuretics.

• Patients needs to be assessed for sulfonamide allergy because some diuretics are sulfonamide derivatives.
• Monitor weight, intake, production and serum electrolyte levels.
• Monitor your blood glucose levels (some medications could cause hyperglycemia).
• Regularly check the extent of urea nitrogen and creatinine within the blood.
• To prevent nocturia, diuretics needs to be administered within the morning.
• Educate patients about their prescribed medications and evaluate negative effects of therapy.

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