DIURETICS

1.1. What are categories of antihypertensive drugs, their actions?

1. Diuretics- promote sodium depletion, which decreases

extracellular fluid volume (ECFV).
2. Sympatholytic (sympathetic depressants) - comprise of 5
groups of drugs: beta-adrenergic blockers, centrally acting
alpha-2 agonists, alpha-adrenergic blockers, adrenergic
neuron blockers, and alpha-1 & beta-1-adrenergic blockers.
Beta-adrenergic blockers block the beta receptors, and alpha-
adrenergic blockers block the alpha receptors.
3. Direct-acting arteriolar vasodilators- act by relaxing the
smooth muscles of the blood vessels, mainly the arteries,
causing vasodilation.
4. ACE inhibitors- cause little change in cardiac output or heart
rate, and they lower peripheral resistance.
5. Angiotensin II-receptor blocker (ARBs) - they prevent the
release of aldosterone, a sodium-retaining hormone.
6. Calcium channel blockers- block the calcium channel in VSM,
promoting vasodilation.

1.2. What are the classification of sympatholytic drugs that helps to

control hypertension?

>Beta-adrenergic blockers

>Centrally acting alpha-2 agonists

>Alpha-adrenergic blockers

>Adrenergic neuron blockers

>Alpha-1 & beta-1-adrenergic blockers

1.3. What are the side effects and adverse reactions that might
develop during the antihypertensive drug therapy considering the
various categories?

-decreased pulse rate, decreased blood pressure, dizziness,

insomnia, depression, fatigue, nightmares, and sexual dysfunction.
(Marami pa eh T^T)

1.4. Describes the herbal alerts for clients taking antihypertensive

medications?
 1. Ma-huang (ephedra) - decreases or counteracts the effect of
antihypertensive drugs. When taken with beta blockers,
hypertension may continue or increase.

2. Black cohosh – increases the hypotensive effect of

antihypertensive drugs.

3. Hawthorn – may increase the effects of beta blockers and

angiotensin-converting enzyme (ACE) inhibitors.

4. Licorice – antagonizes the effects antihypertensive drugs.

5. Goldenseal – may increase the effects of antihypertensive

drugs.

6. Parsley – may potentiate hypotension when taken with an

antihypertensive drug.

1.5. What are the nursing interventions for client receiving

antihypertensive drugs?

* Monitor vital signs, especially blood pressure and pulse.

* Monitor laboratory results, especially BUN, serum creatinine, AST,

and LDH.

1.1. What are categories of diuretics and their actions?

1. Thiazide and thiazide-like diuretics – act on the distal

convoluted renal tubule, beyond the loop of Henle, to promote
sodium, chloride, and water excretion.
2. Loop or high-ceiling diuretics – act on the thick ascending loop
of Henle to inhibit chloride transport of sodium into the
circulation and inhibit passive reabsorption of sodium.
3. Osmotic diuretics – increase the osmolality (concentration)
and sodium reabsorption in the proximal tubule and loop of
Henle.
4. Carbonic anhydrase inhibitors – acetazolamide and
methazolamide block the action of the enzyme carbonic
anhydrase, which is needed to maintain the body’s acid-base
balance. This group of drug is used primarily to decrease IOP
in patients with open-angle (chronic) glaucoma.
 5. Potassium-sparing diuretics - used as mild diuretics or in
combination with another diuretic such us hydrochlorothiazide
or an antihypertensive drug.

1.2. Identify the various side effects and adverse reactions of

diuretics in various categories?

1. Thiazide and thiazide-like diuretics – electrolyte imbalances

(hypokalemia, hypercalcemia, hypomagnesemia, and
bicarbonate loss), hyperglycemia (elevated blood glucose),
and hyperlipidemia (elevated blood lipid level).
2. Loop or high-ceiling diuretics – electrolyte imbalances like
hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia,
and hypochloremia.
3. Osmotic diuretics – side effects and adverse effects of
Mannitol (most frequently prescribed osmotic diuretic) include
fluid and electrolytes imbalance, pulmonary edema, nausea
and vomiting, tachycardia, and acidosis.
4. Carbonic anhydrase inhibitors – Acetazolamide can cause fluid
and electrolyte imbalance, metabolic acidosis, nausea,
vomiting, anorexia, confusion, orthostatic hypotension, and
crystalluria. Hemolytic anemia and renal calculi can also
occur.
5. Potassium-sparing diuretics – main side effect is
hyperkalemia. Headache, dizziness, weakness, GI
disturbances (anorexia, nausea, vomiting, diarrhea)
hyperuricemia, muscle cramps, numbness, and tingling of the
hands and feet can occur.

1.3. What are the nursing interventions for clients receiving diuretics
in various categories?

Thiazide and thiazide-like diuretics

*Monitor vital signs and serum electrolytes, especially

potassium, glucose, uric acid, and cholesterol levels. Report
changes. If a patient is taking digoxin and hypokalemia occur,
digitalis toxicity frequently results.

*Observe for signs and symptoms of hypokalemia such as muscle

weakness, leg cramps, and cardiac dysrhythmias.
*Monitor the patient’s weight daily. A weight gain of 2.2 lb is
equivalent to 1L of body fluids.

*Note urine output to determine fluid loss or retention.

Loop or high-ceiling diuretics

*Monitor urinary output to determine body fluid gain or loss.

Urinary output should be at least 30 mL/h or 600 mL/24h.

*Notify a health care provider if urine output does not increase; a

severe renal disorder may be present.

*Weigh the patient to determine fluid loss or gain. A loss of 2.2 lb

is equivalent to a fluid loss of 1 L.

*Monitor vital signs, and be alert for marked decreases in blood

pressure.

*Administer IV furosemide slowly; hearing loss may occur if it is

rapidly injected.

*Observe for signs and symptoms of hypokalemia (<3.5 mEq/L),

such as muscle weakness, abdominal distension, leg cramps,
and/or cardiac dysrhythmias.

*Monitor serum potassium levels, especially when a patient is

taking digoxin. Hypokalemia enhances the action of digitalis,
causing digitalis toxicity.

Potassium-sparing diuretics

*Note the half-life of spironolactone. With a long half-life, the

drug is usually administered once a day, sometimes twice a day.

*Monitor urinary output; it should increase. Report if urine output

is less than 30 mL/h or less than 600 mL/day.

*Record vital signs and report any abnormal changes.

*Observe for signs and symptoms of hyperkalemia (serum

potassium >5.0 mEq/L). Nausea, diarrhea, abdominal cramps,
numbness and tingling of the hands and feet, leg cramps,
tachycardia and later bradycardia, peaked narrow T wave on
electrocardiogram, or oliguria may signal hyperkalemia.

*Administer spironolactone in the morning and not in the evening

to avoid nocturia.