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Diuretics review.docx

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NURS 2050
Cynthia Barkhouse Mckeen

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Diuretics: prevent resorption of NaCl (and blocking passive resorption of water, by increasing OSM) Loop Diuretics: High Ceiling Thiazide Diuretics: Low Ceiling - Can give large doses, without reaching a peak - Max effects at low doses - Good in those with renal impairment (don’t need - Not for those with renal impairment (need ↑GFR), ↑GFR) or for those allergic to sulfonamides - 20% filtration (most profound diuresis) - 10% filtration, early distal - Edema, HTN - Edema, HTN **drug of choice ** Rapid onset, for urgent use Example: furosemide Example: hydrochlorothiazide Adverse Reactions: hypotension, ↓ K, Na, Cl, Adverse Reactions: hypotension, ↓ K, Na, Cl, Ottotoxicity Ottotoxicity Potassium Sparing Diuretics: Aldosterone Antagonist - This one prevents Resorption of NaCl, but also resorbs K - Aldosterone reabsorbs water and Na, but excretes K. With this diuretic, potassium is spared. - Used with HTN and severe heart failure Example: spironolactone Adverse Reactions: ↑K, ↓Na, Endocrine effects (b/c of steroid like structure, gynecomastia, altered menses) Adverse Reactions for all: Hypovolemia, Electrolyte imbalance, Acid-Base imbalance Ways to block RAAS Beta Blockers ACE Inhibitors ARBs- ANG II blocker Suppress renin release, Stop conversion of ANG I – ANG II Blocks action of Ang II at Beta 1 ↓ BP, BV ↓ BP by blocking aldosterone ↓ renal perfusion Uses: HTN, reduces mortality in ppl with MI & CHF, nephropathy (slows renal disease) Aldosterone Antag Adverse Effects: Has similar side effects, minus the Spironolactone will - first dose hypotension bradykinin cough spare K and promote - Bradykinin cough **can cause cancer so its not preferred. renal resorption of K to - Angioedema block aldosterone - Hyperkalemia - Increase creatinine - Renal impairment ** CI for bilateral renal stenosis b/c they are excreted by kidneys, so it reaches toxic levels Angiotensin II: - Stimulates Aldosterone secretion - ↑ BP (thirst
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