Diuretics

ACTIONS

Loop diuretics inhibit sodium (Na) and chloride (Cl) reabsorption through direct action primarily in the ascending loop of Henle but also in the proximal and distal tubules. Thiazide diuretics act primarily on the distal tubules, inhibiting Na and Cl reabsorption.

USES

• To treat edema that involves fluid volume excess resulting from a number of disorders of the heart, liver, or kidney

• Hypertension

CONTRAINDICATIONS

• Pregnancy, breast-feeding

• Severe adrenocortical impairment

PRECAUTIONS

• Fluid and electrolyte depletion, gout

• Patients taking digitalis, lithium, nonsteroidal antiinflammatory drugs (NSAIDs), and other antihypertensive medications

SIDE EFFECTS

• ^**Dehydration, hyponatremia, hypochloremia, hypokalemia^**

• ^**Unusual tiredness, weakness,^** dizziness

• Irregular heart beat, weak pulse, ^**orthostatic hypotension^**

• Tinnitus, ^**hyperglycemia, hyperuricemia,^** hearing loss (Lasix)

NURSING IMPLICATIONS

1. ^*Monitor for adequate intake and output and potassium loss.^*

2. ^*Monitor patient’s weight and vital signs.^*

3. ^*Monitor for signs and symptoms of hearing loss, which may last from 1 to 24 hours.^*

4. ^‡Teach patient to take medication early in the day to decrease nocturia.^‡

5. ^‡Teach patient to report any hearing loss or signs of gout.^‡

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