hydrochlorothiazide, furosemide, triamterene - group 4

Study Guide

 

Hydrochlorothiazide

Diuretic (Thiazide)

Esidrex, HCTZ, Hydro-chlor, Hydro-D, HydroDIURIL, Microzide, Novo-Hydrazide, Oretic

 

 

Classifications: Therapeutic: Antihypertensives, diuretics

                              Pharmacologic: Thiazide diuretics, thiazide-like diuretics

 

Indications: Management of hypertension from mild to moderate. Also treats edema associated with CHF, Renal dysfunction, Cirrhosis, Corticosteroid therapy and Estrogen therapy.

Desired Outcomes: Decrease in blood pressure, increase in urine output, decrease in edema

 

Action > Increases the excretion of water and sodium by slowing down sodium reabsorption in the distal tubule. Promotes excretion of chloride, potassium, magnesium and bicarbonate. Also may produce arteriolar dilation

Therapeutic Effects: Lowers blood pressure in hypertensive patients and diuresis with mobilization of edema

 

Adverse Reactions/Side Effects: Dizziness, drowsiness, lethargy, weakness, hypotension, anorexia, cramping, n/v, photosensitivity, rashes, hyperglycemia, hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia, hyperuricemia, bone marrow depression, anemia, decreased platelets

 

      

          

Nursing Implications

 

Assessment

Monitor BP, intake, output and daily weight and assess feet, legs and sacral area daily for edema. Assess the patient for anorexia, n/v, muscle cramps, paresthesia and confusion, especially in those taking digitalis glycosides.

 

Patient/Family Teaching

Tell the patient to take this medication at the same time every day. If the dose is missed, instruct the patient to take the dose as soon as remembered but not just before the next dose is due. Do not double doses. Tell the patient to monitor their weight biweekly and to notify a health care professional if there are any significant changes. Caution the patient to change positions slowly to reduce the risk for orthostatic hypotension. Advise the patient to report muscle weakness, cramps, n/v, diarrhea or dizziness to a health care professional. Instruct patient and family in correct technique for monitoring weekly blood pressure.

 

Davis’s Drug Guide for Nurses Pages 409-411                                        

Pharmacology: A Nursing Process Approach Pages 627-632

 

 

 

Group 4: Toni, Laura, Victoria, Aliya


Furosemide

(Lasix)

Toni, Laura, Alyia, Victoria

Therapeutic: Diuretic

Pharmacologic: Loop Diuretic

 

Indications:

Edema associated with CHF, hypertension, hepatic or renal disease and acute pulmonary edema.

 

Action:

 Lasix is a loop diuretic, which inhibits the absorption of Na+ and Cl- not only in the proximal and distal tubules but also in the loop of Henle, by this action it increases the excretion of Na+ and H20 and controls blood pressure and fluid retention.

 

Therapeutic effects:

Decreased edema, increased urinary output, Decrease in BP.

 

Adverse reactions:

·        Dehydration

·        Hypochloremia

·        Hypokalemia

·        Hypomagnesemia

·        Hyponatremia

·        Hypovolemia

·        Metabolic alkalosis

 

Contraindications:

Hypersensitivity, cross sensitivity with thiazides and sulfonamides may occur. Hepatic coma or anuria. Avoid in patients with alcohol intolerance.

 

Assessment:

Assess pt. fluid status during therapy. Monitor daily weights, Intake and Output ratios, amount and location of edema, lung sounds, Monitor BP and pulse.

 

Patient Teaching:

Patient may experience symptoms from excessive fluid and/or electrolyte losses. The postural hypotension that sometimes occurs can usually be managed by getting up slowly. Potassium supplements and/or dietary measures may be needed to control or avoid hypokalemia. Patients with DM should be told that Lasix might increase BS levels and thereby affect urine glucose tests that they need monitor BS. To use sunscreen and protective clothing because the skin of some patients may be more sensitive to the effects of sunlight while taking Furosemide.

 

Davis Drug guide pages: 558-560



Study Guide

 

triamterene (Dyrenium)

 

Drug Category: Potassium-sparing diuretic

 

Anticipated action: Used to treat edema by causing the kidneys (distal renal tubules) to eliminate sodium and water from the body while retaining potassium.

 

Standard dosing range:

·        PO (Adults): 100 mg BID (not to exceed 300mg/day)

·        PO (Children): 2-4mg/kg/day in divided doses (do not exceed 6mg/kg/day or 300mg/day)

 

Assessments should include:

·        Monitoring of intake and output

·        Daily weight

·        Assess for signs of hyperkalemia (weakness, fatigue, arrhythmias, polyuria, polydipsia)

·        Labs should include serum potassium levels before and throughout therapy

 

Most common side effects:

·        Headache

·        Dizziness

·        Rash

·        Photosensitivity

·        Diarrhea

·        Anorexia

·        Nausea/vomiting

·        Weakness

 

Adverse effects:

·        Bradycardia and arrhythmias

·        Jaundice

·        Bone marrow depression

·        Thrombocytopenia (decrease in blood platelets)

·        Megaloblastic anemia (many large and dysfunctional RBCs in bone marrow)

 

Contraindications:

·        Severe kidney or hepatic disease

·        Severe hyperkalemia

Use caution with:

·        Renal or hepatic dysfunction

·        Diabetes mellitus

 

Educate patient and family:

·        Avoid salt substitutes and foods containing potassium

·        Inform patient that this medication may cause bluish-colored urine

·        To prevent photosensitivity reactions instruct patient to use sunscreen (>15 SPF) and to wear protective clothing

·        Contact healthcare professional if muscle weakness, cramps, fatigue, or severe nausea, vomiting, or diarrhea occurs (may be sign of hyperkalemia)

·        Emphasize importance of follow up appointments to monitor progress

·        Contact your healthcare professional if you experience confusion, convulsions, difficulty concentrating, irritability, muscle cramps, and unusual tiredness or weakness (may be sign of excessive sodium loss)


Aliya, Laura, Toni, Victoria

Davis's drug guide pgs 406-408 / Pharmacology pg 638t / www.drugs.com  (triamterene)

 

Youtube video with information concerning Triamterene: http://www.youtube.com/watch?v=ob7SioZVUUU

YouTube Video

Another youtube video; this one goes over diuretics and how they effect the kidney:    http://www.youtube.com/watch?v=6Wc4f2KnbYo


Questions:

 

1)     Which of the following side effects of Hydrochlorothiazide is a life-threatening effect?

a)     Dizziness

b)     Vomiting

c)     Hyperglycemia

d)     Marked Hypotension

 

2)     Which of the following is NOT a therapeutic effect/use of Hydrochlorothiazide?

a)     Increase urine output

b)     Control angina

c)     Treat hypertension

d)     Treat edema from CHF, hepatic cirrhosis and renal dysfunction

 

3)     The nurse prepares to administer which diuretic to treat a client suffering from acute pulmonary edema:

a)     spironolactone (Aldactone)

b)     amiloride (Midamor)

c)     triamterene (Dyrenium)

d)     furosemide (Lasix)

 

4)     When assessing a client for side affects of triamterene (Dyrenium) the nurse would specifically monitor for signs of:

a)     hypokalemia

b)     hypoglycemia

c)     hyperkalemia

d)     hypernatremia

 

 

 

 

 

 

 

Answers: (1) D (2) B (3) D (4) C 

 

 


 

 



 

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