Drugs Affecting The Renal System I. Diuretics II. Parenteral Fluids (Video) III. Electrolytes (Video)

Drugs affecting
the Renal System
I. Diuretics
II. Parenteral Fluids (video)
III. Electrolytes (video)

Diuretic Agents
 Drugs that work on the nephrons in

the kidney
 Accelerate the rate of urine
formation.
 Result: removal of sodium and water
Sodium
 Where sodium goes,

water follows.
 If it is not absorbed,
it is excreted with
the urine.
Osmosis
 is the
spontaneous net
movement of
solvent molecules
through a
selectively
permeable
membrane into a
region of higher
solute
concentration.
Diuretic Agents
 Loop diuretics
 Thiazide and thiazide-like diuretics
 Carbonic anhydrase inhibitors
 Osmotic diuretics
 Potassium-sparing diuretics
Loop Diuretics
• bumetanide (Bumex)
• furosemide (Lasix)
Loop Diuretics:
Mechanism of
Action
• Blocks transporter in the thick

ascending limb (~25% Na)
• Result: water, sodium, potassium,

calcium, magnesium and chloride
are excreted
Loop Diuretics: Drug
Effects
• Decreased fluid volume causes:
– Reduced BP
– Reduced pulmonary vascular resistance
– Reduced systemic vascular resistance (arteries)
– Reduced central venous pressure (venae
cavae)
• Potassium depletion
Loop Diuretics:
Therapeutic Uses
• Edema associated with CHF or hepatic

or renal disease
• Control of hypertension
Loop Diuretics: Side
Effects
Body System Effect
CNS Dizziness, headache,
tinnitus, blurred vision
GI Nausea, vomiting,
diarrhea
Loop Diuretics: Side
Effects
Body System Effect
Hematologic Agranulocytosis,
thrombocytopenia
Hypokalemia,
Metabolic hyperglycemia,
hyperuricemia
Thiazide and Thiazide-Like
Diuretics: Mechanism of Action
• Action primarily in the ascending loop of Henle and
early distal tubule (~5% Na). Inhibit Na and Cl
transporter.
• Result: water, Na, and Cl are excreted; Ca and Mg

are absorbed
• Potassium is also excreted to a lesser extent
• A thiazide-like diuretic has similar physiological

properties to a thiazide diuretic, but does not
have the chemical properties of a thiazide.
Diuretics
• hydrochlorothiazide (Esidrix, HydroDIURIL)
• chlorothiazide (Diuril)
• trichlormethiazide (Metahydrin)
Thiazide-like
• chlorthalidone (Hygroton)
• metolazone (Mykrox, Zaroxolyn)
Diuretics: Drug Effects
• Lowered peripheral vascular resistance

Diuretics:
Therapeutic Uses
• Hypertension
(one of the most prescribed group of agents for this)
• Edematous states
• Idiopathic hypercalciuria
• Diabetes insipidus
• Adjunct agents in treatment of CHF, hepatic cirrhosis

Diuretics: Side Effects
Body System Effect

CNS  Dizziness, headache,
blurred vision,
paresthesias,
decreased libido
GI
 Anorexia, nausea,
vomiting, diarrhea
Body System Effect
GU Impotence
Integumentary Urticaria, photosensitivity
Metabolic Hypokalemia, glycosuria,
hyperglycemia
Carbonic Anhydrase
Inhibitors:
Mechanism of Action
Reduces formation of hydrogen and
bicarbonate ions from carbon dioxide and
water by inhibiting, in proximal renal tubule,
the enzyme carbonic anhydrase
Result: water, sodium, potassium, and

bicarbonate are excreted
Carbonic Anhydrase
Inhibitors (CAIs)
 acetazolamide (Diamox)
 methazolamide
 dichlorphenamide
Carbonic Anhydrase
Inhibitors:
Therapeutic Uses
 Acetazolamide is used in the management
of edema secondary to CHF when other
diuretics are not effective.
 CAIs are less potent diuretics than loop
diuretics or thiazides
CAI Side Effects:
 Metabolic acidosis
 Drowsiness
 Anorexia
 Paresthesias
 Hematuria
 Urticaria
 Photosensitivity
 Melena
Osmotic Diuretics
• Mannitol (Resectisol, Osmitrol)

• Urea
• Glycerine
• Isosorbide
Osmotic Diuretics:
Mechanism of Action
• Work in the proximal tubule, loop of Henle

• Nonabsorbable, producing an osmotic effect
• Pull water into the blood vessels and
nephrons from the surrounding tissues
Osmotic Diuretics: Drug
Effects
• Reduced cellular edema
• Increased urine production, causing diuresis
• Rapid excretion of water, sodium, and other
electrolytes, as well as excretion of toxic
substances from the kidney
• Reduces excessive intraocular pressure
Osmotic
Diuretics:
Therapeutic
Uses
• Used in the treatment of patients in the early,
oliguric phase of acute renal failure
• To promote the excretion of toxic substances
• Reduction of intracranial pressure
• Treatment of cerebral edema
Osmotic Diuretics: Side
Effects
• Convulsions
• Thrombophlebitis
• Pulmonary congestion
Also headaches, chest pains, tachycardia,

blurred vision, chills, and fever
Potassium-Losing
 Carbonic Anhydrase Inhibitors (CAI)
 Loop Diuretics
 Osmotic Diuretics
 Thiazide Diuretics
4. Potassium-Sparing
Diuretics
• amiloride (Midamor)
• triamterene (Dyrenium)
• spironolactone (Aldactone)
Potassium-Sparing
Diuretics: Mechanism of
Action
• Work in collecting ducts and late
distal convoluted tubules
• Interfere with sodium-potassium exchange
• Block the resorption of sodium, chloride
and water
Potassium-Sparing
Diuretics: Drug Effects
• Prevent potassium from being pumped into
the tubule, thus preventing its secretion
• Competitively block the aldosterone

receptors and inhibit its action
• The excretion of sodium and water

is promoted
Potassium-Sparing
Diuretics: Therapeutic Uses
spironolactone and triamterene
• Hyperaldosteronism
• Hypertension
• Reversing the potassium loss caused by
• potassium-losing drugs
amiloride
• Treatment of CHF
Potassium-Sparing
Body System Effect
CNS Dizziness, headache
GI Cramps, nausea,
vomiting, diarrhea
Other Urinary frequency,

weakness
**hyperkalemia
Potassium-Sparing
spironolactone
• gynecomastia, amenorrhea, irregular menses
Diuretic Agents:
Nursing
Implications
• Perform a thorough patient history and physical
examination.
• Assess baseline fluid volume status, intake and

output, serum electrolyte values, weight, and vital
signs.
• Assess for disorders that may contraindicate the use

of, or necessitate cautious use of, these agents.
Diuretic Agents:
Nursing
Implications
• Instruct patients to take in the morning as much as
possible to avoid interference with sleep patterns.
• Monitor serum potassium levels during therapy.
• Potassium supplements are usually not

recommended when potassium levels exceed
3.0 mEq/L.
Diuretic Agents:
Nursing
Implications
• Teach patients to maintain proper nutritional and
fluid volume status.
• Teach patients to eat more potassium-rich foods

when taking any but the potassium-sparing agents.
• Foods high in potassium include bananas, oranges,

dates, raisins, plums, fresh vegetables, potatoes,
meat, and fish.
Diuretic Agents:
Nursing
Implications
• Patients taking diuretics along with a digitalis
preparation should be taught to monitor for
digitalis toxicity.
• Diabetic patients who are taking thiazide and/or

loop diuretics should be told to monitor blood
glucose and watch for elevated levels.
Diuretic Agents:
Nursing
Implications
• Teach patients to change positions slowly, and to
rise slowly after sitting or lying to prevent dizziness
and possible fainting related to orthostatic
hypotension.
• Encourage patients to keep a log of their

daily weight.
• Encourage patients to return for follow-up visits

and lab work.
Diuretic Agents: Nursing
Implications
• Patients who have been ill with nausea, vomiting,

and/or diarrhea should notify their physician as fluid
loss may be dangerous.
• Signs and symptoms of hypokalemia include muscle

weakness, constipation, irregular pulse rate, and
overall feeling of lethargy.
Diuretic Agents: Nursing
Implications
• Instruct patients to notify the physician immediately
if they experience rapid heart rates or syncope
(reflects hypotension or fluid loss).
• A weight gain of 2 or more pounds a day

or 5 or more pounds a week should be
reported immediately.
Diuretic Agents:
Nursing
Implications
Monitor for adverse effects:
• metabolic alkalosis, drowsiness, lethargy,
hypokalemia, tachycardia, hypotension, leg
cramps, restlessness, decreased mental alertness
Diuretic Agents:
Nursing
Implications
• Monitor for therapeutic effects:
– Reduction in edema, fluid volume overload, CHF
– Reduction of hypertension
– Return to normal intraocular pressures
Parenteral Fluids
 Video
Electrolytes
 Video

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Drugs affecting

the Renal System

II. Parenteral Fluids (video)

III. Electrolytes (video)

 Drugs that work on the nephrons in

 Where sodium goes,

• Blocks transporter in the thick

• Result: water, sodium, potassium,

• Edema associated with CHF or hepatic

• Result: water, Na, and Cl are excreted; Ca and Mg

• Potassium is also excreted to a lesser extent

• A thiazide-like diuretic has similar physiological

• Lowered peripheral vascular resistance

• Adjunct agents in treatment of CHF, hepatic cirrhosis

Body System Effect

Result: water, sodium, potassium, and

• Mannitol (Resectisol, Osmitrol)

• Work in the proximal tubule, loop of Henle

Also headaches, chest pains, tachycardia,

 Carbonic Anhydrase Inhibitors (CAI)

• Competitively block the aldosterone

• The excretion of sodium and water

CNS Dizziness, headache

Other Urinary frequency,

• Assess baseline fluid volume status, intake and

• Assess for disorders that may contraindicate the use

• Monitor serum potassium levels during therapy.

• Potassium supplements are usually not

• Teach patients to eat more potassium-rich foods

• Foods high in potassium include bananas, oranges,

• Diabetic patients who are taking thiazide and/or

• Encourage patients to keep a log of their

• Encourage patients to return for follow-up visits

• Patients who have been ill with nausea, vomiting,

• Signs and symptoms of hypokalemia include muscle

• A weight gain of 2 or more pounds a day

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