High Ceiling Loop Diuretics

Prototype: Furosemide (Lasix) Other High-Ceiling Diuretics Ethacrynic acid (Edecrin) Bumetanide (Bumex) Torsemide (Demadex)

Thiazides and Realted Diuretics

Prototype: Hydrochlorothiazide (HCTZ) Other Thiazides and Related Diuretics Chlorothiazide (Diuril) Methyclothiazide (Enduron) Chlorthalidone (Hygroton, Thalitone) Metolazone (Zaroxolyn)

Therapeutic Goal: indicated for people with (1) pulmonary edema associated with congestive heart failure (2) edema of hepatic, cardiac, or renal origin that has been unresponsive to less effective diuretics (3) hypertension that cannot be controlled with thiazide and potassium sparing diuretics (4) all patients who need diuretic therapy but have low renal blood flow. Baseline data: Obtain baseline values for weight, blood pressure (sitting and supine) pulse, respiration, and electrolytes (sodium, potassium, chloride.) For patients with edema record sites and extent of edema. For patients with ascites, measure abdominal girth. For acutely ill patients assess lung sounds. High Risk Patients: Use caution in patients with heart disease, renal impairment, diabetes, history of gout, and in patients who are pregnant or taking digoxin, lithium, ototoxic drugs, NSAIDS, or antihypertensive drugs. Administration: Instruct patients taking meds once a day to take in the morning and those taking BID to take it at 8:00 am and 2:00 pm to reduce effects of nocturia. Report weight loss and oliguria and anuria. Minimizing Adverse Effects: Hyponatremia, Hypochloremia, and Dehydration: Watch for signs of dehydration (dry mouth, unusual thirst, and oliguria) withhold drug if these appear. Dehydration may cause thromboembolism. Watch for symptoms and report immediately (headache, pain in calves, chest, or pelvis.) Hypotension: Monitor BP, withhold medication and notify MD if it drops substantially. Hypokalemia: If serum potassium falls below 3.5 mEq/L fatal dysrhythmias may occur. Can be avoided by comsuming potassium rich foods (nuts, dried fruits, spinach, citrus fruits, potatoes, bananas) taking potassium supplements, or taking potassium sparing diuretics. Teach patients about sign of hypokalemia (irregular heartbeat, muscle weakness, cramping, flaccid paralysis, leg discomfort, extreme thirst, confusion.) Ototoxicity: Inform patients about possible hearing loss and to notify MD immediately if this occurs. Hyperglycemia: May elevate blood glucose in diabetic patients. Hyperuricemia: Inform patients about signs of gout (tenderness or swelling in joints) and to inform MD. Avoid giving with Digoxin (lowers potassium to dangerous levels), Lithium (suppress lithium excretion causing drug to accumulate to possibly toxic levels. Monitor serum Lithium routinely), and other ototoxic drugs (hearing loss risk is increased especially when taking with aminoglycosides).

Therapeutic Goal: Thiazide diuretics are used to treat hypertension and edema. Baseline Data Obtain baseline values for weight, blood pressure (sitting and supine) pulse, respiration, and electrolytes (sodium, potassium, chloride.) For patients with edema record sites and extent of edema. High Risk Patients: Use caution in patients with cardiovascular disease, renal impairment, diabetes, history of gout or in patients taking digoxin, lithium, or antihypertensive drugs. Generally avid in women who are pregnant or breast feeding. Administration: Instruct patients taking meds once a day to take in the morning and those taking BID to take it at 8:00 am and 2:00 pm to reduce effects of nocturia. Report weight loss and oliguria and anuria. Minimizing Adverse Effects: Like high ceiling diuretics, thiazines can cause Hyponatremia, hypochalemia, hypotension, hyperglycemia, and hyperuricemia. Implications for high ceiling diuretics are the same. Thiazines can cause fetal harm and can enter breast milk. Like High ceiling avoid taking with Digoxin and lithium.

Potassium Sparing Diuretics

Prototype: Spironolactone (Aldactone) Other Potassium-Sparing Diuretics Triamterene (Dyrenium) Amiloride (Midamor) Other Aldosterone Blockers Eplerenone (Inspra) Not considered a diuretic Used for heart failure

Therapeutic Goal: Potassium sparing diuretics are given primarily to counterbalance the potassium losing effects of thiazides and high ceiling diuretics. Baseline data: Obtain baseline values of serum potassium, along with Obtain baseline values for weight, blood pressure (sitting and supine) pulse, respiration, and electrolytes (sodium, potassium, chloride.) For patients with edema record sites and extent of edema. Identifying high risk patients: contraindicated in patients with hyperkalemia and for patients taking potassium supplements or another potassium sparing diuretic. Use with caution in patients taking ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors Evaluation: Be sure potassium levels stay between 3.5 to 5 mEq/L. Minimizing adverse effects: Hyperkalemia: If serum potassium exceeds 5 mEq/L or if syptoms occur (abnormal cardiac rhythm) withhold medication and notify MD. Insulin may be given to lower potassium level. Endocrine Effects: Spironolactone may cause menstrual irregularities and impotence. Notify MD if these occur. Drugs that raise Potassium levels: dont combine potassium sparing diuretics with potassium supplements, salt substitutions, or with another potassium-sparing diuretic. Generally avoid combined use with ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors.

Beta Adrenergic antagonists (Beta Blockers) end in lol

Nadolol (Corgard) Sotalol (Betapace) for dysrhythmias Carvedilol (Coreg) blocks beta1, beta2, and alpha1 receptors Labetalol (Trandate) blocks beta1, beta2, and alpha1 receptors Acebutolol (Sectral) Atenolol (Tenormin) Betaxolol (Kerlone) Bisoprolol (Zebeta) Esmolol (Brevibloc) for dysrhythmias Carvedilol (Coreg) for heart failure (blocks beta1, beta2, and alpha1 receptors) Nebivolol (Bystolic) blocks beta receptors (promotes release of nitric acid, a vasodilator) Metoprolol Propanolol
Therapeutic Goal: hypertension, angina pectoris, heart failure, and Cardiac dysrhythmias. Baseline Data: All: Determine Heart Rate; Hypertension: determine supine and standing BP; Angina Pectoris: Determine incidence, severity, and circumstances of angina attacks; Cardiac Dysrhythmias: Obtain a baseline ECG. Use caution with patients with asthma, bronchospasms, diabetes, or severe allergic reactions. Minimizing Adverse Effects: Bradycardia: If heart rate is low withhold medication notify MD, administer atropine and isoproterenol if necessary to restore heart rate. AV Heart Block: Do not give to patients with AV block greater than first degree. Heart Failure: Inform patients about early signs of heart failure (shortness of breath, night coughs, swelling of the extremities) and instruct them to notify MD if these occur. Rebound cardiac excitation: Abrupt withdrawal can cause tachycardia and ventricular dysrhythmias. Warn patients against abrupt discontinuation and advise patient to bring plenty of Rx if travelling. Postural Hypotension: Carvedilol and labetalol can cause postural hypotension. Inform patients about the signs of hypotension (lightheadedness, dizziness) and advise them to sit or lie down if these develop. Advise patients to move slowly when changing from a supine or sitting position to an upright posture. Bronchoconstriction: Can cause substantial airway constriction in patients with asthma. Effects in diabetic patients: Can mask tachycardia as an early sign of hypoglycemia. Watch for other signs of hypoglycemia (sweating, hunger, fatigue, poor concentration) that blood glucose is falling dangerously low. Beta blockers can prevent glycogenolysis (emergency means of increasing blood glucose.) Minimizing adverse interactions: Calcium Channel Blockers: Two CCBs (verapamil and dilitizem) can intensify the cardiosuppresant effects of beta blockers. Insulin: Diabetic patients may need to reduce insulin dosages.

Alpha Adrenergic Antagonists end in sin

Prototype: Prazosin (Minipress) Other Alpha Blockers Terazosin (Hytrin) Doxazosin (Cardura) Tamsulosin (Flomax) for BPH only Alfuzosin (Uroxatral) for BPH only Phentolamine for tissue necrosis

Therapeutic Goal: Doxazosin, Prazosin, Terazosin: Reduction of blod pressure in patients with essential hypertension. Doxazosin, Terazosin, Alfuzosin, Silodosin, Tamsulosin: Reduction of symptoms in patients with BPH (Benign Prostatic Hyperplasia). Baseline Data: Essential Hypertension: determine BP and heart rate. BPH: determine the degree of nocturia, daytime frequency, hesistance, intermittency, terminal dribbling (at the end of voiding), urgency, impairment of size and force of urinary stream, dysuria, and sensation of incomplete voiding. Administration: Instruct patients to take the initial dose at bedtime to minimize the first-dose effect. Except for tamsulosin, which is administered after eating, these drugs may be taken with food. Minimizing adverse effects: Orthostatic Hypotension: Inform patients about the signs of hypotension (lightheadedness, dizziness) and advise them to sit or lie down if these develop. Advise patients to move slowly when changing from a supine or sitting position to an upright posture. First Dose Effect: The first dose may cause fainting from severe orthostatic hypotension. Forewarn patients about this effect and advise them to avoid driving and other hazardous activities for 12 to 24 hours after the initial dose. To minimize risk, advise patients to take the first dose at bedtime.