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Diuretics and GI Drugs
Diuretics, Anti-Diarrheal, and Laxatives
68
Pharmacology
03/18/2010

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Term
Example of a loop diuretic.
Definition
Furosemide
-Lasix-
Term
Indication for loop diuretic.
Definition
Pulmonary edema associated with CHF; HTN or edema of hepatic, cardiac or renal origin- not responsive to other diuretics; Renal impairment b/c GFR is irrelevant to drug's ability to work.
Term
Mechanism of action for loop diuretics.
Definition
Acts in the loop of henle to block reabsorbtion of Na and Cl, preventing reabsorption of water.
Most effective diuretic available.
Term
Contraindications for using loop diuretics.
Definition
Anuria (kidney can't make urine)

Caution in pts w/CV disease, renal impairment, DM, hx of gout, pts who are pregnant or taking digoxin, lithium, ototoxic drugs, NSAIDs, or antihypertensives.

Term
Serious Adverse Effects of loop diuretics.
Definition
Electrolyte imbalance- hypokalemia and hyponatremia/ hypochloremia (leading to dehydration); hypotension (due to less volume and relaxation of venuoles), Ototoxicity (hearing impairment)
Term
Common Adverse Effects for loop diuretics.
Definition
Dry mouth, thirst, oliguria (lack of urine output)
Term
Preadministration assessment for loop diuretics.
Definition
What does fluid balance look like? I/O, daily weights, edema, s/s of dehydration and electrolyte imbalance. Baselines for wt, BP, HR, Resp, electrolytes, and lung sounds.
Term
Monitoring for loop diuretics.
Definition
Labs for Na, K, and Cl; renal function, drug levels, glucose readings, BP, and pulse. Is the drug working, weights, fluid output > fluid input, side effects? 
Term
Patient education for loop diuretics.
Definition
Eat foods high in potassium (bananas, OJ); or take supplements; make sure to drink enough water (8-10 glasses) and dose early in the day to minimize nocturia. Teach pt to monitor BP, s/s of postural hypotension, hypokalemia, ototoxicity, gouty attack- notify PCP of any problems. Diabetic pts should be careful w/ monitoring of their sugars. Bi-weekly wts, don't X2 dose, use sunscreen. 
Term
Mechanism of action for Thiazide diuretics.
Definition
Acts in distal convoluted tubule to block reabsorption of Na and Cl, preventing reabsorption of water. Ability depends on adequate kidney function.
Term
Example of Thiazide Diuretic.
Definition
Hydrochlorothiazide (HCTZ)
Term
Indications for Thiazide Diuretics.
Definition
HTN; Edema associated w/mild to moderate heart failure or hepatic/renal failure.
Term
Contraindications for Thiazide Diuretics.
Definition
Renal impairment, Anuria (kidney can't make urine), allergy to sulfonamides.
Caution w/pts that have CV disease, renal impairment, DM, hx of gout, pts taking digoxin, lithium, or antihypertensives, and generally avoid pts who are pregnant.
Term
Serious Adverse Effects for Thiazide Diuretics.
Definition
Electrolyte imbalance- hypokalemia and hyponatremia/ hypochloremia (resulting in dehydration); effects on fetal growth during pregnancy.
Term
Preadministration assessment for Thiazide Diuretics.
Definition
What does fluid balance look like? I/O, edema, daily wts, s/s of dehydration and electrolyte imbalance. Baselines for wt, BP, HR, Resp, and electrolyte values (K, Na, Cl).
Term
Monitoring for Thiazide Diuretics.
Definition
Labs for Na, K, and Cl; renal function, drug levels, glucose readings, BP, and pulse. Is the drug working, weights, fluid output > fluid input, side effects? Can increase cholesterol leves, so should check lipid profile.
Term
Patient education for Thiazide Diuretics.
Definition
Eat foods high in potassium (bananas, OJ); or take supplements; make sure to drink enough water (8-10 glasses) and dose early in the day to minimize nocturia. Teach pt to monitor BP, s/s of postural hypotension, hypokalemia, ototoxicity, gouty attack- notify PCP of any problems. Diabetic pts should be careful w/ monitoring of their sugars. Bi-weekly wts, don't X2 dose, use sunscreen. 
Term
Example of Potassium-sparing diuretics.
Definition
Spironolactone.
Term
Mechanism of action for potassium-sparing diuretics.
Definition
Blocks action of aldosterone in distal nephron (increases urine production, decreases K excreation, and increases Na excreation)
Term
Indications for potassium-sparing diuretics.
Definition
HTN, edema; Heart failure- reduces mortality and hospital admission due to protective effects.
Term
Contraindications for potassium-sparing diuretics.
Definition
Anuria (kidney can't make urine); Hyperkalemia and pts taking K suplements; acute renal insufficiency/ significant renal excretory function impairment.
Caution in pts taking ACE inhibitors, angiotensin receptor blockers, and direct rennin inhibitors.
Term
Serious adverse effects for potassium-sparing diuretics.
Definition
Electrolyte imbalance- hyperkalemia (causing dysrhythmias), endocrine effects
Term
Preadministration assessment for potassium-sparing diuretics.
Definition
What does fluid balance look like? I/O, edema, daily wts, s/s of dehydration and electrolyte imbalance. Baselines for wt, BP, HR, Resp, and electrolyte values (K, Na, Cl).
Term
Monitoring for potassium-sparing diuretics.
Definition
Labs for Na, K, and Cl; renal function, drug levels, glucose readings, BP, and pulse. Is the drug working, weights, fluid output > fluid input, side effects? 
Term
Patient education for potassium-sparing diuretics.
Definition
Need to watch K intake; make sure to drink enough water (8-10 glasses); take w/meals if it causes GI upset. May cause menstrual irregularities/ impotence due to endocrine effects. Bi-weekly weights, don't 2X dose, use sunscreen.
Often used in combo w/a thiazide or loop diuretic b/c counteracts K loss.
Term
Examples of Osmotic Diuretics.
Definition
Mannitol
Term
Mechanism of action for osmotic diuretics.
Definition
Increased osmotic force w/in lumen of nephron inhibiting passive reabsorbtion of water; mannitol can't be reabsorbed, takes water w/it
Term
Indications for osmotic diuretics.
Definition
Increased intracranial pressure; increased intraoccular pressure; and to prevent renal failure
Term
Contraindications for osmotic diuretics.
Definition
Anuria (kidney can't make urine); severe dehydration; heart failure; pulmonary edema/congestion; intracranial bleeding; renal damage
Term
Serious adverse effects for osmotic diuretics.
Definition
Edema, CHF, hypotension, renal failure.
Term
Common adverse effects for osmotic diuretics.
Definition
Headache, N/V, fluid and electrolyte imbalance.
Term
Preadministration assessment for osmotic diuretics.
Definition
What does fluid balance look like? I/O, edema, daily wts, s/s of dehydration and electrolyte imbalance. Baselines for wt, BP, HR, Resp, and electrolyte values (K, Na, Cl).
Term
Monitoring for osmotic diuretic.
Definition
Labs for Na, K, and Cl; renal function, drug levels, and glucose levels. Is the drug working, weights, fluid output > fluid input, side effects?
Term
Patient education for osmotic diuretics.
Definition
Make sure to drink enough water (8-10 glasses). Bi-weekly weights; don't X2 dose; be careful getting up (postural hypotension); use sunscreen.
Term
Example of an Anti-diarrheal.
Definition
Diphenoxylate HCl w/ Atropine.
Term
Mechanism of action for anti-diarrheal.
Definition
Acts on smooth muscle of intestine to slow motility and prolong transit time, allowing for the reabsorption of fluid.
Term
Indications for anti-diarrheal.
Definition
Treatment of diarrhea.
Term
Contraindications for antidiarrheal.
Definition
Diarrhea associated w/organisms that penetrate intestinal mucosa; pseudo-membranous enterocolitis.
Term
Serious adverse effects for anti-diarrheal.
Definition
Atropine overdose and toxic megacolon.
Term
Common adverse effects for anti-diarrheal.
Definition
drowsiness, dizziness, and dry mouth.
Term
Monitoring for anti-diarrheal.
Definition
Decrease the dose when diarrhea diminishes; monitor for signs of atropine overdose and toxic megacolon.
Term
Patient education for anti-diarrheals.
Definition
Do not exceed prescribed dose.
Term
Examples of bulk forming laxatives.
Definition
Methylcellulose
Like fiber mixes
Term
Mecahnism of action for bulk forming laxatives.
Definition
Nondigestible; absorbs water and swells to soften and increase fecal mass (like dietary fiber); fecal mass swelling promotes peristalsis; works in smooth intestines and colon
Term
Contraindications for bulk forming laxatives.
Definition
Acute abdominal pain, nausea, cramps (symptoms of possible fecal impaction, bowel obstruction, appendicitis, regional enteritis, diverticulitis, or ulcerative colitis).
Term
Serious adverse effects for bulk forming laxatives.
Definition
Esophageal obstruction (if not given with sufficient fluid); intestinal obstruction or impaction; avoid if intestinal lumen is narrowed.
Term
Common adverse effects for bulk forming laxatives.
Definition
Overactive GI activity (too watery of a stool).
Term
Patient education for bulk forming laxatives.
Definition
Educate on good bowel habits (consistant timing, etc), importance of exercise, fluids, and fiber in the diet. Also that laxatives should only be used when absolutely necessary, at lowest dose possible, for as brief as possible. Short term use only! Works in 1-3 days.
Term
Example of a Surfactant laxative.
Definition
Docusate sodium.
Term
Mechanism of action for surfactant laxative.
Definition
Alters BM consistancy by allowing fluid to penetrate fecal material; also causes secretion of electrolytes and water into intestine; works in smooth intestine and colon.
Term
Indications for surfactant laxative.
Definition
Often used to soften stool in conditions where passing hard stool and straining would be contraindicated.
Term
Contraindications for surfactant laxatives.
Definition
Acute abdominal pain- possible fecal impaction, bowel obstruction.
Term
Common adverse effects of surfactant laxatives.
Definition
GI (nausea, cramping), overactive GI activity (watery stool)
Term
Patient education for surfactant laxatives.
Definition
Educate on good bowel habits (consistant timing, etc), importance of exercise, fluids, and fiber in the diet. Also that laxatives should only be used when absolutely necessary, at lowest dose possible, for as brief as possible. Short term use only! Requires several days to work.
Term
Examples of stimulant laxatives.
Definition
Bisacodyl
Like Exlax
Term
Mechanism of action for stimulant laxatives.
Definition
Stimulates peristalsis and softens feces by increasing amount of electrolytes and water in intestinal lumen; works in smooth intestine OR colon (depending on drug used)
Term
Indications for stimulant laxatives.
Definition
Opiod induced constipation; constipation resulting from slow intestinal transit; Oral: 6-12 hrs, Rectal: 15-60 mins
Term
Contraindications for stimulant laxatives.
Definition
Acute abdominal pain- possible fecal impaction, bowel obstruction
Term
Serious adverse effects for stimulant laxatives.
Definition
Atony of colon- the colon does not want to work w/out it
Term
Common adverse effects for stimulant laxatives.
Definition
Abdominal discomfort (widely abused); overactive GI tract (stool too watery)
Term
Patient education for stimulant laxatives.
Definition
Educate on good bowel habits (consistant timing, etc), importance of exercise, fluids, and fiber in the diet. Also that laxatives should only be used when absolutely necessary, at lowest dose possible, for as brief as possible. Short term use only, do not abuse! Don't take bisacodyl w/in 1hr of ingesting milk or antacids. Senna can cause urine to turn yellowish-brown or pink. Castor oil acts rapidly (don't administer at bedtime) and is very powerful, so not for routine constipation.
Term
Example of osmotic laxative.
Definition
Magnesium hydroxide
Like milk of magnesia.
Term
Mechanism of action for osmotic laxatives.
Definition
Draw water into the intestinal lumen by osmotic pressure; fecal swelling increases peristalsis; works in smooth intestine and colon.
Term
Indications for osmotic laxative.
Definition
Low dose is for relief of constipation (works in 6-12 hrs). High dose is for an evacuation of the bowels (happens in 2-3 hrs).
Term
Contraindications for osmotic laxatives.
Definition
Acute abdominal pain- possible fecal impaction, bowel obstruction.
Mg salts- pts w/renal dysfunction
Na salts- pts w/heart failure, HTN, edema, and caution w/kidney disease
Term
Serious adverse effects for osmotic laxatives.
Definition
Dehydration w/all of them.
Mg salts: toxic mg levels w/renal failure. Na salts: fluid retention, renal failure in pts w/kidney disease or those taking diuretics, ACE, or ARBs.
Term
Common adverse effects for osmotic laxatives.
Definition
Overactive GI activity (too watery of stools).
Term
Patient education for osmotic laxatives.
Definition
Educate pts on good bowel habits (consistent timing, etc). Importance of exercise, fluids, and fiber in the diet. Also that laxatives should only be used when absolutely necessary, at lowest dose possible, for as brief as possible. Short term use only! Increase fluid intake during treatment.