| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|
| Acetazolamide (Diamox)—PO 250–1,000 mg/day; IV 500 mg | Glaucoma; heart failure; convulsive disorders | Weak diuretic; produces acidosis; self-limiting effect; increases bicarbonate excretion | Electrolyte depletion symptomatology—lassitude, apathy, decreased urinary output, mental confusion |
| NURSING IMPLICATIONS: Weigh daily, I&O assess edema; give early in day to allow sleep at night; observe for side effects; replace electrolytes as ordered |
| Ethacrynic acid (Edecrin)—PO 50–200 mg daily in divided doses | Pulmonary edema; ascites; edema of heart failure | Inhibits the reabsorption of Na+ in the ascending loop of Henle | Nausea, vomiting, diarrhea; hypokalemia; hypotension; gout; dehydration; deafness; metabolic acidosis |
| NURSING IMPLICATIONS: Assess for dehydration—skin turgor, neck veins; hypotension; KCl supplement |
| Furosemide (Lasix)—PO 40–80 mg daily in divided doses | Edema and associated heart failure; cirrhosis; renal disease; nephrotic syndrome: hypertension | Inhibits Na+ and Cl– reabsorption in the loop of Henle | Dermatitis, pruritus; paresthesia; blurring of vision; postural hypotension; nausea, vomiting, diarrhea, dehydration, electrolyte depletion; hearing loss (usually reversible) |
| NURSING IMPLICATIONS: Assess for weakness, lethargy, leg cramps, anorexia; peak action in 1–2 hr; duration 6–8 hr; do not give at bedtime; supplemental KCl indicated; may induce digitalis toxicity |
| Hydrochlorothiazide (HydroDIURIL, Esidrix, Microzide)—PO 25–100 mg 3 times daily Chlorothiazide (Diuril)—PO 500–1,000 mg daily oral suspension | Edema; heart failure; Na+ retention in steroid therapy; hypertension | Inhibits NaCl and water reabsorption in the distal ascending loop and the distal convoluted tubule of the kidneys | Hypokalemia, nausea, vomiting, diarrhea; dizziness; paresthesias; may exacerbate diabetes |
| NURSING IMPLICATIONS: Watch for muscle weakness; give well-diluted potassium chloride supplement; monitor urine for changes in sugar and acetone |
| Mannitol (Osmitrol)—IV 50–100 mg/24 hr as 15%–20% solution | Cerebral edema, oliguria, acute renal failure, drug intoxication | Hypertonic solution that kidney tubules cannot reabsorb, thereby causing obligatory water loss | Diarrhea; water intoxication, thirst, headache |
| NURSING IMPLICATIONS: Usually Foley catheter required; monitor cardiac and respiratory status; a rate of infusion to elicit 30–50 mL urine/hr |
| Sevelamer hydrochloride (Renagel)—PO 2 capsules or tablets 3 times daily | Reduction of serum phosphorus level | Polymer binds intestinal phosphate | Headache; infection; pain; diarrhea, constipation; cough |
| NURSING IMPLICATIONS: Important to take multivitamin supplement approved by physician. Do not take after printed expiration date |
| Spironolactone (Aldactone)—PO 25 mg 2–4 times daily | Cirrhosis of liver; when other diuretics are ineffective | Inhibits effects of aldosterone in distal tubules of kidney | Headache; lethargy; diarrhea; ataxia; skin rash; gynecomastia |
| NURSING IMPLICATIONS: Potassium-sparing drug; do not give supplemental KCl; monitor for signs of electrolyte imbalance |