Thiazide Diuretics Nursing Implications & Drug Study
THIAZIDE DIURETICS
GENERAL DESCRIPTION
Thiazide diuretics appeared as a result to synthesize more potent carbonic anhydrase inhibitors. Like CAI and some loop diuretics, thiazide diuretics also has unsubstituted sulphonamide group which is the main functional group for its diuretic activity. Thiazide diuretics are more effective in patients with normal kidney functions. Its prototype drug is hydrochlorothiazide which is also available in combination with other diuretics like potassium-sparing thiazide. Thiazide diuretics are one of the first-line treatment of hypertension.
EXAMPLES: Chlorothiazide, Hydrochlorothiazide, Metazolone, Bendroflumethiazide, Indapamide, Trichlormethiazide, Chlorthalidone
HYDROCHLOROTHIAZIDE
- GENERIC NAME: Hydrochlorothiazide
- BRAND NAME: Esidrix, HydroDIURIL, Aquazide, Microzide
- Combination of hydrochlorothiazide and other K-sparing diuretics are as follows
- Dyazide, Maxzide (Hydrochlorothiazide + Triamterene)
- Moduretic (Hydrochlorothiazide + Amiloride)
- Aldactazide (Hydrochlorothiazide + Spironolactone)
Hydrochlorothiazide GENERAL DESCRIPTION
Hydrochlorothiazide belongs to the thiazide diuretics. It is the prototype of thiazide group of diuretics. It is commonly used in the treatment of hypertension and edema caused by heart failure, liver or kidney failure. Hydrochlorothiazide is the first-line treatment in hypertension. Hydrochlorothiazide are less expensive of all antihypertensive drugs.
Hydrochlorothiazide MECHANISM OF ACTION
Hydrochlorothiazide inhibits NaCl reabsorption from the luminal side of epithelial cells in distal convoluted tubule (DCT) by blocking the Na+/Cl- transporter. As a result of sodium impairing in DCT natriureis occurs with water loss. While in PCT hydrochlorothiazide induced volume depletion which increases passive reabsorption of Na+ and Ca2+
Low dose of hydrochlorothiazide is the best choice of treatment for the elder patient. Several clinical trial shows that hydrochlorothiazide reduce the risk of stroke in hypertensive patient as compared to beta blockers.
Hydrochlorothiazide PHARMACOKINETICS
Hydrochlorothiazide is administered orally.
Hydrochlorothiazide INDICATIONS
The major indication for thiazides diuretic are
- Hypertension
- Heart failure
- Nephrolithiasis due to idiopathic hypercalciuria
- Nephrogenic diabetes insipidus
- Resistant Edema
CONTRAINDICATIONS
- Hypersensitivity to sulphonamide
- Gout
- Hepatic cirrhosis
- Borderline renal failure
- Heart failure
SIDE EFFECTS & ADVERSE EFFECTS
- Hypokalemic metabolic acidosis
- Hyperuricemia
- Impaired carbohydrate intolerance (diabetic or impaired IGT patient)
- Hyperlipidemia
- Hyponatremia
- Weakness
- Fatigability
- Paresthesia
DRUG INTERACTION
- Propentheline slightly increase the absorption of hydrochlorothiazide.
- Hydrochlorothiazide when given with NSAIDs can increase the blood pressure and may exacerbate CHF & risk of hospitalization
- Colestipol reduce the absorption of hydrochlorothiazide more than one third and Colestyramine reduce the absorption of hydrochlorothiazide by more than two third.
- Hydrochlorothiazide when given with large doses of Ca supplement or Vitamin D, can cause hypercalcemia and possibly metabolic alkalosis because hydrochlorothiazide reduce the excretion of Ca.
- Amiloride and Triamterene may cause hypercalcemia when given with hydrochlorothiazide.
Nursing Considerations and implications for hydrochlorothiazide
- Dose should be given in early timings because of increase urination.
- Obtain complete health history (Electrolyte balance & renal function)
- Obtain vital signs with the baseline values specially Blood pressure
- Find out patient’s medication history including alcohol and nicotine consumption to avoid drug interaction
- Determine possible drug allergies of patient.
- Obtain blood and urine specimen for laboratory analysis
- Observe for any change in consciousness, dizziness, fatigue, postural hypotension
- Monitor for fluid intake by measuring intake, output and daily weight.
- Monitor laboratory values specially potassium and sodium levels, BUN, Serum Uric acid
PATIENT EDUCATION (Nursing implications)
- Do not breast feed while taking the medicine.
- Take medicine with meal to avoid gastric problems.
- Explain the right use of medicine with dosage
- Report any visible s/s of proximal edema, SOB, potential sign of Heart Failure or Pulmonary edema
- Report immediate if feeling dizzy or change in consciousness
- Advise them to change position slowly to avoid postural hypotension
- Monitor BP as specified by the HP
- Mention possible side effects that can cause by the use of diuretics such as dry mouth, increase in urination.
- Ask health care professional before taking any vitamin/minerals or other supplements
- When outdoor, wear dark glasses or light color clothe because some diuretics cause photosensitivity.
CHLORTHALIDONE
- GENERIC NAME: Chlorthalidone
- BRAND NAME: Hygroton, Thalitone, CTD
GENERAL DESCRIPTION
Chlorthalidone belongs to the thiazide diuretics. It is commonly used in the treatment of hypertension and edema caused by heart failure, liver or kidney failure. Chlorthalidone is the first-line treatment in hypertension. Chlorthalidone are less expensive of all antihypertensive drugs. It may be combined with other antihypertensive effect to increase the effectiveness
MECHANISM OF ACTION
Chlorthalidone inhibits NaCl reabsorption from the luminal side of epithelial cells in distal convoluted tubule (DCT) by blocking the Na+/Cl- transporter. As a result of sodium impairing in DCT natriureis occurs with water loss. While in PCT Chlorthalidone induced volume depletion which increases passive reabsorption of Na+ and Ca2+.
Low dose of Chlorthalidone is the best choice of treatment for the elder patient. Several clinical trial shows that chlorthalidone reduce the risk of stroke in hypertensive patient as compared to beta blockers.
PHARMACOKINETICS
Chlorthalidone is given orally. Onset of action is about .5 hours. It slowly absorbed and has a longer duration of action of 72 hours. It has 40-60 hours of half-life. Chlorthalidone is excreted in urine unchanged.
INDICATIONS
The major indication for thiazides diuretic are
- Hypertension
- Heart failure
- Nephrolithiasis due to idiopathic hypercalciuria
- Nephrogenic diabetes insipidus
- Resistant Edema
CONTRAINDICATIONS
- Hypersensitivity to sulphonamide
- Gout
- Hepatic cirrhosis
- Borderline renal failure
- Heart failure
SIDE EFFECTS & ADVERSE EFFECTS
- Hypokalemic metabolic acidosis
- Hyperuricemia
- Impaired carbohydrate intolerance (diabetic or impaired IGT patient)
- Hyperlipidemia
- Hyponatremia
- Weakness
- Fatigability
- Paresthesia
DRUG INTERACTION
- Chlorthalidone when given with NSAIDs can increase the blood pressure and may exacerbate CHF & risk of hospitalization
- Colestipol reduce the absorption of Chlorthalidone more than one third and Colestyramine reduce the absorption of Chlorthalidone by more than two third.
- Chlorthalidone when given with large doses of Ca supplement or Vitamin D, can cause hypercalcemia and possibly metabolic alkalosis because Chlorthalidone reduce the excretion of Ca.
- Amiloride and Triamterene may cause hypercalcemia when given with Chlorthalidone.
NURSING IMPLICATIONS AND CONSIDERATIONS
- Dose should be given in early timings because of increase urination.
- Obtain complete health history (Electrolyte balance & renal function)
- Obtain vital signs with the baseline values specially Blood pressure
- Find out patient’s medication history including alcohol and nicotine consumption to avoid drug interaction
- Determine possible drug allergies of patient.
- Obtain blood and urine specimen for laboratory analysis
- Observe for any change in consciousness, dizziness, fatigue, postural hypotension
- Monitor for fluid intake by measuring intake, output and daily weight.
- Monitor laboratory values specially potassium and sodium levels, BUN, Serum Uric acid.
PATIENT EDUCATION
- Do not breast feed while taking the medicine.
- Explain the right use of medicine with dosage
- Report any visible s/s of proximal edema, SOB, potential sign of Heart Failure or Pulmonary edema
- Report immediate if feeling dizzy or change in consciousness
- Advise them to change position slowly to avoid postural hypotension
- Monitor BP as specified by the HP
- Mention possible side effects that can cause by the use of diuretics such as dry mouth, increase in urination.
- Ask health care professional before taking any vitamin/minerals or other supplements
- When outdoor, wear dark glasses or light color clothe because some diuretics cause photosensitivity.