Thiazide Diuretics
Prototype thiazide diuretic
Hydrochlorothiazide (HCTZ)
Prototype potassium sparing diuretic
Spironolactone
Which loop diuretic is the prototype?
Furosemide
Best time to administer daily loop diuretic?
Early in the day
Teaching for spironolactone diet
Avoid high potassium foods
Primary use of thiazides
Stage 1 Hypertension
Why are potassium sparing diuretics commonly added?
High risk for hypokalemia
Why are loop diuretics called "high-ceiling"?
They produce large diuresis even at high doses
Priority assessment after IV furosemide?
Blood pressure
Priority nursing action with muscle weakness on diuretics
Check potassium levels
Why are thiazides ineffective at GFR <30 mL/min?
Require adequate urine flow
Why must ACE inhibitors be used cautiously with spironolactone?
Risk of hyperkalemia
Which condition makes loops preferred over thiazides?
Impaired kidney function
Key teaching to prevent fluid rebound?
Do not restrict fluids excessively
Why combine loops with potassium sparing diuretics?
Reduce potassium loss
Which electrolyte increases with thiazides?
Calcium
Why is spironolactone useful in heart failure?
Blocks aldosterone mediated remodeling
Which serious adverse effect is associated with rapid IV push?
Ototoxicity
Why are older adults at higher risk with loops?
Increased dehydration and kidney sensitivity
Which patient should avoid thiazides?
Severe renal disease
Why do thiazides raise blood glucose?
Hypokalemia impairs insulin release
Why must aldosterone be present for spironolactone to work?
It competitively blocks aldosterone receptors
Why does hypokalemia increase digoxin toxicity risk?
Low potassium increases digoxin binding
Which symptom requires immediate provider notification?
Palpitations
Best indicator spironolactone is working in HF
Stable potassium with improved edema