Thiazide Diuretics (Nursing)

00:00 So let's get started with the thiazides. Now you see the loop diuretics, we look about 25% of the sodium and electrolytes are loss there but with the thiazide diuretics it's just 5%. So, these 2 are kind of close and they have some things and adverse effects in common but the loop diuretic is going to be much stronger than a thiazide diuretic. Now you're thinking but "Why is she saying that over and over again?" Because it's a really important nursing concept. If we have somebody who comes in with just a little bit of high blood pressure, a thiazide diuretic might be one of the first drugs that we try. We likely will not go for a loop diuretic with somebody who has just a little bit of elevated blood pressure. We're going to start with something a little kinder and gentler like a thiazide diuretic. If I have a patient who's super sick and way volume overload and they're all swollen up and their kidneys aren't working really well, we're going to go for something like a loop diuretic over a thiazide diuretic. So, write yourself some notes just to remind yourself which one is the strongest, then the next strongest, and the least strongest of these 3; the loop, the thiazide, and the potassium-sparing. So we have that concept kind of solid in your brain before we keep moving on. Okay, the thiazide diuretics are similar to what? Okay, good slide reading. They're similar to the loop diuretics. Right. Now, the thiazides will also increase the renal excretion, meaning get rid of sodium, chloride, potassium, and water because that's really what we're looking for. Right? We want to get rid of the water but it'll also elevate the levels of glucose and uric acid just like loop diuretics. So thiazides act similarly to loop diuretics and they have some of the same side effects. We get rid of the electrolytes so we're going to watch our patient closely for low levels of that and they elevate blood sugar and uric acid. Now, why is that a problem? Well if a patient is diabetic, an elevated blood sugar might be a problem so we're going to want to watch that closely like we do with all our diabetics. If the diabetic client notices their blood sugar is harder to control, they need to contact their healthcare provider. Now, what's the problem with uric acid? Well, that can lead to gout and if you've ever seen gout it's excruciating pain because uric acid will build up in the joints and it causes your patients a lot of pain. So if they are prone to gout, we want to be aware of that, ask them about it in their history and if they start to have any joint pain they need to notify their healthcare provider so we can follow up with some treatment for that. Now let's look at some of the differences. We look at the similarities, they get rid of water and electrolytes, they elevate glucose and uric acid. Now let's look at the differences. Loop diuretics work great for patients who are in renal failure. Well, they don't work great but they're the best choice for somebody when they are in renal failure. We would not use a thiazide diuretic if a patient has low renal blood flow or their kidneys aren't working well. Okay, that's important. So if you see a test question or ____ they might say if a patient who comes in in severe congestive heart failure with kidneys that are failing, which is the most likely diuretic a physician or a healthcare provider would order? It would not be a thiazide. Right? It would be a loop diuretic. So keep that in mind. In fact, you have to have furosemide onboard. It's just an example of one of the loop diuretics that we would use for anybody whose kidneys are really struggling. Now there are some other loop diuretics but furosemide is just a good one to remember.