Oretic
hydrochlorothiazide
(hye-droe-klor-oh-thye-a-zide) hydrochlorothiazide,Microzide
(trade name),Oretic
(trade name),Urozide
(trade name)Classification
Therapeutic: antihypertensivesPharmacologic: thiazide diuretics
Indications
- HF,
- Renal dysfunction,
- Cirrhosis,
- Glucocorticoid therapy,
- Estrogen therapy.
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (diuretic effect)
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
PO† | 2 hr | 3–6 hr | 6–12 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- drowsiness
- lethargy
- weakness
Cardiovascular
- hypotension
Gastrointestinal
- anorexia
- cramping
- hepatitis
- nausea
- vomiting
Dermatologic
- stevens johnson syndrome (life-threatening)
- photosensitivity
- rash
Ear, Eye, Nose, Throat
- acute angle-closure glaucoma
- acute myopia
Endocrinologic
- hyperglycemia
Fluid and Electrolyte
- hypokalemia (most frequent)
- dehydration
- hypercalcemia
- hypochloremic alkalosis
- hypomagnesemia
- hyponatremia
- hypophosphatemia
- hypovolemia
Hematologic
- blood dyscrasias
Metabolic
- hyperuricemia
- hypercholesterolemia
Musculoskeletal
- muscle cramps
Miscellaneous
- pancreatitis
Interactions
Drug-Drug interaction
Additive hypotension with other antihypertensives, acute ingestion of alcohol, or nitrates. .Additive hypokalemia with corticosteroids, amphotericin B, piperacillin, or ticarcillin.↓ the excretion of lithium.Cholestyramine orcolestipol ↓ absorption.Hypokalemia ↑ risk of digoxin toxicity.NSAIDs may ↓ effectiveness. .Route/Dosage
When used as a diuretic in adults, generally given daily, but may be given every other day or 2–3 days/weekAvailability (generic available)
Nursing implications
Nursing assessment
- Monitor BP, intake, output, and daily weight and assess feet, legs, and sacral area for edema daily.
- Assess patient, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Notify health care professional if these signs of electrolyte imbalance occur. Patients taking digitalis glycosides are at risk of digitalis toxicity because of the potassium-depleting effect of the diuretic.
- If hypokalemia occurs, consideration may be given to potassium supplementation or decreasing dose of diuretic.
- Assess patient for allergy to sulfonamides.
- Hypertension: Monitor BP before and periodically throughout therapy.
- Monitor frequency of prescription refills to determine compliance.
- Lab Test Considerations: Monitor electrolytes (especially potassium), blood glucose, BUN, serum creatinine, and uric acid levels before and periodically during therapy.
- May cause ↑ serum and urine glucose in diabetic patients.
- May cause ↑ serum bilirubin, calcium, creatinine, and uric acid, and ↓ serum magnesium, potassium, sodium, and urinary calcium concentrations.
- May cause ↑ serum cholesterol, low-density lipoprotein, and triglyceride concentrations.
Potential Nursing Diagnoses
Excess fluid volume (Indications)Risk for deficient fluid volume (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Implementation
- Administer in the morning to prevent disruption of sleep cycle.
- Intermittent dose schedule may be used for continued control of edema.
- Oral: May give with food or milk to minimize GI irritation. Tablets may be crushed and mixed with fluid to facilitate swallowing.
Patient/Family Teaching
- Instruct patient to take this medication at the same time each day. Take missed doses as soon as remembered but not just before next dose is due. Do not double doses.
- Instruct patient to monitor weight biweekly and notify health care professional of significant changes.
- Caution patient to change positions slowly to minimize orthostatic hypotension. This may be potentiated by alcohol.
- Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
- Instruct patient to discuss dietary potassium requirements with health care professional (see ).
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Advise patient to report rash, muscle weakness, cramps, nausea, vomiting, diarrhea, or dizziness to health care professional.
- Emphasize the importance of routine follow-up exams.
- Hypertension: Advise patients to continue taking the medication even if feeling better. Medication controls but does not cure hypertension.
- Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, regular exercise, smoking cessation, moderation of alcohol consumption, and stress management).
- Instruct patient and family in correct technique for monitoring weekly BP.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products,, especially cough or cold preparations.
Evaluation/Desired Outcomes
- Decrease in BP.
- Decrease in edema.