Name of the Thiazide Diuretics drug:
Bendroflumethiazide
Mechanism of Action:
Bendroflumethiazide is a thiazide diuretic which works by inhibiting sodium reabsorption at the beginning of the distal convoluted tubule (DCT). Water is lost as a result of more sodium reaching the collecting ducts.
Inhibit Na+/Cl symporter in the distal convoluted tubules thereby reducing Na+ reabsorption and reducing water reabsorption.
Diuretics are sometimes called “water tablets” because they make you pee more.
Indications:
- Hypertension.
- Oedema in heart failure, liver disease and kidney disease.
Bendroflumethiazide
| Bendroflumethazide |
| Availability : tablets 2.5 mg and 5 mg. |
| Administration and handling : May take with or without food.• Give last dose no later than 6 pm unless instructed otherwise. |
| When bendroflumethiazide is added to other antihypertensive agents, the dosage of the latter can usually be reduced gradually as bendroflumethiazide takes effect |
| Oedema : Initially 5 to 10 mg once daily or on alternate days. Maintenance: 2.5 to 10 mg two or three times weekly. 5 mg given orally once daily in the morning usually produces the desired effect without diuresis interfering with sleep, but this dose can be increased to 10 mg if required. During the first few days of treatment there is usually a large increase in urinary volume, which diminishes as treatment continues. |
| Essential hypertension : 2.5 mg to 10 mg once daily, alone or in conjunction with other antihypertensive agents. Doses higher than 2.5 mg per day (for hypertension) are rarely necessary. |
Cautions And Contraindications:
- Electrolyte disturbances (including refractory hypokalemia, hyponatremia, hypercalcemia and symptomatic hyperuricemia).
- Addison’s disease.
- Avoid in breastfeeding mothers due to suppression of lactation.
- Anuria
- Sinus bradycardia
- Thiazide diuretics can cause an idiosyncratic reaction, resulting in acute angle-closure glaucoma and elevated intraocular pressure with or without a noticeable acute myopic shift and/or choroidal effusions.
- Symptoms may include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation
- Bendroflumethiazide may raise serum uric acid levels with consequent exacerbation of gout in susceptible patients
Side-Effects:
- Postural hypotension.
- Hyponatremia.
- Hypokalemia.
- Hyperuricemia. (e.g. gout)
- Hyperglycemia.
- Male sexual dysfunction.
- Suppression of lactation. Raised LDL cholesterol
Metabolism and Half-Life:
- Metabolized in the liver and excreted in urine.
- T ½ is 3 – 4h.
NURSING CONSIDERATIONS
Baseline assessment
- Check vital signs, esp. B/P for hypotension, before administration.
- Assess baseline electrolytes, esp. for hypokalemia.
- Evaluate skin turgor, mucous membranes for hydration status.
- Evaluate for peripheral edema.
- Assess muscle strength, mental status. Note skin temperature, moisture.
- Obtain baseline weight. Monitor I&O.
Intervention/evaluation
- Continue to monitor B/P, vital signs, electrolytes, I&O, daily weight. Note extent of diuresis.
- Watch for changes from initial assessment (hypokalemia may result in weakness, tremor, muscle cramps, nausea, vomiting, altered mental status, tachycardia; hyponatremia may result in confusion, thirst, cold/clammy skin).
- Be alert for potassium depletion in pts taking digoxin (cardiac arrhythmias). Potassium supplements are frequently ordered.
- Check for constipation (may occur with exercise diuresis)
Patient/family teaching
- Expect increased frequency (diminishes with continued use), volume of urination.
- Take last dose no later than 6 pm unless instructed otherwise.
- To reduce hypotensive effect, go from lying to standing slowly.
- Eat foods high in potassium, such as whole grains (cereals), legumes, meat, bananas, apricots, orange juice, potatoes (white, sweet), raisins.
- Protect skin from sun, ultraviolet light (photosensitivity may occur).
Drug Interactions:
- Enhanced hypotensive effect with other antihypertensives.
- Increased risk of nephrotoxicity with NSAIDs
- Reduced hypoglycemic effect of oral antidiabetic agents.
Important points:
- Thiazides are less effective than loop diuretics because 90% of Na+ has been reabsorbed by the time the filtrate reaches the distal convoluted tubule.
- Hypokalemia results from increased activity of Na+/K+ ATPase in collecting ducts.
- This is caused by increased Na+ in filtrate and an aldosterone- mediated effect (diuretic- induced hypovolemia causes activation of the renin-angiotensin in –aldosterone system)
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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