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Chapter 51 Diuretic Agents. Classes of Diuretics. Thiazide and thiazide-like diuretics Loop diuretics Carbonic anhydrase inhibitors Potassium-sparing diuretics Osmotic diuretics. Function of Diuretic Agents. I ncrease the amount of urine produced by the kidneys Increase sodium excretion.

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classes of diuretics
Classes of Diuretics
  • Thiazide and thiazide-like diuretics
  • Loop diuretics
  • Carbonic anhydrase inhibitors
  • Potassium-sparing diuretics
  • Osmotic diuretics
function of diuretic agents
Function of Diuretic Agents
  • Increase the amount of urine produced by the kidneys
  • Increase sodium excretion
indications for diuretic use
Indications for Diuretic Use
  • Edema associated with congestive heart failure
  • Acute pulmonary edema
  • Liver disease (including cirrhosis)
  • Renal disease
  • Hypertension
  • Conditions that cause hyperkalemia
causes of edema and ascites in patients with liver failure
Causes of Edema and Ascites in Patients With Liver Failure
  • Reduced plasma protein production
    • Results in less oncotic pull in the vascular system and fluid loss at the capillary level
  • Obstructed blood flow through the portal system
    • Caused by increased pressure from congested hepatic vessels
thiazide and thiazide like diuretics
Thiazide and Thiazide-Like Diuretics
  • Hydrochlorothiazide (HydroDIURIL)
  • Chlorothiazide (Diuril)
  • Bendroflumethiazide (Naturetin)
  • Benzthiazide (Exna)
  • Hydroflumethiazide (Diucardin)
  • Methyclothiazide (Aquatensen)
  • Polythiazide (Renese)
  • Trichlormethiazide (Diurese)
indications for thiazide and thiazide like diuretics
Indications for Thiazide and Thiazide-Like Diuretics
  • Treatment of edema associated with CHF, liver, or renal disease
  • Monotherapy or adjuncts for the treatment of hypertension
focus on the prototype thiazide diuretic hydrochlorothiazide
Focus on the Prototype Thiazide Diuretic: Hydrochlorothiazide
  • Indications:Adjunctive therapy for edema associated with CHG, cirrhosis, corticosteroid and estrogen therapy, and renal dysfunction; treatment of hypertension
  • Actions:Inhibits reabsorption of sodium and chloride in distal renal tubules, increasing the excretion of sodium, chloride, and water by the kidneys
  • Oral route: Onset 2 h; peak 4–6 h; duration 6–12 h
  • T½:5.6–14 h; metabolized in the liver and excreted in urine
loop diuretics currently available
Loop Diuretics Currently Available
  • Furosemide (Lasix)
    • Most commonly used; less powerful than new drugs; larger margin of safety for home use
  • Bumetanide (Bumex) and torsemide (Demadex)
    • New drugs; more powerful than Lasix
  • Ethacrynic acid (Edecrin)
    • First loop diuretic introduced, used less frequently in the clinical setting
indications for loop diuretics
Indications for Loop Diuretics
  • Acute CHF
  • Acute pulmonary edema
  • Edema associated with CHF
  • Edema associated with renal or liver disease
  • Hypertension
focus on the loop diuretic prototype furosemide
Focus on the Loop Diuretic Prototype: Furosemide
  • Indications:Treatment of edema associated with CHF, acute pulmonary edema, hypertension
  • Actions:Inhibits reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis
  • Oral route: Onset 60 min; peak 60–120 min; duration 6–8 h
  • IV, IM route: Onset 5 min; peak 30 min; duration 2 h
  • T½:120 min; metabolized in the liver and excreted in urine
focus on the carbonic anhydrase inhibitors prototype acetazolamide diamox
Focus on the Carbonic Anhydrase Inhibitors Prototype: Acetazolamide (Diamox)
  • Indications:Treatment of glaucoma; edema caused by CHF, drug-induced edema; centrencephalic epilepsy; prophylaxis and treatment of acute altitude sickness
  • Actions:Inhibits carbonic anhydrase, which decreases aqueous humor formation in the eye; intraocular pressure and hydrogen secretion by the renal tubules
  • Routes: Oral, SR, IV
  • T½:5–6 hr; excreted unchanged in urine
potassium sparing diuretics
Potassium-Sparing Diuretics
  • Types
    • Amiloride (Midamor)
    • Spironolactone (Aldactone)
    • Triamterene (Dyrenium)
  • Uses
    • Patients at high risk for hypokalemia associated with diuretic use
osmotic diuretics
Osmotic Diuretics
  • Types
    • Glycerin (Osmoglyn), Isosorbide (Ismotic), Mannitol (Osmitrol), and Urea (Ureaphil)
  • Action
    • Pull water into the renal tubule without sodium loss
  • Indications
    • Increased cranial pressure or acute renal failure due to shock, drug overdose, or trauma