Drug
Thiazides
Chlorothiazide
Hydrochlorothiazide
Thiazide-like Analogs
Chlorthalidone
Indapamide
Metolazone
Loop Diuretics
Bumetanide
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Actions
Therapeutic Uses
Pharmacokinetics
Adverse Effects
Others
-Hypertension :reduce
systolic and diastolic BP
for extended periods of
time; after 3-7 days of tx
BP stabilizes and can be
maintained by dailydosage of the drugs
-DOC: reducing ECF
volume in mild to
moderate HF
-Idiopathic hypercalciuria
-Diabetes insipidus
-Hypokalemia
-Predisposes pts taking
DIGITALIS to ventricular
arrhythmias
-Hyponatremia: due to
elevation of ADH as a result
of hypovolemia
-Hyperuricemia: decrease
the amount of acid excreted
by organic acid secretory
system
-Orthostatic hTN, lightheadedness
-Hypercalcemia
-Hyperglycemia: due to
impaired release of insulin
and tissue uptake of glucose
-Hyperlipidemia: increased
cholesterol, LDL
-Hypersensitivity: BM
suppression, dermatitis,
necrotizing vasculitis,
interstitial nephritis
-Chlorthalidone: HTN
-Indapamide: useful in
treatment of pts with
renal failure
-Chlorthalidone: very
long duration of action,
given once per day
-Indapamide: long
duration of action,
metabolized and
excreted by GIT and
kidneys
-Highest efficacy to
mobilize Na+ and Cl-
-Hypomagnesemia
-Ototoxicity (especially
-High-ceiling diuretics
-Bumetanide and
Diuretics
Furosemide
Torsemide
Ethacrynic acid
Aldosterone
Antagonists
Spironolactone
Eplerenone
Triamterene
Amiloride
(K+- Sparing)
Acetazolamide
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Henle
-Inhibit the cotransport of
Na+/K+/2Cl- in luminal
membrane Reabsorption
of ions is decreased
-Increase the Ca2+ content of
urine
-Decreased renal vascular
resistance, increased renal
blood flow
-Increase PG synthesis
-Act in collecting tubules to
inhibit Na+ reabsorption and
K+ excretion
-Spironolactone: antagonizes
aldosterone at intracellular
cytoplasmic receptor sites
Prevents translocation of
complex into nucleus, so
cant bind to DNA Failure
to produce proteins which
stimulate Na+/K+-exchange
in CT Prevention of Na+
absorption and K+ and H+
secretion
-Canrenone:
mineralocorticoid- blocking
activity
-Block Na+ transport
channels Decrease in
Na+/K+ exchange
-Useful in emergency
situations
-Hypercalcemia
-Hyperkalemia
when used w/
aminoglycoside antibiotics)
-Hyperuricemia: compete
with uric acid for renal and
biliary secretory systems
-Acute hypovolemia, may
lead to hTN, shock, cardiac
arrhythmias
-Hypokalemic alkalosis
Furosemide are
sulfonamide derivatives
-Spironolactone given
with THIAZIDES or LOOP
DIURETICS to prevent K+
excretion
-DOC: pts with hepatic
cirrhosis
-Spironolactone:
Secondary
hyperaldosteronism
-Spironolactone prevents
remodling of heart in
progressive HF
-Spironolactone:
completely absorbed
after orally and strongly
bound to proteins
-Spironolactone gets
converted to active
metabolite: canrenone
-Spironolactone:
induces hepatic CYP450
-Spironolactone: gastric
upsets that can cause peptic
ulcers
-Gynecomastia in males
-Menstrual irregularities in
females
-Hyperkalemia
-Nausea
-Lethargy
-Mental confusion
-Inhibits CA located
-Chronic tx of glaucoma:
-Used in combination
with other diuretics for
potassium-sparing
abilities
-Given orally 1-4 times
-Hyperchloremic metabolic
Diuretics
Osmotic Diuretics
Mannitol
Urea
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intracellularly on apical
membrane of PCT epithelium
-Decreased ability to
exchange Na+ and H+ leads
to mild diuresis
-HCO3- retained in lumen,
causing increase in urinary
pH
-Phosphate excretion in
increased
-Hydrophilic substances
which have the ability to
carry water with them into
the tubular fluid
decreased production of
aqueous humor
-Prophylaxis of mountain
sickness: given nightly for
5 days before ascent
prevents weakness,
breathlessness, dizziness,
nausea, cerebral and
pulmonary edema
daily
-Secreted by PCT
acidosis
-Potassium depletion
-Renal stone formation
-Drowsiness
-Paresthesia (tingling)
-Extracellular water
expansion
-Dehydration
-Hypo- or hypernatremia
Diuretics
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