1. Chapter 51 Diuretic Agents
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Chapter 51 Diuretic Agents

2. Classes of Diuretics Thiazide and thiazide-like diuretics
Loop diuretics
Carbonic anhydrase inhibitors
Potassium-sparing diuretics
Osmotic diuretics
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3. Function of Diuretic Agents
Increase the amount of urine produced by the kidneys
Increase sodium excretion
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4. Indications for Diuretic Use
Edema associated with congestive heart failure
Acute pulmonary edema
Liver disease (including cirrhosis)
Renal disease
Hypertension
Conditions that cause hyperkalemia
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5. 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
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6. Thiazide and Thiazide-Like Diuretics
Hydrochlorothiazide (HydroDIURIL)
Chlorothiazide (Diuril)
Bendroflumethiazide (Naturetin)
Benzthiazide (Exna)
Hydroflumethiazide (Diucardin)
Methyclothiazide (Aquatensen)
Polythiazide (Renese)
Trichlormethiazide (Diurese)
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7. Sites of Action of Diuretics in the Nephron
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8. 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
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9. 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
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10. 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
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11. Indications for Loop Diuretics
Acute CHF
Acute pulmonary edema
Edema associated with CHF
Edema associated with renal or liver disease
Hypertension
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12. 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
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13. 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
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14. Potassium-Sparing Diuretics
Types
Amiloride (Midamor)
Spironolactone (Aldactone)
Triamterene (Dyrenium)
Uses
Patients at high risk for hypokalemia associated with diuretic use
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15. 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
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