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Chapter 51 Diuretic Agents. Classes of Diuretics Thiazide and thiazide-like diuretics Loop diuretics Carbonic anhydrase inhibitors Potassium-sparing diuretics.

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Presentation on theme: "Chapter 51 Diuretic Agents. Classes of Diuretics Thiazide and thiazide-like diuretics Loop diuretics Carbonic anhydrase inhibitors Potassium-sparing diuretics."— Presentation transcript:

1 Chapter 51 Diuretic Agents

2 Classes of Diuretics Thiazide and thiazide-like diuretics Loop diuretics Carbonic anhydrase inhibitors Potassium-sparing diuretics Osmotic diuretics

3 Function of Diuretic Agents Increase the amount of urine produced by the kidneys Increase sodium excretion

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

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

6 Thiazide and Thiazide-Like Diuretics Hydrochlorothiazide (HydroDIURIL) Chlorothiazide (Diuril) Bendroflumethiazide (Naturetin) Benzthiazide (Exna) Hydroflumethiazide (Diucardin) Methyclothiazide (Aquatensen) Polythiazide (Renese) Trichlormethiazide (Diurese)

7 Sites of Action of Diuretics in the Nephron

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

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 T ½ : 5.6–14 h; metabolized in the liver and excreted in urine

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

11 Indications for Loop Diuretics Acute CHF Acute pulmonary edema Edema associated with CHF Edema associated with renal or liver disease Hypertension

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 T ½ : 120 min; metabolized in the liver and excreted in urine

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 T ½ : 5–6 hr; excreted unchanged in urine

14 Potassium-Sparing Diuretics Types –Amiloride (Midamor) –Spironolactone (Aldactone) –Triamterene (Dyrenium) Uses –Patients at high risk for hypokalemia associated with diuretic use

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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