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DIURETIC AGENTS

CLASSIFICATION / DRUG INDICATIONS treatment of edema caused by congestive heart failure (CHF), liver disease, or renal disease, and for adjunctive treatment of hypertension ACTIONS Block the chloride pump Keep the chloride and sodium in the tubule to be excreted in the urine, thus preventing the reabsorption of both in the vascular system Block the chloride pump in the ascending loop of Henle, causing reabsorption of sodium and chloride ADVERSE EFFECTS interference with the normal regulatory mechanisms of Nephron Hypokalemia Decreased calcium excretion d blood glucose levels Slightly alkalinized urine Related to the imbalance in electrolytes and fluid Hypokalemia Alkalosis Hypocalcemia – causes tetany Related to disturbances in acid and base balance and electrolyte balance Metabolic acidosis Hypokalemia Paresthesias of extremities, confusion, drowsiness Hyperkalemia CONTRAINDICATIONS Gout Systemic lupus Diabetes Hyperparathyroidism Bipolar disorders Pregnancy and lactation DRUG - DRUG Cholestyramine or colestipol (take 2 hrs. apart) Digoxin Antidiabetic agents Lithium Aminoglycosides and cisplatin (ototoxicity) ↑Anticoagulatio n Indomethacin, ibuprofen, salicylates, and NSAID Salicylates and lithium

THIAZIDE DIURETICS hydrochlorothiazide (HydroDIURIL)

LOOP DIURETICS furosemide (Lasix)

Acute CHF Acute pulmonary edema Edema associated with CHF Edema associated with renal or liver disease Hypertension Pharmacokinetics Adjunct to other diuretics Glaucoma **Not used for HTN or diuretic --Adjuncts with thiazide or loop diuretics --Patients who are at risk for hypokalemia Increased cranial pressure or acute renal failure due to shock, drug overdose, or trauma

Electrolyte depletion Anuria Severe renal failure Hepatic coma Pregnancy and lactation Cautions SLE, gout, and diabetes mellitus Angle closure glaucoma Cautions:Lactation F/E imbalances Renal or hepatic disease Adrenocortical insufficiency Respiratory acidosis COPD Hyperkalemia, renal disease, and anuria Patients taking amiloride and triamterene Renal disease and anuria Pulmonary congestion Intracranial bleeding and dehydration CHF

CARBONIC ANHYDRASE INHIBITORS (enzyme)

--Block the effects of carbonic anhydrase, slowing down the movement of hydrogen ions --More sodium and bicarbonate are lost in the urine Cause a loss of sodium while retaining potassium Block the actions of aldosterone in the distal tubule Pull water into the renal tubule without sodium loss

POTASSIUMSPARING DIURETICS spironolactone (Aldactone) OSMOTIC DIURETICS mannitol (Osmitrol)

Salicylates

Related to sudden drop in fluid levels N/V hypotension light-headedness, confusion headache