In general Effect Therapeutic use Adverse

effect
Thiazides -most widely used -Act mainly in the cortical region of the ascending loop of Henle and the distal convoluted -affecting the severe edema often seen in hepatic cirrhosis -Hypokalemia
diuretics tubule to decrease the reabsorption of Na+ and heart failure with minimal side effects -Hyponatremia
(Chloroth -Sulfonamide derivatives -Must be excreted into the tubular lumen to be effective; do not change acid-base status of -Hydrochloro>Chloro -Hyperuricemia
iazide, -Effective orally blood -Effective in the majority of patients with mild to moderate -Orthostatic
-Take 1 to 3 weeks to -NSAIDs (e.g. indomethacin) inhibit production of renal prostaglandin, reduce renal blood flow essential hypertension hypotension
Hydrochl produce a stable ->Effect of Thiazides diminish with concomitant use of NSAIDs -Some patients can be continued for years on thiazides -Hypercalcemia
orothiazi reduction in blood -Inhibit Na+/Cl− cotransporter on the luminal membrane of the tubules alone -can lead to
de) pressure ->hyperosmolar urine (unique) -However, many patients require additional medication for glucose
-Exhibit a prolonged -Because thiazides increase Na+ in the filtrate arriving at the distal tubule, more K+ is also blood pressure control intolerance due
half-life exchanged for Na+ -In heart failure: When given in combination, thiazides to impaired
-Have equal maximum -Mg loss especially in elderly patients should be administered 30 minutes prior to loop diuretics release of
diuretic effects -Thiazides promote the reabsorption of Ca2+ in the distal convoluted tubule where in order to allow the thiazide time to reach the site of insulin and
-sometimes called “low parathyroid hormone regulates reabsorption action and produce effect tissue uptake of
ceiling diuretics” -Reduced peripheral vascular resistance -> Initial reduction in blood pressure results from a -Hypercalciuria glucose
-secreted by the organic decrease in blood volume and a decrease in cardiac output -> With continued therapy, -Diabetes insipidus: Can substitute for ADH in the
acid secretory system of volume recovery occurs treatment of nephrogenic diabetes insipidus
the kidney

Loop -Furosemide is the most -Bumetanide, furosemide, torsemide, and ethacrynic acid Inhibit the cotransport of -drugs of choice for reducing acute pulmonary edema and -Ototoxicity,
commonly used of these Na+/K+/2Cl− in the luminal membrane in the ascending limb of the loop of Henle acute/chronic peripheral edema caused from heart failure Ethacrynic acid
diuretics drugs -greatest diuretic effect of all the diuretic drugs, since the ascending limb accounts for or renal impairment is the most
(„high -Bumetanide and reabsorption of 25% to 30% of filtered NaCl (Downstream sites are unable to compensate) -Hypercalcemia likely to cause
torsemide are much -act promptly, even in patients with poor renal function or lack of response to other diuretics -Hyperkalemia deafness
ceilling more potent than --may increase renal blood flow, possibly by enhancing prostaglandin synthesis ->inhibited by -Hyperuricemia
drugs“) furosemide->use is NSAID -acute Hypovol.
increasing -Administered orally or parenterally, brief duration of action is relatively brief (2 to 4 hours) -Low K and Mg
-secreted into urine

Aldostero Spironolactone -Prevents translocation of the receptor complex into the nucleus of the target cell -Heart failure: prevent remodeling that occurs as -Gastric upset
/Eplerone antagonize at ->Failure to produce mediator proteins that normally stimulate the Na+/K+-exchange sites of compensation for the progressive failure (reduced -gynecomastia
ne intracellular cytoplasmic the collecting tubule mortality esp. in low EF) -menstrual irr.
Antagoni receptor sites rendering -In most edematous states, blood levels of aldosterone are high, causing retention of Na+ -often given with thiazide or loop to prevent K loss -Hyperkalemia
the spironolactone– -Spironolactone antagonizes the activity of aldosterone -> retention of K, secretion of Na -diuretic of choice in patients with hepatic cirrhosis and -nausea,
sts receptor complex -Effect of these agents may be diminished by administration of NSAIDs secondary hyperaldosteronism lethargy,
inactive -orally administered, binds to plasma proteins -resistant hypertension confusion
-polycystic ovary syndrome: blocks androgen receptors

CA -good other pharm. -Acetazolamide inhibits CA located intracellularly (cytoplasm) and on the apical membrane of - decreases the production of aqueous humor and reduces -low serum K
Effects the proximal tubular epithelium intraocular pressure in patients with chronic open-angle -Renal Stones
Inhibitors -Eliminated renally by -Decreased ability to exchange Na+ for H+ (mild diuresis) glaucoma -Drowsiness
active tub. Secr. and - Additionally, HCO3−is retained in the lumen -> hyperchloremic metabolic acidosis -Acetazolamide can be used in the prophylaxis of acute -Paraesthesia
pass. Reabsorp. -administered orally or iv, 90% protein bound mountain sickness - avoid in cirrh!!
Osmotic -hydrophilic, filtered -Filtered substances (mannitol, urea) that undergo little or no reabsorption will cause an -Used to maintain urine flow following acute toxic ingestion -Extracts water
through glomerulus increase in urinary output of substances capable of producing acute renal failure from cells
Diuretics -not absorbed -> should -Mainly water and only a small amount of additional salt is excreted -Increased cranial pressure (extracell.
be given iv -Not useful for treating conditions in which Na+ retention Water
occurs expansion)
-Dehydration

Thiazide- Chlorthalidone Indapamide: Metolazone

-Is a nonthiazide -Lipid-soluble and has a long duration of action -More potent than the thiazides
Like derivative -At low doses: Significant antihypertensive action and minimal diuretic effects -Causes Na+ excretion even in advanced renal failure
drugs -Behaves -Metabolized and excreted by the gastrointestinal tract and the kidneys (unlike the thiazides)
pharmacologically like ->Less likely to accumulate in patients with renal failure (useful in their treatment)
hydrochlorothiazide
-Long duration of action
-Used once daily to treat
hypertension