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Chapter 51 Diuretic Agents

Chapter 51 Diuretic Agents. Classes of Diuretics. Thiazide and thiazide-like diuretics Loop diuretics Carbonic anhydrase inhibitors Potassium-sparing diuretics Osmotic diuretics. Function of Diuretic Agents. I ncrease the amount of urine produced by the kidneys Increase sodium excretion.

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Chapter 51 Diuretic Agents

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  1. Chapter 51Diuretic 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 • T½:5.6–14 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 • T½:120 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 • T½:5–6 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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