1
,Diuretics may also be used as adjunct therapy for disease processes in which the
treatment itself may contribute to fluid retention—for example, use of some CCBs and
antiarrhythmics. Spironolactone blocks the mineral corticosteroid receptor that
aldosterone binds to; *Aldosteronism. It is also useful in ventricular remodeling and
decreasing the inflammatory cascade that can occur in the days following an MI.
Amiloride's potassium-sparing characteristics are used to counter any chronic
potassium losses that cannot be reliably corrected with diet or supplements.
Uses
Diuretics are first-line therapy in the treatment of HF & HTN through their reduction in
ECF volume. Ones most commonly used in primary care are the distal tubular (thiazides
and aldosterone antagonists) & loop diuretics.
Side effects
All - hypokalemia, arrhythmia, metabolic alkalosis, fatigue, postural hypotension,
hyperlipidemia
K+-sparing - hyperkalemia, gynecomastia, peptic ulcer
Thiazides - hyperglycemia & hypercalcemia
Loop- hypocalcemia
Drug Interactions
Alldiruetics- a) digoxin (hypokalemia/toxicity risk); b) NSAIDs (reduce diuresis), c)
lithium (toxicity risk), d) corticosteroids (enhance hypokalemia), e) anti-diabetic
drugs (decrease anti-diabetic levels)
Thiazides&Beta blockers increase hyperglycemia/ hyperlipidemia
Loops & aminoglycosides cause ototoxicity & nephrotoxicity
Spironolactone – Aldactone
Furosemide-Lasix
, Metolazone- Zaroxolyn
Hctz-Apo-Hydro; Aquazide;BPZide; Dichlotride;Esidrex; Hydrochlorot;Hydrodiuril;
HydroSaluric;Microzide; Oretic
Amiloride (Midamor)
Triamterene (Dyrenium)
3. Preferred diuretic with renal impairment
Loop diuretics are the best Tx for renal impairment generally (GFR <30);Amiloride
is contraindicated in diabetic neuropathy patients, pts c a BUN > 30 or a creatinine
>1.5mg. Metolazone is the only thiazide effective in stage 3 or 4 CKD. Potassium
sparing diuretics are absolutely contraindicated in patients with severe renal
impairment.
4. Post diuretic sodium retention
Loop diuretics cause a post-effect, a compensatory sodium-retention process that
begins as the diuretic action wanes.
The effect of loop diuretics dissipates rapidly, after which the kidneys immediately begin
to reabsorb sodium and nullify the diuretic effect. This process is called post-diuretic
sodium chloride retention. If sodium chloride intake is high and the half-life of the
diuretic is short (as with a loop diuretic), post-diuretic sodium chloride retention
compensates entirely for the sodium loss.7 Therefore, sodium restriction is important
when a patient is taking loop diuretics.
5. Recognition that some diuretics are sulfa derivatives
Carbonic anhydrase inhibitors, loop diuretics, thiazides, but NOT ethacrynic acid. Lasix
is. Diuretics that do not contain a sulfonamide group (eg, amiloride hydrochloride,
eplerenone, ethacrynic acid, spironolactone, and triamterene) are safe for patients with
an allergy to sulfa.
6. Management of edema
,Diuretics may also be used as adjunct therapy for disease processes in which the
treatment itself may contribute to fluid retention—for example, use of some CCBs and
antiarrhythmics. Spironolactone blocks the mineral corticosteroid receptor that
aldosterone binds to; *Aldosteronism. It is also useful in ventricular remodeling and
decreasing the inflammatory cascade that can occur in the days following an MI.
Amiloride's potassium-sparing characteristics are used to counter any chronic
potassium losses that cannot be reliably corrected with diet or supplements.
Uses
Diuretics are first-line therapy in the treatment of HF & HTN through their reduction in
ECF volume. Ones most commonly used in primary care are the distal tubular (thiazides
and aldosterone antagonists) & loop diuretics.
Side effects
All - hypokalemia, arrhythmia, metabolic alkalosis, fatigue, postural hypotension,
hyperlipidemia
K+-sparing - hyperkalemia, gynecomastia, peptic ulcer
Thiazides - hyperglycemia & hypercalcemia
Loop- hypocalcemia
Drug Interactions
Alldiruetics- a) digoxin (hypokalemia/toxicity risk); b) NSAIDs (reduce diuresis), c)
lithium (toxicity risk), d) corticosteroids (enhance hypokalemia), e) anti-diabetic
drugs (decrease anti-diabetic levels)
Thiazides&Beta blockers increase hyperglycemia/ hyperlipidemia
Loops & aminoglycosides cause ototoxicity & nephrotoxicity
Spironolactone – Aldactone
Furosemide-Lasix
, Metolazone- Zaroxolyn
Hctz-Apo-Hydro; Aquazide;BPZide; Dichlotride;Esidrex; Hydrochlorot;Hydrodiuril;
HydroSaluric;Microzide; Oretic
Amiloride (Midamor)
Triamterene (Dyrenium)
3. Preferred diuretic with renal impairment
Loop diuretics are the best Tx for renal impairment generally (GFR <30);Amiloride
is contraindicated in diabetic neuropathy patients, pts c a BUN > 30 or a creatinine
>1.5mg. Metolazone is the only thiazide effective in stage 3 or 4 CKD. Potassium
sparing diuretics are absolutely contraindicated in patients with severe renal
impairment.
4. Post diuretic sodium retention
Loop diuretics cause a post-effect, a compensatory sodium-retention process that
begins as the diuretic action wanes.
The effect of loop diuretics dissipates rapidly, after which the kidneys immediately begin
to reabsorb sodium and nullify the diuretic effect. This process is called post-diuretic
sodium chloride retention. If sodium chloride intake is high and the half-life of the
diuretic is short (as with a loop diuretic), post-diuretic sodium chloride retention
compensates entirely for the sodium loss.7 Therefore, sodium restriction is important
when a patient is taking loop diuretics.
5. Recognition that some diuretics are sulfa derivatives
Carbonic anhydrase inhibitors, loop diuretics, thiazides, but NOT ethacrynic acid. Lasix
is. Diuretics that do not contain a sulfonamide group (eg, amiloride hydrochloride,
eplerenone, ethacrynic acid, spironolactone, and triamterene) are safe for patients with
an allergy to sulfa.
6. Management of edema
