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Diuretics

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Isaac Lee

on 14 May 2014

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Transcript of Diuretics

Diuretics
What is a diuretic?
Secretes sodium and water in the kidneys
Formation of urine
Increases flow of urine with greater sodium secretion
The significance of diuretics in North America
Action of diuretics
Each group of diuretics have different actions in the nephron
Loop diuretics
Inhibits Na+ and Cl- reabsorption
Thiazide diuretics
Inhibits Na+ and Cl- reabsorption
Potassium-sparing diuretics
Excretes Na+ and H20
Works as vasodilators
Has three major groups
Acts on the ascending loop of Henle and proximal and distal tubules
Acts on the distal tubules
Retains K+
Acts on the collecting ducts and distal convoluted tubules
Diuretic: Mechanism of action
Thiazides
Inhibits active exchange of Na+ and Cl- in the cortical dilating segment of the ascending loop of Henle
K-sparing
Inhibits reabsorption of Na+ in the distal convoluted tubules and collecting tubule
Loop diuretics
Inhibits exchange of Na+, Cl-, and K+ in the thick segment of the loop of Henle
Groups and demographics
• Diuretics are considered the first line of defense in regards to drug therapy in North America
• Diuretics are the most common drugs used in North America because hypertension and heart failure are one the most prevalent diseases in North America
• It is the go to drug due to its safety assessment, efficacy as well as low cost compared to other drugs on the market
• There are studies that have suggested that diuretics may cause unwarranted tachycardia. However results indicate that the benefits outweigh the potential risk
• Lasix is the most common diuretic used in North America. Pills can cost as low as $27.00 and as high as $145 depending on the amount of pills
• In North America, obesity rates, stress rates and lifestyle choices immensely affect both hypertension and heart failure and contributes to the amount of diuretics widely used
Diuretics can be ...
Used for all ages
Used to treat many different health problems
Advice, adverse effects, and interactions of diuretics
Advice:
Patients on diuretics will produce more urine than patients who are not which may disrupt daily activities
Indications:
Severe heart failure, acute pulmonary edema, acute MI, hypertensive crisis, hypertension, renal failure, primary aldosteronism (high levels of aldosterone in the blood) and Secondary aldosteronism (such as recurrent heart failure, renovascular hypertension, cirrhosis of liver with ascites, nephrotic syndrome).
Adverse effects:
Impotence, hypokalemia, hyponatremia, ventricular arrythmias, diabetes, hypovolemia, hypotension, precipitation of gout, hyperuricemia, increase in blood tryglyceride and cholesterol levels, some diuretics may also cause gynecomastia.
Dosage
Quiz Time!
References
Description and Action of diuretics
• Pharmacology 2nd edition - Lilley, Harrington, Snyder
http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/diuretic/art-20048129?pg=1
Need for diuretics in North America
Group and demographics
Dosage
Advice, adverse effects, and interactions
Pictures and videos
- http://img.medscape.com/slide/migrated/editorial/cmecircle/2007/7241/images/slide41.jpg
- http://www.cardiachealth.org/sites/default/files/images/stories/Medications/diuretics.bmp
- http://www.youtube.com/ watch?v=XVb7ykMfR68
Loop diuretics
Bumetanide (Burinex)
Usual dosage range in adults: 0.5 - 2mg per day
Given orally
Max 10g per day
Thiazides and thiazide-like diuretics
Ethacrynic acid
Given both orally and intravenously in adults
Orally: 50 - 100mg per day, Max 200mg per day
IV: 0.5 - 1 mg/kg/min
Furosemide (Lasix)
Given both orally and intravenously in adults
Orally: 20 - 80mg as a single dose
Potassium-sparing diuretics
Amiloride hydrochloride (Midamor)
Spironolactone
Triamterene
Given orally to adults
Orally: 5 - 10mg per day
Given orally to adults
Orally: 25 - 200mg per day
Given orally to adults
Orally: 50mg, 1-4 times a day after meals
Hydrochlorothiazide
Metolazone
Given orally to adults
Orally: 25 - 200mg per day, usually divided
Given orally to adults
Orally: 2.5 - 20mg per day
Pharmacology 2nd edition - Lilley, Harrington, Snyder
- http://www.empr.com/lasix/drug/138/
- http://www.patient.co.uk/doctor/diuretics
- http://www.patient.co.uk/doctor/diuretics
- http://www.drugs.com/lasix.html
- http://www.ncbi.nlm.nih.gov/pubmed/6617241
Interactions:
Ibuprofen, Indomethacin, Naproxen, and other nonsteroidal anti-inflammatory drugs (NSAIDS), Antidiabetics, Aminoglycoside
Loop diuretics:
Thiazides:
Ibuprofen, Indomethacin, Naproxen, and other nonsteroidal anti-inflammatory drugs (NSAIDS), Aminoglycoside, Antidysrhythmics that prolong QT interval, Steroids, Lithium
• About 1 in 3 U.S. adults—or 67 million people—have high blood pressure
CHF affects over 6 million people in North America and is the most common cause of hospitalization for people over 65 years of age
Which diuretic is an aldosterone antagonist and which group does it belong to?
Spironolactone and it is a potassium-sparring diuretic
- http://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=2104&relation_id=85675&disease_id=223&page_no=1
- http://www.cdc.gov/bloodpressure/
What is the most common Loop diuretic?
Furosemide (Lasix)
How many jelly beans in this jar?
Five
What is a diuretic?
A drug that alters renal mechanism to increase the urine flow with greater Na+ excretion
What are the two most common diseases treated with diuretics?
Heart failure and hypertension
Thanks for watching!
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