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Diuretics: Generally indicated for patients with congestive heart
failure (CHF), people at high risk
for coronary disease, diabetics, prevention of recurrent stroke, and
African-Americans. KNOW:
Thiazide diuretics are first-line drugs for the treatment of hypertension
because they have been shown to reduce morbidity and mortality. Diuretics should be avoided
in patients with gout, renal insuffiency due to pre-renal causes, and/or
patients taking lithium. High doses
of thiazide and loop diuretics can lead to temporary elevations of low-density
lipoprotein cholesterol, triglycerides, and total cholesterol but low doses of
thiazide do not lead to these elevations. -Loop
diuretics: furosemide (Lasix),
bumetanide (Bumex), torsemide (Demadex), and ethacrynic acid (Edecrin).
These drugs are indicated for treatment of CHF, acute pulmonary edema,
and hypercalcemia. Loop diuretics
are not good agents for the management of chronic hypertension due to their
short duration of action. Ototoxcity is most commonly associated with ethacrynic acid
but may occur with high doses of all the other loop diuretics. -Furosemide
is twice as potent when given IV, compared with oral, therefore 10 mg of IV
furosemide equals approximately 20 mg of oral furosemide. -Torsemide
has good oral bioavailability and dosed in a 1:1 ratio oral to IV.
Therefore 10 mg IV torsemide equals approximately 10 mg of oral torsemide. Potassium-sparing
diuretics:
amiloride (Midamor), spironolactone (Aldactone), and Triamterene (Dyrenium).
These agents increase the risk of hyperkalemia. Therefore, patients who
are taking ACE inhibitors and/or have renal insufficiency while taking
potassium-sparing diuretics should be closely monitored for hyperkalemia.
In addition, one should consider discontining potassium supplements prior
to starting potassium-sparing diuretics to decrease the risk of hyperkalemia and
avoid using these agents in patients with renal insufficiency.
-Spironolactone
an compelling indication for class 3 or 4 heart failure and postmyocardial
infarction. It is also one of the
main treatments of ascites due to liver disease. Spironolactone is associated
with gynecomastia. Thiazide
diuretics:
chlorothiazide (Diuril), chlorthalidone (Hygroton), hydrochlorothiazide (HCTZ,
Hydrodiuril, Microzide, Esidrix), indapamide (Lozol) methyclothiazide (Aquatensen,
Enduron) and metolazone (Mykrox, Zaroxolyn).
-Thiazide
diuretics are first line diuretics for treatment of hypertension and are
also beneficial in the treatment of osteoporosis. Some thiazide diuretics are combined with potassium sparing
diuretics to decrease the risk of hypokalemia (e.g. Maxide which is
hydrochlorothiazide combined with triamterene).
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