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Thiazide-
Hydrochlorathiazide (Hydro-diuril),(HCTZ)
- Derivatives of sulfonamides and inhibit tubular reabsorption of Na+ and Cl-.
- Decreased libido photosensitivity, hyperuricemia, blood dyscrasias, jaundice.
- PO, with food. Increased risk of Dig toxicity r/t potential change in serum K+ level. Risk of quinidine toxicity if taken with this med.
- Edema of CHF, renal, cirrhosis, glucocorticoid, estrogen therapy, HTN, and diabetes insipidus.
- Block the chloride pump keep the chloride and sodium in the tubule to be excreted in the urine, preventing the reabsorption of both in the vascular system.
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Loop Diuretics
Furosemide (Lasix)
- Potent diuretic, works on loop of Henle. Rapid onset. Inhibit reabsorption of Na+ and CL-.
- Tinnitus, encephalopathy, photosensitivity, hyperglycemia, blood dyscrasias.
- PO, IM, or IV. Allergy to sulfonimides?? Tinnitus, hearing loss, give with food. IV undiluted over 1-2 mins. Increased ototoxicity with aminoglycosides or cisplatin. Can increase risk of bleeding with anticoagulants. Decreased antihypertensive effects with indomethacin, ASA, or NSAIDS.
- Edema of CHF, acute pulmonary edema, HTN, renal and liver disease.
- Hypercalcemia.
- Block the chloride pump in the ascending loop of henle causing reabsorption of sodium and chloride.
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Carbonic-Anhydrase Inhibitors
Acetazolamide (Diamox)
- Works on the proximal tubule of the nephron.
- Hypokalemia, Acidosis, Metalic taste, leukopenia.
- PO, IM, IV. PO must be with food. IM is very painful. Check for allergy to sulfonamides. Increased excretion of ASA and Lithium with these.
- Adjunctive therapy of glacoma. Can be used for altitude sickness, seizures, and edema.
- Inhibits carbonic anhydrase which decreases aqueous humor formation in the eye, intraoccular pressure and hydrogen secretion by the renal tubules. More sodium and bicarbonate are lost in the urine.
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Potassium sparing Diuretics
Spironolactone (Aldactone)
- Block aldosterone receptors. Excretion of Na+ but retain K+.
- Hyperkalemia, gynecomastia (enlargement of the breast in male), photosensitivity. PO--with food. Watch for hyperkalemia. Avoid salt substitutes which contain K+. Decrease in diuretic effect if combined with ASA.
- Edema, HTN, hyperaldostronism. Used frequently with Thiazides.
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Osmotic Diuretics
Mannitol (osmitrol)
- Osmotic diuretic-works on proximal, increased osmotic pressure of the glomular filtrate, inhibits reabsorption of water and lytes.
- Convulsions, blurred vision, thrombophlebitis, tachycardia, pulmonary edema.
- IV infusion or GU irrigant. Check neuro with ICP> Check eyes for IOP. Monitor renal function.
- Acute renal failure, edema, GU irrigant. Increased ICP or IOP.
- Elevates the osmolarity of the glomerular filtrate, leading to a loss of water, sodium, and chloride
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