Diuretics


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Diuretics

 

agents that increase the excretion of urine and decrease the amount of fluid in the tissues and serous cavities. Natriuretics increase the excretion of sodium ions. Diuretics are used primarily to treat edema accompanying cardiovascular, liver, and kidney diseases. Depending on their effect, they are classified as renal diuretics, which act directly on the kidneys and have the most pronounced effect, and extrarenal diuretics, which act indirectly through other systems in the body.

Renal diuretics act by blocking the kidney enzymes responsible for the transport of electrolytes, as well as by inhibiting reabsorption in the terminal tubules, which intensifies the excretion of sodium, chlorine, and potassium ions. Among the renal diuretics are the mercury compounds Mercusal and Novurit and carbonic anhydrase inhibitors such as Diacarb and dichlorphenamide (Daranid)—sulfonamide derivatives that intensify the excretion of bicarbonate, causing a drop in the alkaline reserve in the blood and, in some cases, acidosis. Benzothiadizine and sulfamoylanthranilic and dichlorophenoxyacetic acid derivatives such as dichlothiazide (Hypothiazide), furosemide (Lasix), and ethacrynic acid (Uregit) are extremely potent diuretics that sharply increase the excretion of sodium and have a hypotensive effect. Pyrimidine and pteridine derivatives, such as Allacyl and triamterene (pterofen), inhibit tubular reabsorption of sodium and chlorine ions but do not affect the excretion of potassium. Aldosterone antagonists, including spironolactone (Aldactone and Verospiron), increase the excretion of sodium and decrease the excretion of potassium and urea.

Depending on how they act, extrarenal diuretics are classified as osmotic and other types of agents. Among the osmotic agents are potassium acetate, mannitol, and urea, which are excreted by the kidneys and absorb water. They cause the excretion of sodium and chlorine in proportion to the increase in volume of urine and are used to lower intracranial pressure and reduce cerebral edema. Acid-forming diuretics include ammonium chloride and potassium chloride, which act by the transformation of cations. The ammonium ion is transformed into urea in the liver, the calcium ion settles in the intestine in the form of phosphate or carbonate, and chlorine ions occur in excess in the blood plasma and are excreted by the kidneys with sodium.

Extracts and tinctures are sometimes prepared for use as diuretics from bearberry leaf (tincture or decoction), field horsetail (decoction or fluid extract), and Orthosiphon leaf (tincture).

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Module 2: Post-Test Rethinking the role of thiazide-type diuretics in the management of hypertension: which diuretic is best?
This finding also is in line with the data of other studies (32-35), where a higher dose of diuretics is usually given to CHF patients who have a more compromised renal function at baseline.
However, they have no diuretic ability, though to stimulate urine production the thiazide diuretic preparations should be included additionally.
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I think the thiazide diuretics remain an excellent first choice for most people with high blood pressure, and the small increased risk of developing diabetes seen in the ALLHAT study shouldn't deter patients from taking them or physicians from prescribing them.
Serum magnesium, plasma renin, aldosterone, urinary electrolytes and assay for diuretics were arranged; her oral potassium dose was increased, and the follow-up visit was scheduled at 2 weeks.
In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) more than 33,000 patients with high blood pressure were randomly assigned to take either a diuretic (chlorthalidone) or one of two newer drugs, a calcium channel blocker (amlodipine) or an ACE inhibitor (lisinopril).
In his evidence during the Enright hearing, Dr Adrian McGoldrick, the Turf Club's chief medical officer, said: "Furosemide is a very potent diuretic which is used, among other things, for rapid weight loss.
Loop diuretics, such as bumetanide (Bumex), furosemide (Lasix), and torsemide (Demadex)
These deaths spurred the researchers to prospectively study 1,822 colonoscopy patients who underwent bowel preparation with low-volume PEG in 2014 and who were considered at high risk of hypokalemia by their gastroenterologists or because of hospitalization or diuretic use.