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).

References in periodicals archive ?
Antihypertensive agents in general reduced the risk for Alzheimer's disease (AD), but the potassium-sparing diuretics were particularly beneficial, said Dr.
05) associated with higher creatinine levels in the multivariate models for both men and women (Table IV) were: older age, black race, history of heart attack, and current medication with frusemide, potassium-sparing diuretics, and cimetidine.
Patients with moderate renal impairment who are taking medications that interfere with potassium excretion, such as potassium-sparing diuretics, or medications that interfere with the renin-angiotensin-aldosterone system are more likely to develop hyperkalemia.
Hyperkalemia also may occur if you use potassium salt substitutes with blood pressure medications such as potassium-sparing diuretics (such as spironolactone and triamterene), angiotensin converting enzyme (ACE) inhibitors (benazepril and lisinopril are examples), and angiotensin-receptor blockers (e.
gyn, has told them they can't take any pill containing drospirenone or spironolactone," because of its possible effect on potassium levels, especially in combination with other drugs that increase serum potassium (ACE inhibitors, angiotensin receptor blockers, potassium-sparing diuretics, heparin, aldosterone antagonists, and nonsteroidal anti-inflammatories).
Caution should be exercised when using these therapies in patients with severe CKD concomitantly using one or a combination of the following medications: ARBs, non-steroidal anti-inflammatory agents (NSAIDs), potassium supplements, and potassium-sparing diuretics.
One large retrospective study evaluated 6796 patients using potassium-sparing diuretics vs non-potassium-sparing diuretics in the Studies of Left Ventricular Dysfunction (SOLVD) trial.
When broken down further by subtypes of antihypertensive agents, the potassium-sparing diuretics had the most significant protective effect, with a 73% reduction in risk for Alzheimer's disease.
Also contraindicated in people on potassium supplements, potassium-sparing diuretics (amiloride, spironolactone, or triamterene), and drugs that are strong inhibitors of CYP450 3A4, such as ketoconazole or itraconazole.
Fifty-four subjects (mean age, 74 years) had physician-diagnosed hypertension for which they took beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, potassium-sparing diuretics, alpha-blockers, or a combination of these drugs.
23 in Archives of Internal Medicine found that treatment for nighttime leg cramps was significantly more likely in the year after people began taking long-acting beta agonists (inhaled drugs that treat asthma and other lung diseases), potassium-sparing diuretics or thiazide diuretics (used to lower blood pressure and treat certain heart conditions).