Monday, 5 November 2018

Diuretics, Introduction, Classification, Uses, Adverse Drug Reaction

DIURETICS
Diuretics, Introduction, Classification, Uses, Adverse Drug Reaction

Introduction

Diuretics are the drugs which cause a net loss of Na+ and water in urine. However Na+ balance is soon restored, even with continuing diuretic action, by the compensatory homeostatic mechanism of the body, albeit with a certain degree of persisting Na+ deficit and reduction in extracellular fluid volume.
Diuretics are among the most prescribed drugs. Application of diuretics in the management of hypertension has outstripped their use in edema.

CLASSIFICATION

1. High efficacy diuretics (Inhibitors of Na+ K+2Cl- cotransport)

Sulphamoyl derivatives
Furosemide,
Bumetanide,
Torasemide

2. Medium efficacy diuretics (Inhibitors of Na+Cl- symport)

(a) Benzothiadiazole (thiazide)
Hydrochlorothiazide,
Benzthiazide,
Hydroflumethiazide,
Bendroflumethiazide

(b)Thiazide-like (related heterocyclics)
Chlorthalidone,
Metolazone,
Xipamide,
Indapamide,
Clopamide

3. Weak or adjunctive diuretics

(a) Carbonic anhydrase inhibitors
Acetazolamide

(b)Potassium-sparing diuretics

(i) Aldosterone antagonists
Spironolactone,
Eplerenone

(ii) Inhibitors of renal epithelial Na+ channel
Triamterene,
Amiloride

(c)Osmotic diuretics
Mannitol,
Isosorbide,
Glycerol


USES OF DIURETICS
1. Edema2. Acute pulmonary edema(acute LVF following MI)3. Cerebral edema4. Hypertension5. Hypercalcemia of malignancy6. Diabetes insipidus

ADVERSE DRUG REACTION
Hypokalaemia, Acute saline depletion, Dilutional Hyponatremia,
GIT and CNS disturbance, Hearing loss, Allergic manifestation, Hyperuricaemia, Hyperglycaemia and hyperlipidemia, Hypocalcaemia, Magnesium depletion



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