Diuretics

Loop Diuretics (Furesemide, torsemide, bumetanide and Ethacrynic Acid) are the inhibitors of Na/K/2Cl cotransport system in thick ascending limb of loop of Henle.

Drugs in this category are:
furosemide
bumetanide
torsemide
ethacrynic acid

Loop diuretics inhibit the Na+/K+/2Cl− co-transporter channel in the ascending limb of the lop of henle.
Na+, Cl−, and K+ are lost in the urine

Used in Edema, Heart failure, Nephrotic syndrome

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Let’s talk about DIURETICS!

There are 4 different types of diuretics:
1) Thiazides
2) Loop diuretics
3) Potassium sparing diuretics
3) Aldosterone antagonists

1- Thiazides are antihypertensive drugs used to reduce the blood pressure in lower doses, but they are mainly used to relieve oedema due to chronic heart failure.

2- Loop diuretics are the most potent diuretics being used in pulmonary oedema due to left ventricular failure and in patients with chronic heart failure.

Combination diuretic therapy may be effective in patients with oedema resistant to treatment with one diuretic. Vigorous diuresis, particularly with loop diuretics, may induce acute hypotension; rapid reduction of plasma volume should be avoided.

Thiazides and related diuretics

Thiazides and related compounds are moderately potent diuretics; they inhibit sodium reabsorption at the beginning of the distal convoluted tubule. They act within 1 to 2 hours of oral administration and most have a duration of action of 12 to 24 hours; they are usually administered early in the day so that the diuresis does not interfere with sleep.

In the management of hypertension a low dose of a thiazide produces a maximal or near-maximal blood pressure lowering effect, with very little biochemical disturbance. Higher doses cause more marked changes in plasma potassium, sodium, uric acid, glucose, and lipids, with little advantage in blood pressure control. Chlortalidone and indapamide are the preferred diuretics in the management of hypertension. Thiazides also have a role in chronic heart failure.

Bendroflumethiazide can be used for mild or moderate heart failure; it is licensed for the treatment of hypertension but is no longer considered the first-line diuretic for this indication, although patients with stable and controlled blood pressure currently taking bendroflumethiazide can continue treatment.

The thiazide diuretics benzthiazide, clopamide, hydrochlorothiazide, and hydroflumethiazide do not offer any significant advantage over other thiazides and related diuretics.

2) Loop diuretics
Examples of loop diuretics are Furosemide and bumetanide .
Loop diuretics are also used in patients with chronic heart failure. Diuretic-resistant oedema (except lymphoedema and oedema due to peripheral venous stasis or calcium-channel blockers) can be treated with a loop diuretic combined with a thiazide or related diuretic.
If necessary, a loop diuretic can be added to antihypertensive treatment to achieve better control of blood pressure in those with resistant hypertension, or in patients with impaired renal function or heart failure.

Loop diuretics can exacerbate diabetes (but hyperglycaemia is less likely than with thiazides) and gout. If there is an enlarged prostate, urinary retention can occur, although this is less likely if small doses and less potent diuretics are used initially.

3) Potassium-sparing diuretics
and aldosterone antagonists

Amiloride hydrochloride and triamterene on their own are weak diuretics. They cause retention of potassium and are therefore given with thiazide or loop diuretics as a more effective alternative to potassium supplements. See compound preparations with thiazides or loop diuretics.

Potassium supplements must not be given with potassium- sparing diuretics. Administration of a potassium sparing diuretic to a patient receiving an ACE inhibitor or an angiotensin-II receptor antagonist can also cause severe hyperkalaemia.

4) Aldosterone antagonists
Spironolactone potentiates thiazide or loop diuretics by antagonising aldosterone; it is a potassium-sparing diuretic. Spironolactone is of value in the treatment of oedema and ascites caused by cirrhosis of the liver; furosemide can be used as an adjunct. Low doses of spironolactone are beneficial in moderate to severe heart failure and when used in resistant hypertension [unlicensed indication].
Spironolactone is also used in primary hyperaldosteronism (Conn’s syndrome). It is given before surgery or if surgery is not appropriate, in the lowest effective dose for maintenance.
Spironolactone can lead to gynecomastia in men (enlargement or swelling of breast tissue).

Potassium supplements must not be given with aldosterone antagonists.

Information in description, from British National Formulary and in line with NICE guidelines.

If you are interested in antihypertensive drugs and understanding all classes my e-book and book ‘ Hypertension: Easy Peasy Pharmacology ‘ are available at:

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Diuretics are a group of drugs that increase the production of urine. Diuretics are categorized according to the renal structures they act on and the changes they …

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Diuretics are a group of drugs that increase the production of urine. Diuretics are categorized according to the renal structures they act on and the changes they lead to in the volume and composition of urine, as well as electrolyte balance. Some of these effects are useful in treating disorders such as hypercalcemia, hypocalcemia, and hyperaldosteronism. The most commonly used diuretics with a pronounced diuretic effect are thiazides, loop diuretics, and potassium-sparing diuretics. Osmotic diuretics and carbonic anhydrase inhibitors are used in acute settings to lower intracranial and/or intraocular pressure (e.g., cerebral edema, acute glaucoma). The most serious side effects of the majority of diuretics include volume depletion and excessive changes in serum electrolyte levels (particularly of sodium and potassium), which increases the risk for cardiac arrhythmias.

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CONTENT IN THIS VIDEO,
IN THIS VIDEO ,WE EXPLAINED DIURETICS IN A SIMPLE MANNER WITH ITS MECHANISMS, USES, ADVERSE EFFECTS THAT YOU CAN UNDERSTOOD EASILY.
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TIME STAMP
0:00 – INTRO
18:49 – MNEMONICS
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DIURETICS PHARMACOLOGY | RENAL PHARMACOLOGY | DIURETICS – IN TAMIL
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Diuretics are a group of drugs that increase the production of urine. Diuretics are categorized according to the renal structures they act on and the changes they lead to in the volume and composition of urine, as well as electrolyte balance. Some of these effects are useful in treating disorders such as hypercalcemia, hypocalcemia, and hyperaldosteronism. The most commonly used diuretics with a pronounced diuretic effect are thiazides, loop diuretics, and potassium-sparing diuretics. Osmotic diuretics and carbonic anhydrase inhibitors are used in acute settings to lower intracranial and/or intraocular pressure (e.g., cerebral edema, acute glaucoma). The most serious side effects of the majority of diuretics include volume depletion and excessive changes in serum electrolyte levels (particularly of sodium and potassium), which increases the risk for cardiac arrhythmias.

#carbonicanhydraseinhibitors #carbonicanhydrase #diuretics #diureticsintroduction #diureticspharmacology #pharmacology #usmle #usmlestep1 #nationalexittest #mbbs #pharmacologyvideos #pharmacology #diureticslecture

Potassium-Sparing Diuretics
Instructional Tutorial Video
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In this lecture Diuretic Classification Discussed with Mnemonics & Tricks.
Diuretics MCQ also discussed at the end of lecture.
Short and Easy trick to learn the classification of diuretics given.

Q. 1 Which of the following compound is Na+ / K+ /2Cl- co-transporter inhibitor
A. #Furosemide
B. #Benzthiazide
C. #Acetazolomide
D. #Amiloride

Q. 2 Which of the following compound is Na+ / Cl- Symporter inhibitor
A. Furosemide
B. #Xipamide
C. #Spironolactone
D. #Triamterene

Q. 3 Which of the following compound is #OsmoticDiuretic
A. Furosemide
B. Xipamide
C. Spironolactone
D. #Isosorbide

Q. 4 Which of the following compound is #AldosteroneAntagonist
A. Furosemide
B. Xipamide
C. Spironolactone
D. Acetazolamide

Q. 5 Which of the following compound is Potassium Sparing Diuretic
A. Furosemide
B. Xipamide
C. Spironolactone
D. Triamterene

1. A & B 2. B & C 3. C & D 4. A & C

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Diuretic Drugs and Mechnism of Action

Trick to remember Classification of Diuretics

Diuretics: Drugs which promote excretion of water & electrolytes from body through kidneys in
the form of urine are called diuretics.
Classification:-
1) Water & Osmotic agents
a) Electrolytes:-Sodium & Potassium salts
b) Non electrolytes:- Mannitol, Urea
2) Organic mercurials:- Mersalyl acid
3) Acidifying agents:-Ammonium chloride, Arginine hydrochloride
4) Alpha-beta unsaturated ketones:- Ethacrynic acid
5) Purinase & related compound: Caffeine
6) Sulphonamides:-
a) Carbonic anhydrase inhibitors-e.g. Acetazolamide
b) Benzothidiazines: – Chlorthiazide, Hydrochlorthiazide
c) Sulphamoyl benzoic acid derivatives e.g. Frusemide
7) Endocrine antagonists: (aldostrone antagonists) e.g. Spironolactone
8) Miscellaneous agents: – Trimaterene

Overview

Diuretics, also called water pills, are medications designed to increase the amount of water and salt expelled from the body as urine. There are three types of prescription diuretics. They’re often prescribed to help treat high blood pressure, but they’re used for other conditions as well.

What diuretics help treat
The most common condition treated with diuretics is high blood pressure. The drugs reduce the amount of fluid in your blood vessels, and this helps lower your blood pressure.

Other conditions are also treated with diuretics. Congestive heart failure, for instance, keeps your heart from pumping blood effectively throughout your body. This leads to a buildup of fluids in your body, which is called edema. Diuretics can help reduce this fluid buildup.

Types of diuretics
The three types of diuretic medications are called thiazide, loop, and potassium-sparing diuretics. All of them make your body excrete more fluids as urine.

Thiazide diuretics
Thiazides are the most commonly prescribed diuretics. They’re most often used to treat high blood pressure. These drugs not only decrease fluids, they also cause your blood vessels to relax.

Thiazides are sometimes taken with other medications used to lower blood pressure. Examples of thiazides include:

chlorthalidone
hydrochlorothiazide (Microzide)
metolazone
indapamide
Loop diuretics
Loop diuretics are often used to treat heart failure. Examples of these drugs include:

torsemide (Demadex)
furosemide (Lasix)
bumetanide
Potassium-sparing diuretics
Potassium-sparing diuretics reduce fluid levels in your body without causing you to lose potassium, an important nutrient.

The other types of diuretics cause you to lose potassium, which can lead to health problems such as arrhythmia. Potassium-sparing diuretics may be prescribed for people at risk of low potassium levels, such as those who take other medications that deplete potassium.

Potassium-sparing diuretics don’t reduce blood pressure as well as the other types of diuretics do. Therefore, your doctor may prescribe a potassium-sparing diuretic with another medication that also lowers blood pressure.

Examples of potassium-sparing diuretics include:

amiloride
triamterene (Dyrenium)
spironolactone (Aldactone)
eplerenone (Inspra)

Reference: https://www.healthline.com/health/diuretics

0.00 classification of diuretic drugs,
4.00 diuretics classification,
8.00 classification of diuretics

In this video, Dr Matt explains the five classes of diuretics including:
– Mechanism of action
– Clinical indications
– Adverse effects