Selection of the appropriate medication and dose optimizes the administration of diuretics in a variety of circumstances, particularly salt-sensitive hypertension, which is prevalent in the obese, the elderly, and black patients. Wargo and W. Therefore, when furosemide is administered by continuous infusion, an intravenous loading dose of furosemide is required to increase the initial intratubular concentration of furosemide 4, 7. Nephrotic syndrome causes retention through defective glomerular barriers, induction of the distal nephron and altered capillary permeability [ 2 ]. Fiaccadori, G.
George C. Roush, Domenic A. Diuretics are the second most commonly prescribed class of antihypertensive medication, and thiazide-related diuretics have increased at a rate greater than that of antihypertensive medications as a whole. The latest hypertension guidelines have underscored the importance of diuretics for all patients, but particularly for those with salt-sensitive and resistant hypertension. HCTZ is 4. Combined with thiazide-type diuretics, potassium-sparing agents decrease ventricular ectopy and reduce the risk for sudden cardiac death relative to thiazide-type diuretics used alone. A recent synthesis of 44 trials has shown that the relative potencies in milligrams among spironolactone SPIR, amiloride, and eplerenone EPLER are approximately from 25 to 10 to , respectively, which may be important when SPIR is poorly tolerated. SPIR reduces proteinuria beyond that provided by other renin angiotensin aldosterone inhibitors.
Log in to view full text. If you’re not a subscriber, you can. Colleague’s E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. Diuretics are among the most commonly used drugs. They increase the rate of urine flow and sodium excretion and are used to induce negative fluid and sodium balance in a variety of clinical situations, including hypertension, heart failure, renal failure, nephrotic syndrome, and cirrhosis. It is essential for clinicians to understand the mechanism of action of various diuretics to be able to maximize the efficacy of these agents when used as monotherapy and in combination with agents that have different targets of action in the kidney. The pharmacology of commonly used diuretics and the renal anatomy and physiology relevant to diuretic effects are reviewed.
Diuretics play significant role in pharmacology and treatment options in medicine. This paper aims to review and evaluate the clinical use of diuretics in conditions that lead to fluid overload in the body such as cardiac failure, cirrhosis, and nephrotic syndrome. To know the principles of treatment it is essential to understand the underlying pathophysiological mechanisms that cause the need of diuresis in the human body. Various classes of diuretics exist, each having a unique mode of action.