Diuretics NSAIDs

Drug interactions Diuretics" NSAIDs (e.g., ibuprofen)" Lamotrigine Clozapine" Contraceptives HIV protease inhibitors" ... 

K /Na exchange in distal tubule Dose Adults. 5-10 mg PO daily Peds. 0.625 mg/kg/d X in renal impair Caution [B, ] Contra T K, SCr >1.5 mg/dL, BUN >30 mg/dL, diabetic neuropathy Disp Tabs SE T K HA, dizziness, dehydration, impotence Interactions T Risk of hyperkalemia W/ ACEI, K-sparing diuretics, NSAIDs, K salt substitutes T effects OF Li, digoxin, antihypertensives, amantadine T risk of hypokalemia W/ licorice EMS Monitor ECG for signs of hyperkalemia (peaked T waves) T effects of digoxin OD May cause bradycardia, light-headedness, and syncope symptomatic and supportive... 

Er hromycin Sulfisoxazole (Eryzole, Pediazole) [Anti-infective, Macrolide/Sulfonamide] Uses Upper lower resp tract bacterial Infxns H. influenzae otitis media in children Infxns in PCN-allergic pts Action Macrolide antibiotic w/ sulfonamide Dose Adults. Based on erythromycin content 400 mg erythromycin/1200 mg sulfisoxazole PO q6h Feds > 2 mo. 40-50 mg/kg/d erythromycin 150 mg/kg/d sulfisoxazole PO -s- q6h max 2 g/d erythromycin or 6 g/d sulfisoxazole x 10 d in renal impair Caution [C (D if near term), +] w/ PO anticoagulants, hypoglycemics, phenytoin, cyclosporine Contra Infants <2 mo Disp Susp SE GI upset Additional Interactions T Effects of sulfonamides W/ ASA, diuretics, NSAIDs, probenecid EMS See Erythromycin OD See Erythromycin... 

Use with caution in older patients with Hepatic impairment Patients taking diuretics, NSAIDs or with nephropathy Sinus node dysfunction or Heart block, Osteoporosis, Unsteady gait, Urinary incontinence... 

Use with caution in oider patients with Renal impairment. Hypothyroidism, Dehydration, Hyponatremia, Patients taking diuretics, NSAIDs or ACE inhibitors... 

Geriatric Considerations - Summary Volume of distribution (Vd), clearance, and half-life are significantly altered in older adults. Lithium toxicity may occur within the usual adult therapeutic range. Older adults are likely to exhibit toxic effects at lower serum concentrations. Significantly lower doses are often efficacious for affective disorders than are used in younger adults. Monitor serum concentrations closely, increased riskof lithium toxicity when a diuretic, NSAID, or ACE Inhibitor is started in a patient already taking lithium. 

Drugs that can precipitate lactic acidosis in patients taking metformin include ACE inhibitors, thiazide diuretics, NSAIDs, and drugs such as furosemide, nifedipine, cimetidine, amiloride, triamterene, trimethoprim, and digoxin, which are all secreted in the renal tubules, compete with metformin, and can contribute to increased plasma metformin concentrations (76). 

Renal prostaglandins are involved in the mechanism of action of diuretics. NSAIDs block the synthesis of prostaglandins and hence can reduce the effects of diuretics. The combination may also increase the risk of NSAID-induced nephrotoxicity [5]. Patients with cirrhosis and ascites are at a greater risk of this interaction. 

The nonsalicylate NSAIDs can also affect renal function. Risk factors fc>r NSAID-induced acute renal failure include congestive heart feilure, glomerulonephritis, chronic renal insufficiency, cirrhosis, systemic lupus erythematosus, diabetes mellitus, significant atherosclerotic disease in the elderly and use of diuretics. NSAIDs can adversely affect cardiovascular homeostasis and can be a risk factor for the onset or exacerbation of heart feilure. 

Diuretics NSAIDs cause sodium retention and reduce diuretic and antihypertensive efficacy risk of hyperkalaemia with potassium-sparing diuretics increased nephrotoxicity risk (with indomethacin, ketorolac). 

SLC22A8) urate Drugs B-lactam antibiotics, diuretics, NSAIDs, quinidine... 

For patients who do not have the above findings, their renal failure should be considered acute until proven otherwise. In these individuals, a careful review of their recent medications, including nonprescription, complementary, and alternative medications is mandatory. Special attention should be focused on diuretics, NSAIDs, antihypertensives, and any recent additions or changes in the patient s medications. 

The antihypertensive effects of captopril can be antagonized (reduced) by (A) Angiotensin II receptor blockers Loop diuretics NSAIDs... 

ACE inhibitors or Loop diuretics NSAIDs Antihypertensive effects opposed... 

NSAiDs ACE inhibitors + NSAIDs Alpha blockers + NSAiDs Angiotensin II receptor antagonists + Aspirin or NSAiDs Beta blockers + Aspirin or NSAiDs Calcium-channel blockers + Aspirin or NSAiDs Guanethidine + NSAiDs Hydralazine + NSAiDs Thiazide and related diuretics + NSAiDs... 

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