Diuretics Various

The 3-0X0 compounds 20 and their 1,1-dioxides are claimed to possess stronger diuretic activity than the thiazide diuretics. Various other 3-0X0 compounds have attracted interest as potential oncostatic agents. Recently a paper has appeared describing analgesic, antiinflammatory, and antipyretic effects produced by 4-alkyl-3-oxo derivatives of this heterocycle. ... 

Hyperaldosteronism is a syndrome caused by excessive secretion of aldosterone. It is characterized by renal loss of potassium. Sodium reabsorption in the kidney is increased and accompanied by an increase in extracellular fluid. Clinically, an increased blood pressure (hypertension) is observed. Primary hyperaldosteronism is caused by aldosterone-producing, benign adrenal tumors (Conn s syndrome). Secondary hyperaldosteronism is caused by activation of the renin-angiotensin-aldosterone system. Various dtugs, in particular diuretics, cause or exaggerate secondary peadosteronism. 

A diuretic is a drug that increases die secretion of urine (ie, water, electrolytes, and waste products) by die kidneys. Many conditions or diseases, such as heart failure, endocrine disturbances, and kidney and liver diseases can cause retention of excess fluid (edema). When die patient shows signs of excess fluid retention, die primary healdi care provider may order a diuretic. There are various types of diuretic drugs, and the primary healdi care provider selects the one that best suits die patient s needs and effectively reduces the amount of excess fluid in body tissues. 

Figure 46-1. The nephron is the functional unit of the kidney. Note the various tubules, the site of most diuretic activity. The loop of Henle is the site of action for the loop diuretics. Thiazide diuretics ad at the ascending portion of the loop of Henle and the distal tube of the nephron.

It is critically important to recognize that the treatments of hyperkalemia discussed thus far are transient, temporizing measures. They are intended to provide time to institute definitive therapy aimed at removing excess potassium from the body. Agents that increase potassium excretion from the body include sodium polystyrene sulfonate, loop diuretics, and hemodialysis or hemofiltration (used only in patients with renal failure). Sodium polystyrene sulfonate (Kayexalate , various manufacturers) can be given orally, via NG tube, or as a rectal retention enema and is dosed at 15 to 60 grams in four divided doses per day. 

Zechelius, Brunhild, Dipl. Ecotrophologist, Study of a Juice Fasting Treatment Based on Elderberry Juice, Elderflower Syrup, Elderberry Herbal tablets, Blood Purifying Drops, Diuretic Capsules and Various teas, Empirical Study, 1988. 

This drug exhibits strong diuretic action during both acidosis and alkalosis. It is used for arterial hypertension, in edematous syndromes of various genesis, congestive effects in cardiovascular insufficiency, nephrosis and nephritis, and toxicosis. It is especially recommended for hypertonic illnesses. It lowers intraocular pressure in a number of cases. Synonyms of this drug are clotride, diupres, diuril, and others. 

Furosemide is a highly effective and quick-acting diuretic whose action, hke all of the examined loop diuretics, is associated with blocking reabsorption of ions in the ascending bend of Henle s loop. It is used for edema syndrome of various origins, edema of the lungs and brain, chronic renal insufficiency, some forms of hypertonic crises, and poisoning by barbiturates and other compounds excreted mainly with urine. 

Clonidine is a selective Oj-adrenergic agonist that exhibits pronounced hypotensive action that is associated with a reduction of overall peripheral vascular resistance, decline in frequency of cardiac contraction, and reduced cardiac output. Clonidine is the drug of choice for treating various degrees of hypertension when used in combination with oral diuretics. 

It is used both independently and in combination with oral diuretics for treating various degrees of hypertension. A synonym of this drug is vitensin. 

Cross-sensitivity Cross-sensitivity between antibacterial sulfonamides and sulfonamide derivative diuretics, including acetazolamide and various thiazides, has been reported. 

The therapeutic efficacy of ATi-receptor blockers in hypertensive disease is well documented. The ATi-blockers are assumed to be as effective as various classes of well-known antihypertensives, such as jS-blockers, diuretics, ACE-inhibitors and calcium antagonists. A major advantage of the ATi-blockers may be their favourable pattern of side-effects, which so far does not appear to differ from the use of placebo. In particular the fact that ATi-blockers do not cause cough (in contrast to the ACE-inhibitors) appears to be an advantage. 

These agents inhibit sodium reabsorption at the level of the distal tubulus (Fig. 7). They are rather mild and slow-acting diuretics, mainly used in the longterm treatment of essential hypertension. The various compounds available all act via the same principle. There exist differences in the onset and duration of action. In practice very few drugs are sufficient, such as hydrochlorothiazide, a well-known example. Other thiazides are chlorthiazide, chlortalidon and indapamide. 

III.c.6.2. Resistant hypertension. Hypertension should be considered resistant if the BP cannot be reduced to below 140/90 mmHg in patients who adhere to a triple-drug regimen that includes a diuretic, with all three drugs in near maximal doses. For older patients with isolated SBP, resistance is defined as failure of an adequate triple-drug regimen to reduce SBP below 160 mmHg. The various causes of true resistance are listed in Table 9. One of the most common causes is volume overload as a result of inadequate diuretic therapy. Patients who have resistant hypertension or who are unable to tolerate antihypertensive therapy may benefit from referral to a hypertension specialist. 

This chapter includes an overview of the features of fluid balance and renal function that are essential to understanding diuretic action, a discussion of the uses of diuretics for treating abnormalities of fluid balance, and a detailed description of the various classes of diuretics. The practitioner who is armed with the knowledge of the mechanism of action of diuretic drugs and with appropriate recognition and respect for their potential side effects can use these compounds with a high degree of efficacy and safety. 

Hypercalcemia is a common clinical condition that can accompany a variety of other medical conditions, such as sarcoidosis, vitamin D toxicity, hyperparathyroidism, and malignancy. When calcium levels are exceptionally high, adjunctive measures for the control of plasma calcium levels are necessary, as this is a medical emergency. Various modalities in combination are used to treat this condition intravenous hydration with normal saline and the use of loop diuretics (e.g., furosemide) to induce calcium diuresis are the most important supportive measures. 

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