Loop or high-ceiling diuretics

Loop or High-Ceiling Diuretics Bumetanlde, U5P (Bumex, Generic)... 

Loop or high-ceiling diuretics inhibit the transport of sodium in the ascending Loop of Henle and result in the excretion of sodium and water, potassium, calcium, and magnesium. Loop diuretics are more effective with inhibiting reabsorption of sodium than thiazides diuretics. 

Loop or high-ceiling diuretics are potent and cause marked depletion of water and electrolytes. They are more potent than thiazides and two to three times more effective when inhibiting reabsorption of sodium. However, loop or high-ceiling diuretics are less effective as antihypertensive agents. 

Loop or high-ceiling diuretics can increase renal blood flow up to 40%. This dmg is commonly the choice for patients who have decreased kidney function or end-stage renal disease. 

Loop or high-ceiling diuretics cause excretion of calcium and have a great saluretic (sodium-losing) affect that causes rapid diuresis, decreases vascular fluid volume, and decreased cardiac output and blood pressure. 

Loop or high-ceiling diuretics causes a vasodilatory effect and increase renal blood flow before diuresis. The most common side effects are fluid and electrolyte imbalances such as hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, and hypochloremia. Hypochloremic metabolic alkalosis may result. Orthostatic hypotension can also occur. Thrombocytopenia, skin disturbances, and transient deafness are seen rarely. Prolonged use can cause thiamine deficiency. 

All diuretics that act at site 2 arc equally efficacious and far more efficacious than diuretics that act at sites I. 3. or 4. As mentioned above, because of their site of action and efficacy, these agents are commonly referred to as loop and high-ceiling diuretics. ... 

Loop (high ceiling) diuretics 159 Benzothiadiazides or thiazide-type diuretics 163... 

Similar to the other high-ceiling diuretics, ethacrynic acid inhibits the NaVKV2CI symporter in the ascending limb of the loop of Henie to promote a marked diuresis. Sodium, chloride, potassium, and calcium excretion are increased following oral or intravenous administration of ethacrynic acid. Oral administration of ethacrynic acid results in diuresis within 1 hour and a duration of action of 6 to 8 hours. Toxicity induced by ethacrynic acid is similar to that induced by furosemide and bumetanide. Ethacrynic acid is not widely used, however, because it induces a greater incidence of ototoxicity and more serious gastrointestinal effects than those of furosemide or bumetanide. 

Selection of a diuretic would be based on the drug s ability to mobilize edema fluid and to help reduce the workload on the heart. Thiazide and loop (high-ceiling) diuretics are effective in mobilizing edema fluid and could be used in this patient. Osmotic diuretics are not effective at mobilizing edema fluid and will expand extracellular fluid, which would worsen the workload on the heart. Carbonic anhydrase inhibitors are weak diuretics and would not provide adequate diuresis to effectively reduce the workload on the heart. Potassium-sparing diuretics also are less effective than thiazides or loop diuretics in mobilizing edema fluid and would not be a diuretic of first choice in this patient. 

Diuretics are needed to return to normal the expanded extracellular volume that other antihypertensive agents produce, such as fluid retention and blood volume expansion, via compensatory mechanisms of the body. The loss of efficacy of antihypertensive agents can be restored if a diuretic is used concomitandy. In the treatment of hypertension, high ceiling or loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, are no more efficacious than the thiazide-type of diuretics. In fact, these agents cause more side effects, such as dehydration, metaboHc alkalosis, etc, and therefore, should not be used except in situations where rapid elimination of duid volume is cleady indicated. 

Potassium Sparing Diuretics. Triamterene and amiloride, potassium sparing diuretics, by themselves produce only slight antihypertensive effects. The main use is to prevent or to treat the hypokalemia induced by thiazide-type and high ceiling loop diuretics, such as furosemide and bumetanide. 

Ascites. Patients with cirrhosis, especially fiver cirrhosis, very often develop ascites, ie, accumulation of fluid in the peritoneal cavity. This is the final event resulting from the hemodynamic disturbances in the systemic and splanchnic circulations that lead to sodium and water retention. When therapy with a low sodium diet fails, the dmg of choice for the treatment of ascites is furosemide, a high ceiling (loop) diuretic, or spironolactone, an aldosterone receptor antagonist/potassium-sparing diuretic. 

Furosemide is the classic member of the group of so-called high-ceiling or loop diuretics, which can achieve a much greater peak diuresis than the thiazides. It is widely and frequently used both orally and parenterally over a wider dosage range than the thiazide diuretics, because its concentration-effect curve is steeper and because it is effective in patients with moderate renal insufficiency (creatinine clearance 5-25 ml/minute), in... 

No interactions are expected at standard therapeutic doses. At higher doses or with long-term use, licorice may potentiate potassium depletion of high-ceiling loop diuretics and thiazide diuretics, stimulant laxatives (Mills and Bone 2005), and corticosteroids such as prednisolone (Cheng et al. 2004 De Smet 1993), and may potentiate the action of cardiac glycosides such as digoxin (Kelly 1990). 

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