Diuretic drugs thiazide

Hypertension therapy suggests wide use of diuretics, including thiazide diuretics, drugs related to them, such as metolazone (21.3.20) and indapamide (21.3.26), furosemide (21.4.11), loop diuretics, as well as potassium sparing diuretics—spironolactone (21.5.8), triamterene (21.5.13), and amyloride (21.5.18). 

Drugs that may affect penicillins include allopurinol, aminoglycosides (parenteral), aspirin, beta blockers, chloramphenicol, erythromycin, ethacrynic acid, furosemide, indomethacin, phenylbutazone, probenecid, sulfonamides, tetracycline, and thiazide diuretics. Drugs that may be affected by penicillins include aminoglycosides (parenteral), anticoagulants, beta blockers, chloramphenicol, cyclosporine, oral contraceptives, erythromycin, heparin, and vecuronium. 

Mixtures of benzodiazepines and thiazide diuretic drugs were separated by gradient elution CEC and identified using ESI-MS by Taylor and Teale [38], They used 330-500 x 50-75 pm i.d. colums packed with Hypersil ODS and Apex ODS and gradients of 50-80% acetonitrile in 5 mmol/1 aqueous ammonium acetate to elute the sample components. Benzodiazepines were detected in the positive ion mode using 1% acetic acid as the sheath liquid, whereas the thiazide diuretics were detected in the negative ion mode with 80% isopropanol in water as sheath liquid. 

Q5 Yes. Thiazide diuretic drugs are one of the treatments of choice for hypertension in elderly patients. Bendroflumethiazide, 2.5 mg daily, is commonly prescribed for hypertension in the United Kingdom. Although the thiazides have been in use for many years, their mechanism of action is not completely understood. They reduce renal reabsorption of sodium and water and so initially decrease blood volume they also dilate blood vessels and BP falls. However, blood volume may return to normal while the vasodilation and antihypertensive action remains. 

Orr LE. Potentiation of myelosuppression from cancer chemotherapy and thiazide diuretics. Drug Intell Clin Pharm (1981) 15, 967-70. 

In the patients followed-up for more than 5 years we have observed a progressive increase of serxim uric acid, probably due to the deterioration of the renal glomerular function (as shown in the rise of serum creatinine), to the advanced age of some of the patients, or to some other factors (arterial hypertension, medication with thiazide diuretic drugs, etc.) ... 

CEC-MS is used as an analytical tool for pharmaceutical analysis. The CEC-ESI-MS analysis and quantification of a potential drug candidate from 13 structurally related compounds in extracted plasma were reported by Paterson et al. [26]. The CEC colunm was packed with an experimental mixed mode stationary phase containing both Ci8 and sulfonic acid ligands. These phases promote stable electroosmotic flow across a wide range of pH values and allow a greater choice of buffer pH values. The mobile phase was acetonitrile/25 mM ammonium acetate (75 25) at pH 3.5 adjusted with acetic acid. Taylor et al. reported a CEC-ESI-MS analysis of mixtures of benzodiazepines, corticosteroids and thiazide diuretic drugs [27]. 

Thiazide diuretics have a venerable history as antihypertensive agents until the advent of the angiotensin-converting enzyme (ACE) inhibitors this class of drugs completely dominated first line therapy for hypertension. The size of thi.s market led until surprisingly recently to the syntheses of new sulfonamides related to the thiazides. Preparation of one of the last of these compounds starts by exhaustive reduction of the Diels-Alder adduct from cyclopentadiene and malei-mide (207). Nitrosation of the product (208), followed by reduction of the nitroso group of 209,... 

Tyrosine hydroxylase 1 Thiazide diuretics, a group of drugs with moderate diuretic activity, includes hydrochlorothiazide, chlorthalidone, and xipamide. They decrease active reabsorption of sodium and accompanying chloride by binding to the chloride site of the electroneutral Na+/CF cotransport system in the distal convoluted tubule and inhibiting its action. 

Diuretics are used in a variety of medical disorders. The primary health care provider selects the type of diuretic diat will most likely be effective for treatment of a specific disorder. In some instances, hypertension may be treated with the administration of an antihypertensive drug and a diuretic. The diuretics used for this combination tiierapy include the loop diuretics and the thiazides and related diuretics. The specific uses of each type of diuretic drug are discussed in the following sections. 

Amiloride (Midamor) is used in the treatment of CHF and hypertension and is often used with a thiazide diuretic. Spironolactone and triamterene are also used in tiie treatment of hypertension and edema caused by CHF, cirrhosis, and the nephrotic syndrome Amiloride, spironolactone, and triamterene are also available with hydrochlorothiazide, a thiazide diuretic that enhances tiie antihypertensive and diuretic effects of the drug combination while still conserving potassium. 

Additional adverse reactions of these drugs are listed in tiie Summary Drug Table Diuretics. When a potassium-sparing diuretic and a thiazide diuretic are given together, tiie adverse reactions associated with both drugp may be seen. 

Calcium is contraindicated in patients with hypercalcemia or ventricular fibrillation and in patients taking digitalis. Calcium is used cautiously in patients with cardiac disease. Hypercalcemia may occur when calcium is administered with the thiazide diuretics. When calcium is administered with atenolol there is a decrease in Hie effect of atenolol, possibly resulting in decreased beta blockade. There is an increased risk of digitalis toxicity when digitalis preparations are administered with calcium. The clinical effect of verapamil may be decreased when the drug is administered with calcium. Concurrent ingestion of spinach or cereal may decrease file absorption of calcium supplements. 

Some drugs can cause hyperuricemia and gout, such as thiazide diuretics, niacin, pyrazinamide, cyclosporine, and occasionally, low-dose aspirin. 

Some drugs can cause hyperuricemia and gout, such as thiazide diuretics, niacin, pyrazinamide, cyclosporine, and occasionally, low-dose aspirin. In most cases, these drugs block uric acid secretion in the kidney. Long-term consequences of gout and hyperuricemia include joint destruction, tophi, and nephrolithiasis. 

Thiazide diuretics such as chlorothiazide act on the distal tubule, a portion of the tubule that is permeable to sodium. The mechanism of action of these diuretics involves inhibition of NaCl reabsorption by blocking the Na+, CL symporter in the luminal membrane. The thiazide diuretics are only moderately effective due to the location of their site of action. Approximately 90% of the filtered Na+ ions have already been reabsorbed when the filtrate reaches the distal tubule. These drugs may be used for treatment of edema associated with heart, liver, and renal disease. Thiazide diuretics are also widely used for the treatment of hypertension. 

Acute drug-related hypersensitivity reactions (allergic responses) may cause tubulointerstitial nephritis, which will damage the tubules and interstitium. These reactions are most commonly observed with administration of methicillin and other synthetic antibiotics as well as furosemide and the thiazide diuretics. The onset of symptoms occurs in about 15 days. Symptoms include fever, eosinophilia, hematuria (blood in the urine), and proteinuria (proteins in the urine). Signs and symptoms of acute renal failure develop in about 50% of the cases. Discontinued use of the drug usually results in complete recovery however, some patients, especially the elderly, may experience permanent renal damage. 

The answer is c. (Katzung, pp 254-255.) Thiazide diuretics enhance K, Cl, Na, and Mg ion excretion Ca excretion appears to be reduced following chronic drug administration. Because thiazides inhibit NaCl re absorption in the early portion of the distal tubule, an increased load of Na and Cl ions is presented to the collecting duct, where some Na ions may be actively reabsorbed and K ions secreted, leading to increased K loss. 

The answers are 373-d, 374-c, 375-a. (Kut ung, pp 253— 254, 256-257.) The urinary excretion pattern of electrolytes for the thiazide diuretic agents (e.g., hydrochlorothiazide) shown in the table that accompanies the question is represented by choice a. These drugs block the reabsorption of Na and Cl at the early distal convoluted tubule of the nephron. In addition, they promote the excretion of K and Mg. At high doses, the thiazide diuretics (especially hydrochlorothiazide) may cause a... 

All drugs in this class have similar antihypertensive efficacy and fairly flat dose-response curves. The addition of low doses of a thiazide diuretic can increase efficacy significantly. 

Blockers (without ISA) are first-line therapy in chronic stable angina and have the ability to reduce BP, improve myocardial consumption, and decrease demand. Long-acting CCBs are either alternatives (the nondihy-dropyridines verapamil and diltiazem) or add-on therapy (dihydropy-ridines) to /1-blockers in chronic stable angina. Once ischemic symptoms are controlled with /1-blocker and/or CCB therapy, other antihypertensive drugs (e.g., ACE inhibitor, ARB) can be added to provide additional CV risk reduction. Thiazide diuretics may be added thereafter to provide additional BP lowering and further reduce CV risk. 

Patients with nephrogenic DI should decrease their ECF volume with a thiazide diuretic and dietary sodium restriction (2,000 mg/day), which often decreases urine volume by as much as 50%. Other treatment options include drugs with antidiuretic properties (Table 78-2). 

Many drugs can cause hypokalemia (Table 78-5) and it is most commonly seen with use of loop and thiazide diuretics. Other causes of hypokalemia include diarrhea, vomiting, and hypomagnesemia. 

Stohs and Scratchley (53) investigated several thin layer chromatography systems for thiazide diuretics and antihypertensive drugs, using silica gel G and a variety of detection reagents. 

A few important drugs, namely thiazide diuretics (e.g., chlorothiazide, hydroflumethiazide, bendroflumethiazide, benzthiazide, cyclothiazide etc.), neomycin, tetracyclines, methyldopa etc., help in enhancing the BUN levels perhaps due to interference with normal renal function,... 

---