Name: Zalameda, Erika Therese T.

Program/Year/Section: BSN 2A

Drug Diary

Drugs Acting on the Renal System

Diuretics
Diuretics: Thiazides
Name of the Drug Mode of Action Indication Side Effects Nursing Considerations
Hydrochlorothiazide Action is on the renal To increase urine
- Dizziness - Monitor vital signs and serum
(Esidrix, HCTZ) distal tubules, promoting output; to treat
- Vertigo electrolytes, especially potassium,
sodium, potassium, and hypertension,- Weakness glucose, uric acid, and cholesterol
water excretion and edema from HF,
- Nausea levels. Report changes. If patient is
decreasing preload and hepatic cirrhosis,
- Vomiting taking digoxin and hypokalemia
cardiac output; also renal dysfunction
- Diarrhea occurs, digitalis toxicity frequently
decreases edema; acts - Abdominal results.
on arterioles, causing pain - Observe for signs and symptoms of
vasodilation, thus - hypokalemia (e.g., muscle
decreasing blood Hyperglycemi weakness, leg cramps, cardiac
pressure a dysrhythmias).
- Constipation - Monitor patient’s weight daily.
- Rash Weight gain of 2.2 lb. is
- equivalent to 1 L of body fluids.
Photosensitivi - Note urine output to determine fluid
ty loss or retention.
- Blurred
vision
Chlorthalidone Chlorthalidone prevents Indicated in the - Hypotension - Establish baseline BP
(Hygroton, reabsorption of sodium management of - Vasculitis measurements and check at regular
Thalitone) and chloride through hypertension intervals during period of dosage
inhibition of the Na+/Cl- either as the sole - Dizziness adjustment when chlorthalidone is
symporter in the cortical therapeutic agent upon used for hypertension.
diluting segment of the or to enhance the standing - Be alert to signs of hypokalemia.
ascending limb of the effect of other - Sun Older adult patients are more
loop of Henle. Reduction antihypertensive sensitivity sensitive to adverse effects of drug-
of sodium reabsorption drugs in the more - Skin induced diuresis because of age-
subsequently reduces severe forms of irritation form related changes in the
extracellular fluid and hypertension. the sun cardiovascular and renal systems.
plasma volume via an Also indicated as - Rash - Lab tests: Baseline and periodic:
osmotic, sodium-driven adjunctive - Hives serum electrolytes (particularly K,
diuresis. By increasing therapy in edema - Mg, Ca), serum uric acid, creatinine,
the delivery of sodium to associated with Inflammation BUN, and uric acid and blood
the distal renal tubule, congestive heart of blood glucose (especially in patients with
Chlorthalidone indirectly failure, hepatic vessels diabetes).
increases potassium cirrhosis, and - - Monitor lithium and digoxin levels
excretion via the sodium- corticosteroid and Hyperglycemi closely when either of these drugs is
potassium exchange estrogen therapy. a used concurrently.
mechanism. The exact Chlorthalidone -
mechanism of has also been Hyperuricemi
chlorthalidone's anti- found useful in a
hypertensive effect is edema due to - Glycosuria
under debate, however, various forms of - Gastric
it is thought that renal dysfunction, irritation
increased diuresis such as nephrotic - Constipation
results in decreased syndrome, acute - Diarrhea
plasma and extracellular glomerulonephriti - Loss of
fluid volume which s, and chronic appetite
therefore requires renal failure. - Nausea
decreased cardiac - Vomiting
output and overall lowers - Cramping
blood pressure. - Jaundice
Chlorthalidone has also - Spasticity
been shown to decrease - Weakness
 platelet aggregation and - Vertigo
vascular permeability, as - Headache
well as promote -
angiogenesis in vitro, Numbness/tin
which is thought to be ting
partly the result of - Blurred
reductions in carbonic vision
anhydrase–dependent -
pathways. These Restlessness
pathways may play a - Impotence
role in chlorthalidone's
cardiovascular risk
reduction effects.

Diuretics: Loop (High Ceiling) Diuretics

Name of the Drug Mode of Action Indication Side Effects Nursing Considerations
Furosemide Inhibition of sodium and To treat fluid - Nausea - Monitor urinary output to determine
(Lasix) water reabsorption from retention/fluid - Diarrhea body fluid gain or loss. Urinary output
loop of Henle and distal overload caused - Electrolyte should be at least 30 mL/h or 600
renal tubules; by HF, renal imbalances mL/24 h.
potassium, magnesium, dysfunction, - Vertigo - Notify health care provider if urine
and calcium also may be cirrhosis; - Abdominal output does not increase. Severe
excreted hypertension; cramping renal disorder may be present.
acute pulmonary - Constipation - Weigh patient to determine fluid
edema - Rash loss or gain. A loss of 2.2 lb. is
- Headache equivalent to a fluid loss of 1 L.
- Weakness - Monitor vital signs. Be alert for
- ECG marked decrease in blood pressure.
changes - Administer IV furosemide slowly;
- Blurred hearing loss may occur if rapidly
vision injected.
- Observe for signs and symptoms of
hypokalemia (less than 3.5 mEq/L),
 - such as muscle weakness,
Photosensitivi abdominal distention, leg cramps,
ty and/or cardiac dysrhythmias.
- Muscle - Monitor serum potassium levels,
cramping especially when patient is taking
digoxin. Hypokalemia enhances
action of digitalis, causing digitalis
toxicity.
Bumetanide Bumetanide interferes For the treatment - Dizziness - Monitor I&O and report onset of
(Bumex) with renal cAMP and/or of edema - Muscle oliguria or other changes in I&O ratio
inhibits the sodium- associated with cramps and pattern promptly.
potassium ATPase congestive heart - Tremor of - Monitor weight, BP, and pulse rate.
pump. Bumetanide failure, hepatic the hand Assess for hypovolemia by taking BP
appears to block the and renal disease - Dehydration and pulse rate while patient is lying,
active reabsorption of including the - Low blood sitting, and standing. Older adults are
chloride and possibly nephrotic pressure particularly at risk for hypovolemia
sodium in the ascending syndrome. (Hypotension with resulting thrombi and emboli.
loop of Henle, altering ) - Lab tests: Serum electrolytes, blood
electrolyte transfer in the - Itching studies, liver and kidney function
proximal tubule. This - Rash tests, uric acid (particularly patients
results in excretion of - Spinning with history of gout), and blood
sodium, chloride, and sensation glucose. Determine values initially
water and, hence, (Vertigo) and at regular intervals;
diuresis. - Vomiting measurements are especially
- Headache important in patients receiving
- Nausea prolonged treatment, high doses, or
- Weakness who are on sodium restriction.
- Abdominal - Monitor for S&S of
pain hypomagnesemia and hypokalemia
- Chest pain especially in those receiving digitalis
- Sweating or who have CHF, hepatic cirrhosis,
ascites, diarrhea, or potassium-
depleting nephropathy.
 - - Monitor patients with hepatic
Hyperventilati disease carefully for fluid and
on electrolyte imbalances which can
- Dry mouth precipitate encephalopathy
- Nipple (inappropriate behavior, altered
tenderness mood, impaired judgment, confusion,
- Diarrhea drowsiness, coma).
- Premature - Question patient about hearing
ejaculation difficulty or ear discomfort. Patients
- Difficulty at risk of ototoxic effects include
maintaining those receiving the drug IV,
an erection especially at high doses, those with
severely impaired renal function, and
those receiving other potentially
ototoxic or nephrotoxic drugs
- Monitor diabetics for loss of
glycemic control.
Ethacrynic Acid Ethacrynic acid inhibits For the treatment - Frequent - Observe closely when receiving the
(Edecrin) symport of sodium, of high blood urination drug by IV infusion. Rapid, copious
potassium, and chloride pressure and - Nausea diuresis following IV administration
primarily in the edema caused by - Vomiting can produce hypotension.
ascending limb of Henle, diseases like - Loss of - Monitor IV site closely.
but also in the proximal congestive heart appetite Extravasation of IV drug causes local
and distal tubules. This failure, liver - Stomach pain and tissue irritation from
pharmacological action failure, and pain dehydration and blood volume
results in excretion of kidney failure. - Difficulty depletion.
these ions, increased swallowing - Monitor BP during initial therapy.
urinary output, and - Thirst Because orthostatic hypotension can
reduction in extracellular - Muscle occur, supervise ambulation.
fluid. Diuretics also lower cramps - Monitor BP and pulse throughout
blood pressure initially - Weakness therapy in patients with impaired
by reducing plasma and - Headache cardiac function. Diuretic-induced
extracellular fluid - Diarrhea hypovolemia may reduce cardiac
volume; cardiac output output, and electrolyte loss promotes
also decreases, cardiotoxicity in those receiving
explaining its digitalis (cardiac) glycosides.
antihypertensive action. - Establish baseline weight prior to
Eventually, cardiac start of therapy; weigh patient under
output returns to normal standard conditions. Keep physician
with an accompanying informed of weight loss or gain in
decrease in peripheral excess of 1 kg (2 lb.)/d.
resistance. Its mode of - Monitor I&O ratio. Drug should be
action does not involve discontinued if excessive diuresis,
carbonic anhydrase oliguria, hematuria, or sudden
inhibition. profuse diarrhea occurs. Report
signs to physician.
- Lab tests: Determine baseline and
periodic blood count, serum
electrolytes, CO2, BUN, creatinine,
blood glucose, uric acid, and liver
function.
- Observe for and report S&S of
electrolyte imbalance: Anorexia,
nausea, vomiting, thirst, dry mouth,
polyuria, oliguria, weakness, fatigue,
dizziness, faintness, headache,
muscle cramps , paresthesia,
drowsiness, mental confusion.
Instruct patient to report these
symptoms promptly to physician.
- Report immediately possible signs
of thromboembolic complications.
- Impaired glucose tolerance with
hyperglycemia and glycosuria has
occurred in patients receiving doses
in excess of 200 mg/d.
Torsemide It acts by reducing the Indicated for the - Constipation - Monitor BP often and assess for
(Demadex) oxygen demand in the treatment of - Cough orthostatic hypotension; periodically
medullary thick edema - Decreased assess weight as an index of fluid
ascending loop of Henle associated with sex drive retention.
by inhibiting the congestive heart - Diarrhea - Lab tests: Monitor serum
Na+/K+/Cl- pump on the failure, renal or - Difficulty electrolytes, uric acid, blood glucose,
luminal cell membrane hepatic diseases. having an BUN, and creatinine periodically
surface. This action is From this orgasm throughout the course of therapy.
obtained by the binding condition, it has - Dizziness - Monitor coagulation parameters
of torsemide to a been observed - Electrolyte and lithium levels in patients on
chloride ion-binding site that torsemide is imbalance concurrent anticoagulant and/or
of the transport very effective in - Excessive or lithium therapy.
molecule. Torsemide is cases of kidney increased
known to have an effect failure. urination
in the renin-angiotensin- As well, - Headache
aldosterone system by torsemide is - Impotence
inhibiting the approved to be -
downstream cascade used as an Indigestion/h
after the activation of antihypertensive eartburn
angiotensin II. This agent either alone - Insomnia
inhibition will produce a or in combination - Joint pain
secondary effect marked with other - Nausea
by the reduction of the antihypertensives -
expression of . Nervousness
aldosterone synthase, - Runny or
TGF-B1 and stuffy nose
thromboxane A2 and a - Stomach
reduction on the upset
aldosterone receptor
binding.
Diuretics: Osmotic Diuretics
Name of the Drug Mode of Action Indication Side Effects Nursing Considerations
Mannitol Mannitol is an osmotic Used for the - Hypotension - Take care to avoid extravasation.
(Osmitrol) diuretic that is promotion of - Phlebitis Observe injection site for signs of
metabolically inert in diuresis before - Convulsions inflammation or edema.
humans and occurs irreversible renal - Chills - Lab tests: Monitor closely serum
naturally, as a sugar or failure becomes - Dizziness and urine electrolytes and kidney
sugar alcohol, in fruits established, the - Headache function during therapy.
and vegetables. reduction of - Acidosis - Measure I&O accurately and record
Mannitol elevates blood intracranial - to achieve proper fluid balance.
plasma osmolality, pressure, the Fluid/electroly - Monitor vital signs closely. Report
resulting in enhanced treatment of te imbalances significant changes in BP and signs
flow of water from cerebral edema, - Thirst of CHF.
tissues, including the and the promotion - Nausea - Monitor for possible indications of
brain and cerebrospinal of urinary - Vomiting fluid and electrolyte imbalance (e.g.,
fluid, into interstitial fluid excretion of toxic - Blurred thirst, muscle cramps or weakness,
and plasma. As a result, substances. vision paresthesia, and signs of CHF).
cerebral edema, It is also indicated - Urinary - Be alert to the possibility that a
elevated intracranial as add-on retention rebound increase in ICP sometimes
pressure, and maintenance - Runny nose occurs about 12 h after drug
cerebrospinal fluid therapy for - Skin rash administration. Patient may complain
volume and pressure improving - Hives of headache or confusion.
may be reduced. As a pulmonary - - Take accurate daily weight.
diuretic mannitol induces function in cystic Hypertension
diuresis because it is not fibrosis patients - Fever
reabsorbed in the renal aged 18 and over - Angina-like
tubule, thereby who have passed chest pains
increasing the osmolality the - Congestive
of the glomerular filtrate, BRONCHITOL heart failure
facilitating excretion of tolerance test
water, and inhibiting the (BTT). It is
renal tubular recommended
reabsorption of sodium, that patients take
 chloride, and other an orally inhaled
solutes. Mannitol short-acting
promotes the urinary bronchodilator 5-
excretion of toxic 15 minutes prior
materials and protects to every inhaled
against nephrotoxicity by mannitol dose.
preventing the
concentration of toxic
substances in the tubular
fluid. As an
Antiglaucoma agent
mannitol elevates blood
plasma osmolarity,
resulting in enhanced
flow of water from the
eye into plasma and a
consequent reduction in
intraocular pressure. As
a renal function
diagnostic aid mannitol
is freely filtered by the
glomeruli with less than
10% tubular
reabsorption. Therefore,
its urinary excretion rate
may serve as a
measurement of
glomerular filtration rate
(GFR).
Glycerin When administered It is used as a - Upset - Consult physician regarding fluid
(Osmoglyn) rectally, glycerin exerts a solvent, emollient, stomach intake in patients receiving drug for
hygroscopic and/or local pharmaceutical - Stomach elevated IOP. Although hypotonic
irritant action, drawing agent, and cramps fluids will relieve thirst and headache
 water from the tissues sweetening - Gas caused by the dehydrating action of
into the feces and agent. - Diarrhea glycerin, these fluids may nullify its
reflexively stimulating - Burning osmotic effect.
evacuation. Glycerin - Rectal - Monitor glycemic control in
decreases intraocular irritation diabetics. Drug may cause
pressure by creating an hyperglycemia
osmotic gradient
between the blood and
intraocular fluid, causing
fluid to move out of the
aqueous and vitreous
humors into the
bloodstream.

Diuretics: Carbonic Anhydrase Inhibitors

Name of the Drug Mode of Action Indication Side Effects Nursing Considerations
Acetazolamide The anticonvulsant For adjunctive - Dizziness - Establish baseline weight before
(Diamox) activity of Acetazolamide treatment of: - initial therapy and weigh daily
may depend on a direct edema due to Lightheadedn thereafter when used to treat edema.
inhibition of carbonic congestive heart ess - Monitor for S&S of: mild to severe
anhydrase in the CNS, failure; drug- - Increased metabolic acidosis; potassium loss
which decreases carbon induced edema; amount of which is greatest early in therapy.
dioxide tension in the centrencephalic urine - Monitor I&O especially when used
pulmonary alveoli, thus epilepsies; - Blurred with other diuretics.
increasing arterial chronic simple vision - Lab tests: Blood pH, blood gases,
oxygen tension. The (open-angle) - Dry mouth urinalysis, CBC, and serum
diuretic effect depends glaucoma - Drowsiness electrolytes (initially and periodically
on the inhibition of - Loss of during prolonged therapy or
carbonic anhydrase, appetite concomitant therapy with other
causing a reduction in - Changes in diuretics or digitalis).
the availability of the sense of
hydrogen ions for active taste
transport in the renal
 tubule lumen. This leads - Stomach
to alkaline urine and an upset
increase in the excretion - Nausea
of bicarbonate, sodium, - Vomiting
potassium, and water. - Diarrhea
- Headache
- Tingling
feeling
- Ringing in
the ears
(Tinnitus)
- Confusion
- Tiredness
Methazolamide Methazolamide is a For treatment of - Decreased - Supervise ambulation in older adult,
(Neptazane) potent inhibitor of chronic open- appetite since drug may cause vertigo.
carbonic anhydrase. angle glaucoma - Nausea - Assess patient's ability to perform
Inhibition of carbonic and acute angle- - Vomiting ADL since drug may cause fatigue
anhydrase in the ciliary closure glaucoma - Constipation and lethargy.
processes of the eye - Diarrhea - Lab tests: Obtain periodic serum
decreases aqueous - Changes in electrolytes, especially in older
humor secretion, taste adults. Monitor lithium levels with
presumably by slowing - Drowsiness concurrent administration of lithium
the formation of - Dizziness and methazolamide.
bicarbonate ions with - Fatigue
subsequent reduction in - Weakness
sodium and fluid -
transport. Nervousness
- Tremor
- Headache
- Confusion
- Changes in
vision
 - Increased
urination

Diuretics: Potassium-Sparing
Name of the Drug Mode of Action Indication Side Effects Nursing Considerations
Spironolactone Acts on distal renal To increase urine - Nausea - Note the half-life of spironolactone.
(Aldactone) tubules to promote output; to treat - Vomiting With a long half- life, drug dose is
sodium and water fluid - Diarrhea usually administered once a day,
excretion and potassium retention/overloa - Rash some- times twice a day.
retention d associated with - Dizziness - Monitor urinary output. Urine output
HF, hepatic - Headache should increase. Report if urine
cirrhosis, or - Weakness output is <30 mL/h or <600 mL/day.
nephrotic - Dry mouth - Record vital signs. Report abnormal
syndrome - changes.
Photosensitivi
- Observe for signs and symptoms of
ty hyperkalemia (serum potassium >5.3
mEq/L). Nausea, diarrhea,
abdominal cramps, numbness and
tingling of the hands and feet, leg
cramps, tachycardia and later
bradycardia, peaked narrow T wave
on electrocardiogram, or oliguria
may signal hyperkalemia.
- Administer spironolactone in the
morning and not in the evening to
avoid nocturia.
Eplerenone Eplerenone binds to the For improvement - Headache - Monitor cardiovascular status with
(Inspra) mineralocorticoid of survival of - Dizziness frequent BP determinations. Note
receptor and thereby stable patients - Diarrhea that BP lowering usually occurs
blocks the binding of with left - Stomach within 2 weeks with maximal
aldosterone (component ventricular pain antihypertensive effects achieved
of the renin-angiotensin- systolic - Nausea within 4 weeks.
aldosterone-system, or dysfunction - Fever
 RAAS). Aldosterone (ejection fraction - Chills - Lab tests: Monitor baseline and
synthesis, which occurs <40%) and - Body aches periodic serum potassium, serum
primarily in the adrenal clinical evidence - Unusual sodium, renal function tests, lipid
gland, is modulated by of congestive tiredness profile, and LFTs. Monitor type 2
multiple factors, heart failure after - Vaginal diabetics for microalbuminuria.
including angiotensin II an acute bleeding - Concurrent drugs: Monitor serum
and non-RAAS myocardial - Breast potassium levels more frequently
mediators such as infarction. swelling or when patient also receiving an ACE
adrenocorticotropic tenderness inhibitor or an angiotensin II receptor
hormone (ACTH) and antagonist. Monitor frequently for
potassium. Aldosterone lithium toxicity with concurrent use.
binds to - Withhold drug and notify physician
mineralocorticoid for any of the following: serum
receptors in both potassium >5.5 mEq/L, serum
epithelial (e.g., kidney) creatinine >2.0 mg/dL in males or
and nonepithelial (e.g., >1.8 mg/dL in females, creatinine
heart, blood vessels, and clearance <50 mL/min,
brain) tissues and microalbuminuria in type 2 diabetics.
increases blood
pressure through
induction of sodium
reabsorption and
possibly other
mechanisms.
Amiloride HCI Amiloride works by For use as - Nausea - Monitor for S&S of hyperkalemia
(Midamor) inhibiting sodium adjunctive - Vomiting and hyponatremia. Hyperkalemia
reabsorption in the distal treatment with - Stomach or occurs in about 10% of patients
convoluted tubules and thiazide diuretics abdominal receiving amiloride and serum
collecting ducts in the or other kaliuretic- pain potassium can rise suddenly and
kidneys by binding to the diuretic agents in - Loss of without warning. It is more common
amiloride-sensitive congestive heart appetite in older adults and patients with
sodium channels. This failure or - Gas diabetes or renal disease.
promotes the loss of hypertension. - Diarrhea
 sodium and water from - Headache - Lab tests: Serum potassium levels,
the body, but without - Dizziness particularly when therapy is initiated,
depleting potassium. - Skin rash whenever dosage adjustments are
Amiloride exerts its - Weakness made, and during any illness that
potassium sparing effect - Fatigue may affect kidney function.
through the inhibition of - Constipation Intermittent evaluations of BUN,
sodium reabsorption at - Muscle creatinine, and ECG for patients with
the distal convoluted cramps renal or hepatic dysfunction,
tubule, cortical collecting - Dizziness diabetes mellitus, older adults, or the
tubule and collecting - Cough debilitated.
duct; this decreases the - Shortness of
net negative potential of breath
the tubular lumen and - Impotence
reduces both potassium
and hydrogen secretion
and their subsequent
excretion. Amiloride is
not an aldosterone
antagonist and its effects
are seen even in the
absence of aldosterone.
Triamterene Triamterene inhibits the Indicated for the - Congestive - Monitor BP during periods of
(Dyrenium) epithelial sodium treatment of heart failure dosage adjustment. Hypotensive
channels (ENaC) edema - Swelling reactions, although rare, have been
located on the luminal associated with - Low blood reported. Take care with ambulation,
side in the late distal congestive heart pressure particularly for older adults.
convoluted tubule and failure, cirrhosis - Dizziness - Weigh patient under standard
collecting tubule, which of the liver, and - Fatigue conditions, prior to drug initiation and
are transmembrane the nephrotic - Headache daily during therapy.
channels that normally syndrome; also in - Light - Diuretic response usually occurs on
promotes sodium uptake steroid-induced sensitivity first day of therapy; maximum effect
and potassium edema, idiopathic - Rash may not occur for several days.
secretion. In the late edema, and - Diarrhea
distal tubule to the edema due to - Nausea - Monitor and report oliguria and
collecting duct, sodium secondary - Vomiting unusual changes in I&O ratio.
ions are actively hyperaldosteronis - Uric acid in Consult physician regarding
reabsorbed via ENaC on m. the blood allowable fluid intake.
the luminal membrane Triamterene in - Kidney - Be alert for S&S of kidney stone
and are extruded out of combination with damage formation; reported in patients taking
the cell into the hydrochlorothiazi - high doses or who have low urine
peritubular medium by a de is indicated for Gastrointestin volume and increased urine acidity.
sodium-potassium the management al upset - Lab tests: Obtain baseline and
exchange pump, the Na- of hypertension or - Low periodic determinations of serum
K-ATPase, with water treatment of platelets in potassium and other electrolytes.
following passively. edema in patients the blood Obtain periodic kidney function
Triamterene exerts a who develop - Kidney (BUN, serum creatinine) in patients
diuretic effect on the hypokalemia stones with known or suspected renal
distal renal tubule to following - Folic acid insufficiency. Obtain periodic blood
inhibit the reabsorption hydrochlorothiazi antagonism studies in patients on prolonged
of sodium ions in de monotherapy, - Anaphylaxis therapy or with cirrhosis since both
exchange for potassium and in patients - Acute are prone to develop megaloblastic
and hydrogen ions and who require kidney failure anemia.
its natriuretic activity is thiazide diuretic - Jaundice - Observe for S&S of hyperkalemia,
limited by the amount of and in whom the - Weakness particularly in patients with renal
sodium reaching its site development of - Dry mouth insufficiency, on high-dose or
of action. Its action is hypokalemia - prolonged therapy, older adults, and
antagonistic to that of cannot be risked. Megaloblastic those with diabetes.
adrenal Triamterene anemia - Do not give to a diabetic patient
mineralocorticoids, such allows the unless blood glucose is controlled
as aldosterone, but it is maintenance of because triamterene may increase
not an inhibitor or potassium blood glucose. Monitor patients
antagonist of balance when closely.
aldosterone. given in
Triamterene maintains combination with
or increases the sodium loop diuretics and
excretion, thereby thiazides.
increasing the excretion
of water, and reduces
the excess loss of
potassium, hydrogen
and chloride ions by
inhibiting the distal
tubular exchange
mechanism. Due to its
diuretic effect,
triamterene rapidly and
reversibly reduces the
lumen-negative
transepithelial potential
difference by almost
complete abolition of
Na+ conductance
without altering K+
conductance. This
reduces the driving force
for potassium movement
into the tubular lumen
and thus decreases
potassium excretion.
Triamterene is similar in
action to amiloride but,
unlike amiloride,
increases the urinary
excretion of magnesium.