Prepared by Mr Le Andre Charles

Dip Animal Health and Veterinary Public Health.

BSc Agriculture- major Animal Science
BSc Pharmacy.
 Are widely used in the treatment (RX) of
hypertension and heart failure (HF).
 Act by increasing the volume of urine
production.
 Still considered first line drugs despite many
advances in pharmacotherapy.
 Are used alone or in combination with other
antihypertensive drugs to enhance their
effectiveness.
 They are primarily three types of Diuretics;

1. Loop Diuretics
2. Thiazide and Thiazide like Diuretics
3. Potassium Sparing Diuretics.
 Are the most effective diuretics due to >
diuresis.
 Act by blocking the reabsorption of Na+ and
Cl- in the loop of Henle.
 When given IV the have the ability to cause
large amounts of fluids to be excreted by the
kidneys in a very short time.
 Used to reduce edema associated with HF,
hepatic cirrhosis and chronic renal failure.
 Bumetanide (Bumex)- PO: 0.5-2mg QID, max
10mg/day & IV/IM: 0.5-1mg over 1-2 mins.
 Ethacrynic Acid (Edecrin)- PO: 50-100mg BID
to QID, max 400mg/day & IV 0.5-1mg/kg.
 Furosemide (Lasix)- PO: 20-80mg in one or
more divided doses, max 600mg/day & IV/IM
20-40mg in one or more doses, max
600mg/day
 Torsemide (Demadex)- PO: 10-20mg
QID,max 200mg/day.
 Dehydration
 Dysrhythmias due to hypokalemia hence K+
levels must be monitored.
 K+ loss is of particular importance to patients
taking Digoxin.
 Ototoxicity (rare) but other ototoxic drugs
(Aminoglycosides) should be avoided.
 Comprise the largest and most commonly
prescribed class of diuretics.
 Act on the distal tubule to block Na+
reabsorption and > K+ and water excretion.
 Primarily used to treat mild to moderate
hypertension, HF, liver and renal failures.
 All drugs within this class have the same
efficacy but vary in potency and duration of
action.
 Chlorthiazide (Diuril)-PO:250mg-1g/day & IV
250mg-1g/ day in 1-2 divided doses.
 Hydrochlorothiazide (HCTZ)-PO: 25-
200mg/day in 1-3 divided doses.
 Bendroflumathiazide (Naturetin) PO: 2.5-
20mg/day in 1-2 divided doses.
 Indapamide (Natrilix) PO: 2.5-5mg QID
 Chlorthalidone (Hydroton) PO: 50-100mg
QID.
 Hyperkalemia due to > K+ excretion.
 Hyperglycemia due to < effectiveness of
antidiabetic drugs.
 Uric acid level may > therefore patients must
be monitored for signs and symptoms of
Gout.
 May > lipid levels so these should be use with
caution in patients with existing
hyperlipidemia.
 Produce mild diuresis.
 Normally Na+ and K+ are exchanged in the
distal tubule; Na+ is reabsorbed back into the
body and K+ is secreted into the tubule. K
sparing diuretics block this exchange causing
Na to stay in the tubule and ultimately be
excreted in the urine. When Na is blocked the
body retains K.
 Amiloride HCL (Midamor)- PO: 5mg QID, max
20mg/day.

 Spironolactone (Aldactone)- PO: 25-400mg

QID- BID.

 Triamterene (Dyrenium)- PO: 100mg BID,

max 300mg/day.
 Hyperkalemia marked by muscle weakness,
ventricular tachycardia or fibrilation.

 K supplements must be avoided.

 Give with food to increase absorption of drug.

 Acetazolamide (Diamox) which is a Carbonic
Anhydrase Inhibitor used to < intraocular
fluid pressure in patients with open angle
glaucoma. Given PO 250-375mg/day.

 Mannitol (Osmitrol) is used to reduce

intracranial pressure and maintain urine flow
during long surgeries. It is very potent and
only given IV at 100g over 2-6 hrs.
 Pharmacology for nurses-a pathophysiologic
approach by Michael Adams, Dianne
Josephson and Leland Holland Jr.