Diuretic

Hazha S. Ameen MSc.

1. Thiazide and thiazide-like diuretics

Derived from sulfonamides, thiazide and thiazide-like diuretics are used

to treat edema and to prevent the development and recurrence of
renal calculi.
Thiazide diuretics include: • chlorothiazide • hydrochlorothiazide •
methyclothiazide • polythiazide. Thiazide-like diuretics include: •
chlorthalidone • indapamide • metolazone
Thiazide and thiazide-like diuretics promote the excretion of water by
preventing the reabsorption of sodium in the kidneys. As the kidneys
excrete the excess sodium, they excrete water along with it. These
drugs also increase the excretion of chloride, potassium, and
bicarbonate, which can result in electrolyte imbalances. With long-
term use, thiazide diuretics also lower blood pressure by causing
arteriolar vasodilation.
2.Loop diuretics
Pharmacokinetics
Loop diuretics are absorbed well in the GI tract and are rapidly
distributed. These diuretics are highly protein bound. They undergo
partial or complete metabolism in the liver, except for furosemide,
which is excreted primarily unchanged. Loop diuretics are excreted
primarily by the kidneys.
Sympatholytic drugs
Sympatholytic drugs include several different types of drugs that reduce
blood pressure by inhibiting or blocking the sympathetic nervous
system.
Pharmacokinetics
Most sympatholytic drugs are absorbed well from the
GI tract, distributed widely, metabolized in the liver,
and excreted primarily in urine.
Pharmacodynamics
All sympatholytic drugs inhibit stimulation of the
sympathetic nervous system.
This causes dilation of the peripheral blood vessels or
decreased cardiac output, thereby reducing blood
pressure.
 Pharmacotherapeutics
If blood pressure can’t be controlled by beta-adrenergic
blockers and diuretics, an alpha-adrenergic blocker
(such as prazosin) or a mixed alpha- and beta-
adrenergic blocker (such as labetalol) may be used.
Drug interactions
Sympatholytic drugs can create the following drug
interactions:
tricycle antidepressants may increase blood pressure.
• Carvedilol taken with antidiabetic agents may result
in an increased hypoglycemic effect.
• Carvedilol taken with calcium channel blockers and
digoxin may result in increased digoxin levels.
Adverse reactions
Adverse reactions to central-acting drugs include:
• depression
• drowsiness
• edema
• liver dysfunction
• numbness and tingling
• vertigo
others
• difficulty breathing
• excessive urination
• fainting or dizziness
• orthostatic hypotension
• drowsiness
• diarrhea
• headache.
Direct vasodilators

Direct vasodilators decrease systolic and diastolic blood

pressure.
They act on arteries, veins, or both. Examples of these
drugs include:
• diazoxide
• hydralazine
• minoxidil .
Pharmacodynamics
The direct vasodilators relax peripheral vascular smooth
muscles, causing the blood vessels to dilate.
This lowers blood pressure by increasing the diameter of the
blood vessels, reducing total peripheral resistance.