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Therapeutic Uses of Diuretics

Therapeutic Uses of Diuretics - Therapeutic Uses of...

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Therapeutic Uses of Diuretics Disease States Treatments Edematous States: - Accumulation of excess body fluid usually in ECF - Common in Heart Failure, Cirrhosis, and Renal Disease Example for Pt with severe edema due to heart failure - Start pt on LD (“high ceiling”) - Add TZ to LD for Inc Inc natriuresis - Add K+ sparing diuretic to LD and TZ for INC NATRIURESIS o Prevent or Dec severity of two important LD/TZ side effects Hypokalemi a Metabolic alkalosis o **when used alone in patients with (Inc Aldo) primary hyperaldosteronisum (adrenal adenomas) and secondary (HF, cirrhosis, and renal disease) o Spironolactone can be particularly effective b/c it is specifically blocking ALDO’s action Nonedematous States: - Hypertension TZs BP in HTN - in ECF volume - in TPVR - **Mech uncertain - ALLHAT promotes use of TZs as initial therapy Problem = therapy not personalized ACEI and ARB o (diabetes mellitus especially pt with proteinuria) o Bad for female at childbearing age B-blockers, ACEI, ARB in HF
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B-blockers / Ca+2 blocker for angina pectoris B-blocker patient with frequent migraines Chlorthalidone vs HCTZ o Chlorthalidone may have long duration of action (once a day keep BP lower than HCTZ when compared duration of a day) Nonedematous States: - Nephrolithiasis o presence of kidney stones – Ca+2 containing kidney stones o pt w/ Ca+2 kidney stones have idiopathic hypercalciuria (Inc urinary Ca+2 excretion for unknown reasons) TZs U(Ca+2)*V - TZ decrease
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