Pharmacology

Renal Diuretics
Diuretics

Diuretics (also called 'water pills' or 'fluid pills' )

are drugs that increase urine production in the
kidneys, promoting the removal of salt and fluid
from the body. Diuretics increase urine flow
(cause diuresis).

There are several types of diuretics. Each type

works in a distinct way in a different part of the
kidney.
Types of Diuretics

• carbonic anhydrase inhibitors

• loop diuretics

• miscellaneous diuretics

• potassium-sparing diuretics

• thiazide diuretics
Carbonic Anhydrase Inhibitors

Cause increased excretion of bicarbonate with accompanying

sodium, potassium and water, resulting in an increased flow of
alkaline urine.

They inhibit transport of bicarbonate into the interstitium

from the proximal convoluted tubule. Therefore less sodium is
reabsorbed, causing greater sodium, bicarbonate and water
loss in the urine.

These agents are used more to treat glaucoma, as they tend

to reduce the formation of aqueous humor.
DIAMOX- A Carbonic Anhydrase Inhibitors

Diamox (Acetazolamide) reduces the activity of a protein in

your body called carbonic anhydrase. Blocking this protein
can help reduce the build-up of certain fluids in the body.
Acetazolamide is used in people with certain types of
glaucoma to reduce the amount of fluid in the eye, which
decreases pressure inside the eye.

Acetazolamide is also used as a diuretic ("water pill") in

people with congestive heart failure, to reduce the build-up
of fluid in the body. This build-up is called edema.
Loop Diuretics

This classification of diuretics prevent re-absorption of sodium and

chloride ions in the Loop of Henle. Common loop diuretics are:

Bumex - generic name: bumetanide

Edecrin - generic name: ethacrynic acid

Demadex -generic name: torsemide

Lasix - generic name: Furosemide

Loop diuretics are a powerful type of diuretic that work by inhibiting
the sodium-potassium-chloride (Na+/K+/2Cl) co-transporter in the
thick ascending loop of Henle (hence the name loop diuretic), which
is located in the kidneys. This reduces or abolishes sodium, chloride,
and potassium reabsorption, leading to increased loss of sodium,
chloride, and potassium into the nephron (the functional unit of a
kidney). As a result, water is also drawn into the nephron and urine
volume increases. Loop diuretics also reduce the reabsorption of
calcium and magnesium.

Loop diuretics are used in the treatment of edema due to heart

failure, liver disease and kidney disease. They may also be used to
treat high blood pressure.
Bumex

Bumex is a strong loop diuretic. . It works by forcing the kidney

to eliminate sodium, potassium, and water. Using too much of
Bumex can cause a loss of too much water and electrolytes
Common side effects of Bumex include:

•nausea, vomiting, loss of appetite, diarrhea;

•numbness or tingling, especially in your arms and legs;

•drowsiness, confusion;

•hearing problems, ringing in your ears;

•increased urination; or

•altered sense of taste.

Edecrin works by making the kidneys eliminate larger amounts of
electrolytes (especially sodium and potassium salts) and water
than normal (diuretic effect). It is useful for treating many
conditions in which salt and water retention (eg, edema, swelling)

Using too much of Edecrin can lead to serious water and mineral
loss. Therefore, it is important that you as the nurse monitor for
side effects.

Promptly notify the doctor if the patient becomes very thirsty, has
a dry mouth, becomes confused, or develops muscle
cramps/weakness.
Lasix (furosemide) is a loop diuretic (water pill) that prevents your
body from absorbing too much salt. This allows the salt to instead
be passed in your urine.
Lasix is used to treat fluid retention (edema) in people with
congestive heart failure, liver disease, or a kidney disorder such as
nephrotic syndrome, and high blood pressure (hypertension).

High doses of furosemide may cause irreversible hearing loss.

Other common Lasix side effects may include:
numbness or tingling;
headache, dizziness; or
blurred vision.
MISCELLANEOUS Diuretics

Mannitol (Osmitrol)- is an osmotic diuretic.

Used for preventing or treating excess body water in certain

kidney conditions, reducing swelling of the brain, or reducing
pressure in the eye.

•Osmitrol may cause dizziness. Lab tests, including blood

electrolytes, kidney function, lung function, heart function, and
blood counts, may be performed to check for side effects.
•Use Osmitrol with caution in the ELDERLY; they may be more
sensitive to its effects.
Potassium-sparing diuretics-

These diuretics increase diuresis (urination) without the loss of

potassium. They are generally weak diuretics and work by
interfering with the sodium-potassium exchange in the distal
convoluted tubule of the kidneys or as an antagonist at the
aldosterone receptor. Aldosterone promotes the retention of
sodium and water, so if potassium-sparing diuretics are used to
block this effect, more sodium and water can pass into the
collecting ducts of the kidneys, increasing diuresis.
Because potassium-sparing diuretics do not promote
the secretion of potassium during diuresis they do
not cause hypokalemia (low potassium levels).

However, there is a risk of hyperkalemia (high

potassium levels) if they are used with other agents
that also retain potassium, such as ACE inhibitors.

Potassium-sparing diuretics may be used alone or in

conjunction with loop or thiazide diuretics
Aldactone (spironolactone)
a potassium-sparing diuretic (water pill) that prevents your body
from absorbing too much salt and keeps your potassium levels
from getting too low.
Aldactone is used to diagnose or treat a condition in which you
have too much aldosterone in your body. Aldosterone is a
hormone produced by your adrenal glands to help regulate the
salt and water balance in your body.
Aldactone also treats fluid retention (edema) in people with
congestive heart failure, cirrhosis of the liver, or a kidney
disorder called nephrotic syndrome. This medication is also used
to treat or prevent hypokalemia (low potassium levels in the
blood).
Common Aldactone side effects may include:

•mild nausea or vomiting, diarrhea;

•breast swelling or tenderness;
•dizziness, headache, mild drowsiness;
•leg cramps; or
•impotence, difficulty having an erection
Thiazide diuretics

Act directly on the kidneys and promote diuresis (urine flow) by

inhibiting the sodium/chloride cotransporter located in the distal
convoluted tubule of a nephron (the functional unit of a kidney).
Thiazides decrease sodium reabsorption which increases fluid loss
in urine, which in turn decreases extracellular fluid and plasma
volume. This reduces cardiac output (how hard the heart has to
work to pump blood around the body) and lowers blood pressure.
Thiazides also work in other ways to lower blood
pressure. Thiazides also cause potassium loss while
retaining calcium.

Thiazides are usually used for their blood pressure

lowering effects because their diuretic activity is
relatively weak compared to some other types of
diuretic (such as loop diuretics).
Thiazide Diuretics

Lozol - (generic name Indapamide)

Microzide - (generic name Hydrochlorothiazide or HCTZ)

Zaroxolyn - (generic name Metolazone)

Diuril - (generic name Chlorothiazide)

MEDICINES that INTERACT with Lozol

•Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen) because

they may decrease Lozol's effectiveness.

•Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril) because

the risk of kidney problems may be increased.

•Diazoxide because the risk of high blood glucose levels, high uric acid
levels, or low blood pressure may be increased.

•Adrenocorticotropin hormone (ACTH) or corticosteroids (eg,

prednisone) because they may increase the risk of Lozol's side effects.
•Amantadine, antineoplastic agents (eg, cyclophosphamide), and
•digitalis glycosides (eg, digoxin), ketanserin, lithium, or other
blood pressure medicines because the risk of their side effects
may be increased by Lozol

•Lozol may cause drowsiness, dizziness, lightheadedness, fainting

or blurred vision. These effects may be worse if you take it with
alcohol or certain medicines. Use Lozol with caution. Do not
drive or perform other possibly unsafe tasks until you know how
you react to it.

•Lozol may be prescribed with a potassium supplement.

Side effects of other THIAZIDE MEDICATIONS INCLUDE:

Back pain; constipation; diarrhea; dizziness or

lightheadedness when siting up or standing; drowsiness;
headache; nausea; nervousness; runny nose; trouble
sleeping; upset stomach; vomiting; weakness.
Microzide (Hydrochlorothiazide) HCTZ – may raise blood sugar.

Signs of High Blood Sugar include:

Confusion
Drowsiness
Thirst
Flushing
Increased respiratory rate
Fruity like Breath

If these symptoms occur, tell the doctor right away.

End of Renal Diuretic Lecture