Diuretics in Heart Disease Overview
Diuretics play a crucial role in managing heart disease, with different types like osmotic, carbonic anhydrase inhibitors, loop, thiazide, and potassium-sparing diuretics each serving specific purposes. Osmotic diuretics, like Mannitol, are used in brain hemorrhages and certain shocks but can complicate heart failure. Carbonic anhydrase inhibitors, such as Acetazolamide, are beneficial for altitude sickness and glaucoma but may lead to side effects like encephalopathy. Loop diuretics, treated for congestive heart failure and edema, can cause electrolyte imbalances and renal failure. Thiazide diuretics like Hydrochlorothiazide help manage hypertension but come with potential side effects like gout and low blood pressure. Potassium-sparing diuretics, including Spironolactone, are used in heart failure and liver cirrhosis while focusing on potassium retention. Understanding the efficiency levels of diuretics, such as High, Low, and Moderate, is crucial. Additionally, diuretics in hypertension, like Hydchlorothiazide and Chlorthalidone, have varying impacts on potassium levels and overall effectiveness. Observing these classifications and considerations helps tailor diuretic therapy to individual patient needs.
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Presentation Transcript
Diuretics in Heart Disease Radhika Nandur Bukkapatnam March 12, 2021
Osmotic Diuretics (All over the nephron) Mannitol Used in brain hemorrhages and shocks of certain kinds Side effects (SE): Complicates CHF and dehydration New blood sugar medications: GLP 1 inhibitors: Trulicity, Byetta Used in weight loss, heart failure Can increase infections
Carbonic anhydrase Inhibitors (Proximal) Acetazolamide Used in altitude sickness Meniere s disease Sleep apnea Glaucoma SE: Encephalopathy, renal stones Hypokalemia (Low Potassium), hypophosphatemia (low Potassium)
Loop Diuretics (Loop of Henle) Torsemide Furosemide Bumetenide Ethacrynic acid (non Sulfa) Used in CHF, pedal edema SE: Low Sodium, Potassium, Magnesium, acute renal failure Hearing loss
Thiazide Diuretics (Distal) Hydrochlorothiazide (HCTZ) Chlorthalidone Indapamide Metolazone Removes Sodium, Potassium and Increase Calcium Causes diabetes, gout, sulfa related itching. Can cause low BP , low sodium and potassium
Potassium sparing diuretics Spironolactone Eplerenone Triamterene Potassium in retained and sodium removed in the distal tubule Used in Hypertension Systolic heart failure (Improves Ejection fraction) Used in Cirrhosis of the liver
Efficiency High Efficiency Diuretics Furosemide Torsemide Bumetenide Metolazone Low Efficiency Diuretics Mannitol Acetazolamide Moderate Efficiency Diuretics HCTZ Chlorthalidone Indapamide
Diuretics in Hypertension Hydchochlorothiazide (must check potassium, and watch for gout): First line therapy, esp AA Chlorthalidone (does not remove much gluid) Indapamide (causes low Potassium) Aldactone (Can raise Potassium, hair growth, dizziness)
Diuretics in CHF Diuretics cause forced diuresis in normal functioning kidneys These are the only drugs that provide rapid symptomatic relief They aid the working of Betablockers and ACE inhibitors and ARBs They relieve symptoms, but do not cure the underlying cause Mix loop diuretics with potassium sparing diuretics Mix loop diuretics with Metloazone and Potassium
Side effects of Loop and Thiazide diuretics Hypokalemia Hyponatremia Hypomagnesemia Hypo and hypercalcemia GI/ CNS side effects Acute renal failure Gout Hearing loss
