Topic 8.1

NSG318 PPT 8.1

Purposes of diuretics

Reduce hypertension and decrease edema.

Types of diuretics

Thiazide and thiazide-like, Loop or high-ceiling, Osmotic, Carbonic anhydrase inhibitor, and Potassium-sparing.

Thiazide and Thiazide-Like Diuretics

Prototype: hydrochlorothiazide. Uses: To increase urine output and to treat hypertension, edema, heart failure, nephrotic syndrome, and ascites. Mode of Action: Act on renal distal tubules. Promote sodium, chloride, and water excretion. Decreases preload and cardiac output, edema. Acts on arterioles and causes vasodilation, which decreases BP.

Loop (high-ceiling) Diuretics

Prototype: furosemide (Lasix). Uses: To treat heart failure, renal dysfunction, hypertension, nephrotic syndrome, acute pulmonary and peripheral edema. Mode of Action: Inhibition of sodium and water reabsorption from the loop of Henle and distal renal tubules; potassium, magnesium, and calcium may be excreted.

Potassium-Sparing Diuretics

Prototype: spironolactone. Uses: Peripheral and pulmonary edema, circulatory overload, hypertension, heart failure, ascites, hypokalemia. Mode of Action: Acts on distal renal tubules to promote sodium and water excretion and potassium retention.

Nonpharmacological control of hypertension

Stress-reduction techniques, exercise, salt restriction, decreased alcohol ingestion, and smoking cessation.

Antihypertensive Drugs

Diuretics, Thiazides (hydrochlorothiazide), Loop diuretics (furosemide), Combination of thiazide with potassium-sparing diuretics, Combination of thiazide with other antihypertensive drugs, ACE inhibitors, beta blockers, ARBs.

Antihypertensive: Beta1 Blocker

Prototype: metoprolol (Lopressor). Uses: To control HTN, acute MI, angina, and heart failure. Mode of Action: Promotes BP reduction via beta 1-blocking effects

Alpha-adrenergic Blockers

Prototype: prazosin hydrochloride (Minipress). Uses: To control hypertension. Mode of Action: Dilates peripheral blood vessels by blocking alpha-adrenergic receptors.

Angiotensin-Converting Enzyme (ACE) Inhibitors

Prototype: lisinopril (Prinvil). Uses: Hypertension. Action: Inhibits the formation of angiotensin II and blocks the release of aldosterone.

Angiotensin II Receptor Blockers (ARBs)

Prototype: valsartan. Use: Treatment of hypertension and heart failure. Mode of Action: Potent vasodilator that inhibits binding of angiotensin II.

COMPLEMENTARY AND ALTERNATIVE THERAPIES DECREASE BP

Hawthorne, Goldenseal, and Parsley

COMPLEMENTARY AND ALTERNATIVE THERAPIES INCREASE BP

Licorice antagonizes the effects of antihypertensive drugs.