ABSTRACT
Diuretics are among the most commonly used drugs. They primarily block active reabsorption of sodium at different sites in the nephron, thereby increasing urinary losses of NaCl and H2O. This ability to induce a negative fluid balance has made these drugs particularly useful in the treatment of a variety of conditions, edematous: congestive heart failure, nephrotic syndrome, liver cirrhosis, chronic renal failure, idiopathic edema, and nonedematous states: hypertension, hypercalcemia, nephrolithiasis, and syndrome of inappropriate antidiuretic hormone secretion. The diuretics are generally divided into three major classes, which are distinguished by the sites at which they impair the sodium reabsorption: loop diuretics at the thick ascending limb of the loop of Henle, thiazide-type diuretics at the distal tubule, and potassium-sparing diuretics at the cortical collecting tubule. The loop diuretics that are generally the most potent are furosemide, torasemide, and ethacrynic acid. The thiazide-type diuretics include chlorothiazide and metolazone. Spironolactone and amiloride are potassium-sparing diuretics. Diuretics should be started at an effective single dose and given intermittently with a subsequent increase in dose or frequency of administration. As a general rule, the rate of diuresis in an edematous patient should not exceed 1 to 2kg weight loss per day. In renal failure patients, loop diuretics at a higher than normal dose are required to get the desired diuretic effect because the diuretic excretion is often limited, in part due to the retention of organic anions. The patients with liver cirrhosis are responsive to spironolactone. After the administration of diuretics, even if a net diuresis is induced, the response is short-lived as a new steady state is rapidly established because the diuretic-induced sodium losses are counterbalanced by neuro-humorally mediated increases in tubular reabsorption at nondiuretic sensitive sites. This process is called compensatory antidiuresis or diuretic tolerance. Therefore sodium restriction is important when a patient is taking loop diuretics, and the concurrent use of a thiazide diuretic can inhibit downstream NaCl reabsorption, resulting in an exaggeration of diuresis. The most common side-effects are those encountered in virtually all the effective drugs: hypovolemia, hypokalemia and potassium depletion, hyperuricemia, and metabolic alkalosis. Other side-effects include hyperglycemia, hyperlipidemia, hyperuricemia, ototoxicity and sexual dysfunction. In addition, diuretics have the potential to increase the toxicity of several other agents. Nonsteroidal antiinflammatory drugs may antagonize the natriuretic effects of diuretics. The combination of potassium-sparing diuretics and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may result in severe hyperkalemia.
Subject(s)
Humans , Alkalosis , Amiloride , Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors , Anions , Chlorothiazide , Diuresis , Diuretics , Edema , Ethacrynic Acid , Extremities , Furosemide , Heart Failure , Hypercalcemia , Hyperglycemia , Hyperkalemia , Hyperlipidemias , Hypertension , Hyperuricemia , Hypokalemia , Hypovolemia , Kidney Failure, Chronic , Liver Cirrhosis , Loop of Henle , Metolazone , Natriuretic Agents , Nephrolithiasis , Nephrons , Nephrotic Syndrome , Potassium , Renal Insufficiency , Sodium , Sodium Potassium Chloride Symporter Inhibitors , Spironolactone , Water-Electrolyte Balance , Weight LossABSTRACT
La hipertension arterial (HTA) es un factor de riesgo para enfermedad cardiovascular y es considerada como un problema de salud pública. La HTA constituye una sobrecarga de presión, que induce en el corazón una serie de modificaciones anatómicas y funcionales para compensar esta sobrecarga y esto se logra a través de la hipertrofia del ventrículo izquierdo (HVI). La HVI constituye un factor de riesgo independiente para mortalidad cardiovascular en pacientes con HTA; por consiguiente, la utilización de diferentes fármacos antihipertensivos, pueden reducir y/o revertir la HVI. Evaluar la eficacia de la combinación de bisoprolol con hidroclorotiazida en la reducción de la presión arterial (PA) y masa del ventrículo izquierdo (MVI), en pacientes con HTA y compararlo con el uso de un IECA. El presente estudio clínico controlado y doble ciego, evaluó la regresión de la HVI, en 19 pacientes hipertensos asignados al azar en dos: grupo A (n=10) recibió la combinación de bisoprolol con hidroclorotiazida y el grupo B (n=9) recibió enalapril, durante 6 meses, 16 pacientes completaron el estudio. Se observó reducción significativa de la MVI al 3er y 6to mes de tratamiento en los pacientes tratados con la combinación de bisoprolol con hidroclorotiazida (p<0,05). La reducción de la HVI en los pacientes tratados enalapril ocurrió al 6to mes y no fue significativo (p>0,05). Ambos medicamentos redujeron la PA (p<0,05) 7 pero esta fue mayor en el grupo A (bisoprolol con hidroclorotiazida). La combinación de bisoprolol con hidroclorotiazida es más efectiva en la reducción de la PA y MVI en pacientes con HTA estadio I y II que el enalapril
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Bisoprolol , Chlorothiazide , Efficacy , Enalapril , Hypertension/diagnosis , Hypertension/therapy , Blood Pressure , Pharmacology , Therapeutics , VenezuelaABSTRACT
Se comunica una paciente de 44 años de edad que presentaba lesiones kaposiformes profusas, manifestación cutánea infrecuente del síndrome antifosfolípido. Se describen las características clínicas, los hallazgos de laboratorio, así como el tratamiento de esta enfermedad multisistémica
Subject(s)
Humans , Adult , Female , Antibodies, Antiphospholipid , Medicamentous Disease , Antiphospholipid Syndrome/diagnosis , Thrombosis , Contraceptives, Oral, Synthetic/adverse effects , Calcium Channel Blockers , Chlorothiazide , Chlorpromazine , Contraceptives, Oral , Contraceptives, Oral, Hormonal , Ethosuximide , Phenytoin/adverse effects , Hydralazine , Interferon-alpha , Penicillins , Phenothiazines , Procainamide , Pyrimethamine , Quinidine , Quinine , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/drug therapy , StreptomycinABSTRACT
Background: If phototoxic:ity can be predetermined in vitro, the information will aid in prognosticating whether or not caimpounds have a photosensitizing pczrlial. OBJECTIVE: For the evaluation of the phototoxic potentials of reral drugs, we performed the Candida albicans test and the photohemolysis test. METHODS: The Candida altiicans test is based on growth inhibtion of Candida albicans after application of the drug and ultraviolet light A( UVA ) irradiatior and the photohemolysis test is based on hemolysis of red blood cells caused by irradiation ir the presence of photosensitizing compounds. In the Candida albicans test, clear zones around the drug patches were evaluated, which means positive results for the phototoxic potential of the drugs. In the photohemolysis test, the amounts of hemolysis were evaluated by measuring the relar absorbance at 540nm using a spectrophotometer. RESULTS: In the Candida albicans test, ibuprofen, naldix acid, chlorpromazine and thiodiphenylamine showed positive results, whereas others did not the photohemolysis test, griseofulvin, ibuprofen and nalicdixic acid showed increased amounts hemolysis at UVA and ultraviolet light B(UVB) irracliation, and chlorpromazine, thiodiphenylaiair, chlorothiazide and piroxicam showed increased amounts of hemolysis at UVA irradiation only. CONCLUSION: The results showed that both methods were goodness screening tests for demonstrating the phototoxicity of therapeutic drugs.
Subject(s)
Candida albicans , Candida , Chlorothiazide , Chlorpromazine , Dermatitis, Phototoxic , Erythrocytes , Griseofulvin , Hemolysis , Ibuprofen , Mass Screening , Piroxicam , Ultraviolet RaysABSTRACT
Nephrogenic diabetes insipidus is a rare hereditary disorder characterized by insensitivity of the renal tubule to vasopressin. We report a case of nephrogenic diabetes insipidus associated with severe hydronephrosis in a 18 year old male, which was improved in urine volume, urine osmolarity and urine specific gravity with chlorothiazide therapy.
Subject(s)
Adolescent , Humans , Male , Chlorothiazide , Diabetes Insipidus, Nephrogenic , Hydronephrosis , Osmolar Concentration , Specific Gravity , VasopressinsABSTRACT
Nephrogenic diabetes insipidus is a rare hereditary disorder characterized by insensitivity of the renal tubule to vasopressin. We report a case of nephrogenic diabetes insipidus associated with severe hydronephrosis in a 18 year old male, which was improved in urine volume, urine osmolarity and urine specific gravity with chlorothiazide therapy.
Subject(s)
Adolescent , Humans , Male , Chlorothiazide , Diabetes Insipidus, Nephrogenic , Hydronephrosis , Osmolar Concentration , Specific Gravity , VasopressinsABSTRACT
The effect of administration of methyl dopa or chlorothiazide on fasting blood glucose, glucose uptake by the diaphragm, glucose production by the liver and serum sodium and potassium concentrations in 30 albino rats were investigated. Results showed no significant change in glucose metabolism, but there was significant reduction in serum sodium and potassium after thiazides
Subject(s)
Methyldopa , Chlorothiazide , Carbohydrates , Animals, LaboratoryABSTRACT
A 13-year-old boy was diagnosed as having primary nephrogenic diabetes insipidus, and symptoms developed at 3 years of age. Subsequently he developed bilateral hydronephrosis and a neurogenic bladder. His pedigree could be explored back 5 generations and represented an inheritance as an X-linked recessive transmission factor. He was treated with indomethacin 2 mg/kg/day plus chlorothiazide 500 mg/day and this new treatment showed a markedly decreased urine output and increased urine osmolarity. (Nephrogenic diabetes insipidus, Hydronephrosis, Indomethacin)