Antihypertensives: Diuretics: Loop type

1. indications:

1.1. edema and vol. overload associated w/ HF

1.2. pulmonary edema and refractory edema

1.3. "high ceiling": as you increase dose, the effect becomes greater

1.3.1. most effective diuretics since they work earlier in NaCl reabsorption

2. AE

2.1. similar to thiazides with electrolytes also Na+ and vol. depletion esp in elderly pts

2.2. hypocalcemia and hypomagnesemia

2.3. Ototoxicity (IV): dose related and in pts receiving concurrent aminoglycosides

2.4. rash, photosensitive, bone marrow depression

3. Drug interactions

3.1. aminoglycosides; anticoags (increased); digitalis (K+): digoxin

4. Po, IV, IM

5. MOA: block Na/Cl symporter in thick ascending loop of Henle to decrease Na reabsorption - also affects Ca and Mg -> decreases preload

6. Furosimide

6.1. MC

7. Bumetamide

8. Ethacrynic acid

8.1. not a sulfonamide derivative

8.2. not on US market

9. Torsemide