Distal diuretics

Here we mainly include thiazide diuretics (thiazides), for which we distinguish:
 * 1) 'Renal effect: Thiazides inhibit NaCl reabsorption by distal tubule epithelial cells into  blood. At the same time, they increase reabsorption in the distal tubule  Ca 2+;
 * 2) extrarenal effect: vasodilation in the postcapillary bed reduces the return of blood to  heart and subsequently  cardiac output. Vascular resistance decreases after 2-3 weeks.

Shortcuts
The main representatives are: Other representatives include: chlorothiazide, trichloromethiazide, bendroflumethiazide, methipamide, indapamide.
 * hydrochlorothiazide,
 * chlorthalidone.

Indication

 * Arterial hypertension;
 * heart failure;
 * nephrolithiasis caused by idiopathic hypercalciuria;
 * diabetes insipidus - they reduce the volume of urine in patients.

Contraindications

 * decreased kidney function;
 * pregnancy;
 * bottom;
 * hypercalcemia.

Side effects and toxicity

 * Hypokalaemic metabolic alkalosis and hyperuricemia.
 * Reduced glucose tolerance.
 * May manifest hyperglycemia in  diabetics and individuals with abnormal results  Glucose Test. It is caused by a reduction in the release of insulin from pancreas.


 * Hyperlipidemia.
 * Thiazides lead to an approximately 5-15% increase in cholesterol and lipoproteins (LDL) in the blood. Due to long-term administration, these values ​​may normalize.


 * Dilution hyponatremia.
 * This is a serious side effect. It is the result of increased ADH production due to hypovolemia, decreased dilution capacity Kidneys and thirst. It can be prevented by reducing the dose of the diuretic or reducing water intake.


 * Allergic reactions.

Related Articles

 * Diuretics
 * Renin-angiotensin-aldosterone system
 * Hypertension
 * Hypertensive crisis

Source

 * lectures by doc. Trejtnar, PharmDr. String
 * lectures by doc. Trejtnar, PharmDr. String