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Renal (Diuretic Agents (■ BASIC PHARMACOLOGY OF DIURETIC AGENTS (AGENTS…

- - - - Chlorothiazide
      - Hydrochlorothiazide
    - - Amiloride
      - Triamterine
    - - Furosemide
    - - UREARETICS
      - ANTIDIURETIC HORMONE ANTAGONISTS
      - ANTIDIURETIC HORMONE (ADH, VASOPRESSIN) AGONISTS
      - OSMOTIC DIURETICS
    - - POTASSIUM-SPARING DIURETICS & PROXIMAL TUBULE DIURETICS, LOOP AGENTS, OR THIAZIDES
      - LOOP AGENTS & THIAZIDES
  - - - KIDNEY DISEASE AND RENAL FAILURE
      - HEPATIC CIRRHOSIS
      - HEART FAILURE
      - IDIOPATHIC EDEMA
    - - HYPERTENSION
      - NEPHROLITHIASIS
      - HYPERCALCEMIA
      - DIABETES INSIPIDUS
      - RENAL & CARDIAC PROTECTION
    - - uric acid retention
      - orthostatic hypotension
      - potassium depletion
      - lipid disturbances remain
      - long term adaptation
- - - - ADRENERGIC NEURON-BLOCKING
        AGENTS: decr norepi secretion
        
        Guanadrel
        
        Reserpine
        
        Guanethidine: slow acting; oral
      - GANGLION-BLOCKING AGENTS: non specific, block both symp and para; act very quickly (3s) and used in emergencies; ex: trimetaphan camsylate (IV use only); severe toxicities--> abandonment of ganglion blockers for therapy of HTN.
      - ADRENOCEPTOR ANTAGONISTS
        
        BETA-ADRENOCEPTOR-BLOCKING
        AGENTS
        
        Labetalol(alpha and beta), Carvedilol(alpha and beta), & Nebivolol
        
        Esmolol
        
        Nadolol(doesn't cross BBB), Carteolol, Betaxolol(long half-life), & Bisoprolol
        
        Metoprolol & Atenolol(beta 1; on heart)
        
        Propranolol: beta 1 and 2; also inhibits renin; side effect: depression
        
        Pindolol, Acebutolol, & Penbutolol
        
        ALPHA-ADRENOCEPTOR-BLOCKING
        AGENTS: prazosin(effect on lipid profile), terazosin(better for BPH), doxazosin, phentolamine (don't forget prostate
      - CENTRALLY ACTING
        SYMPATHOPLEGIC DRUGS
        
        METHYLDOPA: alpha 2 agonist; used for gestational HTN; must wait 1 week to see effects
        
        CLONIDINE: alpha 2 agonist; available as patches changed every 15 days; must wait 1 week to see effects
        
        Guanabenz + guanfacine: share the central α-adrenoceptor-stimulating effects of clonidine. no advantages over clonidine--> rarely used.
    - - NO RELEASING
        
        MINOXIDIL: works on head skin vessels-->used in cosmetics
        
        SODIUM NITROPRUSSIDE: most potent BP controlling agent; acts very quickly; u. injected; used in HTN emergency (in urgency: IV form)
        
        HYDRALAZINE: effective on arteries, not veins; used in gestational HTN
      - DIAZOXIDE: used in HTN emergency; mech of action: K; other indications: blood sugar
      - FENOLDOPAM
      - CALCIUM CHANNEL BLOCKERS: also decr heart force;
        
        nicardipine
        
        verapamil
        
        nifedipine: short effect; used in HTN urgency
        
        diltiazem
    - - heart (force and rate)
      - kidney (blood volume-Na)
      - vessels
      - brain
  - - - presence of concomitant disease should influence selection of drugs
        
        diabetes or evidence of chronic kidney disease with proteinuria: RAAS inhibitors
        
        Angina: BB, CCB
        
        heart failure: diuretics, ACE inhibitors, ARB (losartan), BB (carvedilol), or hydralazine combined with nitrates,
        
        BPH (and DM and asthma??): α1 blockers
        
        MI: losartan, diltiazem, verapamil
        
        Atrial tachycardia and fibrillation: BB, nondihydropiridine, Ca antagonists