Thiazide Diuretics are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure such as heart attack, stroke and excessive edema.
Welcome guys to another drug chug episode and today we are continuing diuretics so if you guys follow us along the last part prior we talked about thighs i didn’t as i’d like diuretics in this part we’re gonna continue and we’re gonna start with loop diuretics so let’s get right into it so the next class of diuretics that we see are our loop diuretics and any time
You hear the word loop the first thing you should think about is potent or powerful because our loop diuretics are our most powerful diuretics that we have and the first one we have here is a product called you metin i’d brand name is bumex and this is the most potent out of the three next we have tor some id or demodex and then finally our most popular loop
Diuretic is furosemide or lasix so all of these loop diuretics can be dosed daily twice a day or up to three times a day and one interesting thing is furosemide and the brand-name lasix and the brand name is actually very clever because lasix lasts six hours and that’s why they named lasix which is a pretty cool thing it helps you remember another thing to note
Is that all the starting doses that i’ve listed here are actually all equivalent to the next diuretic so for bumetanide the 0.5 milligrams is as powerful as the torse amide 10 milligrams which is as powerful as the furosemide 20 milligrams so where do these loop diuretics actually work well before we were talking about thighs ides and thighs i’d like diuretics
And those work right here at the distal convoluted tubule well the loop diuretics work right before it in this area here and this is called the ascending loop of henle so these agents because they’re so powerful aren’t used to treat high blood pressure these diuretics are only used to treat edema so these are really good in patients that have heart failure or
Cirrhosis or any condition where they’re holding on to a lot of water that needs to be excreted so what makes loop diuretics so potent is that not only does it make sodium chloride and water remain in the urine but it also makes potassium hydrogen calcium and magnesium also stay in the urine so we know our thiazide only do the top three molecules whereas loop
Diuretics do all of these molecules because we have so many electrolytes in the urine the body’s gonna pull more water into the urine so that we could pee it out so some common side effects we see with our loop diuretics is because we pee out so many electrolytes we might see a deficiency or a decrease in the serum potassium and magnesium level this is to the
Point where the patient could actually be required to take supplementation for potassium and magnesium so it’s a good idea just to check their levels and make sure everything is alright another side effect that we might see and this is typically with larger doses is ototoxicity so if they have any ringing in the ear tinnitus or a hearing impairment that’s also
Something that we could see in these patients another side effect could be something called metabolic alkalosis meaning the blood is becoming basic or less acidic and the reason for this is because we are peeing out more and more hydrogen ions the more hydrogen ions that we pee out and we excrete the more basic our blood comes and the last thing to note here is
All diuretics can cause dehydration but loop diuretics have the potential to cause the most dehydration because they are the most potent and because they’re gonna cause you to lose the most flu i do want to quickly mention sulfa allergies when it comes to thighs i’d and loop diuretics even though computers are getting better at this it’s not uncommon to see a
Flag pop up when we have a patient with a sulfa allergy and they’re prescribed a thiazide or a loop diuretic so if we look at the structures here here we have hydrochlorothiazide which is our thiazide diuretic here we have furosemide which is our loop diuretic and here off to the end we have our sulfamethoxazole which is actually an antibiotic and whenever we talk
About sulfa allergies it’s typically because of this sulfur drug and you can see that all of these drugs have this group this sulfonamide group it was believed that this whole fauna my group causes the allergy and because we see the same sulfonamide group on furosemide and hydrochlorothiazide it was believed that it will cause the allergic reaction well this is
Not true a patient with a sulfa allergy can take fross amide they can take hydrochlorothiazide and because we’re talking about allergic reactions i do want to quickly go over what happens in a patient that has a sulfa allergy they could have anything from a skin rash to hives to itching they could have breathing problems or if it’s severe enough they could have
Stevens-johnson syndrome which is the burning of the skin but again if they have a sulfa allergy it’s okay to give them furosemide it’s okay to give them hydrochlorothiazide and the last diuretic to talk about are the potassium sparing diuretics so in the first part of the series we talked about thighs identies i’d like diuretics in this section of the series
We just finished loop diuretics and now let’s get into the potassium sparing diuretics so here we have potassium sparing diuretics they can also be called aldosterone antagonists because they antagonize the hormone aldosterone in our body and here we only have two agents we have spironolactone which is brand name a lactone and a player known or brand name in
Spre and here they have a pretty wide dosing range and the reason for that because they could be used for several things the first thing we would use potassium sparing diuretics for our as hypertension they could also be used to treat edema and at certain doses they could also be used to treat heart failure just like our thiazide and thiazide like diuretics these
Diuretics also work at the distal convoluted tubules and what’s different is they actually spare potassium meaning the potassium isn’t gonna stay in the urine and be excreted the body’s gonna hold on to potassium which means we’ll have elevated serum potassium levels because these potassium sparing diuretics are also known as aldosterone antagonists which is a
Hormone it’s not uncommon to see that they actually antagonize testosterone at high levels so when these agents start to antagonize testosterone we see some side effects and at high doses we can see something called gynecomastia which happens in men and this means that the breast tissue will start developing in men they can also have sexual dysfunction for women
We can see breast tenderness and also menstrual irregularities another side effect can be hyperkalemia which means there’s too much potassium in our blood and remember these are potassium sparing diuretics so all the potassium is gonna be reabsorbed into our bloodstream and it’s not gonna stay in the urine and this is different than our other two diuretics this
Is the only one that spares potassium so some patient counseling tips whenever we have patients on diuretics it’s a good idea to tell them that this is a water pill especially for our older population because they’ll know that this will make them pee now it’s also a good idea to tell them to not take it before bedtime because they make them pee it’s gonna make
Sense that they’ll stay up all night peeing and the last thing is it’s a good idea to let them know that they could become dehydrated or dizzy so any time they take a water pill make sure they are drinking water and they stand up slowly so let’s have a quick summary of everything we learned so in the first section of this video series we talked about thiazide x’
And thighs i’d like diuretics we talked about how both of these work in the distal convoluted tubule for our thiazide diuretics we had hydrochlorothiazide also known as micros i’d and it’s abbreviated as h ctz we also have clora thiazide or brand-name dire o our thighs i’d like diuretics we talked about mottola zone brand names arak saline in dap amide brand
Name losel and then chlorothalonil or high grande next in this video we talked about loop diuretics we talked about the big three which is bumetanide or brand-name bumex taurus amide demodex and furosemide lasix and this worked in the ascending loop of henle and then we finished off with potassium sparing directs here we talked about spironolactone brand name
L doc tone and then at blair known brand name in spre and we talked about how these are the only diuretics that cause potassium reabsorption back into the blood and how they have a side effect of gynecomastia all right you guys made it to the end so like i promised let’s take a short quiz to see what retained and this quiz is for both part one and part two of
The diuretic series alright so question 1 which of these drugs do not work in the distal convoluted tubule is it a throw some i’d be hydrochlorothiazide see mottola zone or d chlorothalonil question two which type of diuretic is the most powerful is it thighs ides thighs i’d like loop or potassium sparing question 3 which diuretic is the only one that increases
Blood potassium levels is it spironolactone and dap amide taurus amide or demodex question for which diuretic has the potential side effect of gynecomastia is it spironolactone chlorothalonil mottola zone or furosemide alright guys we made it to the end of the video if you enjoyed this video go ahead and hit that like and subscribe button if you haven’t done so
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Transcribed from video
How do Loop & Potassium Sparing Diuretics Work? (+ Pharmacology) By Drug Chug
