Loop diuretics often are used alone or in combination. In patients with New York Heart Association class III and IV congestive heart failure, spironolactone has been found to reduce morbidity and mortality rates. In patients with cirrhosis, ascites is treated with paracentesis and spironolactone.
What is the first-line diuretic for cirrhosis?
1. Potassium-sparing diuretic 2. Uricosuric 3. Loop diuretic 4. Antispasmodic 5. Urinary analgesic 6. Cholinergic 7. Alpha-blocker 8. Thiazide diuretic 9. Antiandrogen 10. Antigout
Can diuretics be used in cirrhosis with ascites?
Medical treatment of ascites is aimed at reverting sodium retention, that is, at creating a negative sodium balance to relieve ascites. Bed rest and low-sodium diet induce the disappearance of ascites in about 10% of patients. Loop diuretics and aldosterone antagonists must be administered to the pa …
Should diuretics be used to treat heart failure and nephrotic syndrome?
Jul 29, 2015 · Oral diuretics and total abstinence from alcohol are both considered the second line of treatment [ 11 ]. Spironolactone is the first-line diuretic recommended for a patient with cirrhosis and edema, initiating with a dose of 50 mg. With its long half-life, doses are altered after 3 …
What are the different types of diuretics?
Apr 28, 2006 · Spironolactone is the drug of choice in the initial treatment of ascites due to cirrhosis. 66 The initial daily dose of 100 mg may have to be progressively increased up to 400 mg to achieve adequate natriuresis.
What is the most widely prescribed class of diuretics?
Thiazide diuretics Thiazides are the most commonly prescribed diuretics. They're most often used to treat high blood pressure. These drugs not only decrease fluids, they also cause your blood vessels to relax.
When are loop diuretics used?
Loop diuretics are medications used in the management and treatment of fluid overload conditions such as heart failure, nephrotic syndrome or cirrhosis, and hypertension, in addition to edema.Jul 25, 2021
What are the major classes of diuretics?
There are five classes of diuretics: thiazides and thiazide-like diuretics; loop diuretics; carbonic anhydrase inhibitors; potassium-sparing diuretics; and osmotic diuretics.Oct 1, 2004
What is a thiazide diuretic drug?
Thiazide diuretics are a type of diuretic (a drug that increases urine flow). They act directly on the kidneys and promote diuresis (urine flow) by inhibiting the sodium/chloride cotransporter located in the distal convoluted tubule of a nephron (the functional unit of a kidney).
What class of diuretic is hydrochlorothiazide?
Hydrochlorothiazide belongs to a class of drugs called thiazide diuretics. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.
What is the most effective diuretic?
Loop diuretics are the most potent diuretics as they increase the elimination of sodium and chloride by primarily preventing reabsorption of sodium and chloride. The high efficacy of loop diuretics is due to the unique site of action involving the loop of Henle (a portion of the renal tubule) in the kidneys.
What kind of diuretic is spironolactone?
Spironolactone is a potassium-sparing diuretic (water pill). It prevents your body from absorbing too much salt and keeps your potassium levels from getting too low. This medicine is also used to treat or prevent hypokalemia (low potassium levels in the blood).Feb 1, 2022
Is Lasix a thiazide diuretics?
Lasix and thiazides are different types of diuretics. Lasix is a type of “loop” diuretic while thiazides refer to a class of diuretics. Lasix is a brand name for furosemide. Examples of thiazide diuretics include chlorthalidone (Thalitone), hydrochlorothiazide (Microzide), and methyclothiazide.
Is hydralazine a thiazide diuretic?
Hydralazine works by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload. The hydrochlorothiazide is a type of medicine known as a thiazide diuretic and helps reduce the amount of water in the body by acting on the kidneys to increase the flow of urine.Feb 1, 2022
Is Amlodipine a thiazide diuretic?
Amlodipine is a calcium channel blocker. Hydrochlorothiazide is a thiazide diuretic (water pill). Valsartan is an angiotensin II receptor blocker (sometimes called an ARB). Amlodipine, hydrochlorothiazide, and valsartan is a combination medicine used to treat high blood pressure (hypertension).
What is SBP in cirrhotic patients?
SBP is a frequent and serious complication of cirrhotic patients with ascites.
What is the cause of increased reabsorption of sodium in the distal tubule?
Cirrhosis is associated with enhanced reabsorption of sodium both at the proximal tubule and at the distal tubule.20Increased reabsorption of sodium in the distal tubule is due to increased circulating concentrations of aldosterone.
Why is ascites important?
Adequate management of ascites is important, not only because it improves quality of life in patients with cirrhosis, but also prevents serious complication such as SBP. However, treatment of ascites does not significantly improve survival.
Which diuretic is the weakest?
Due to its distal site of action, spironolactone is the weakest diuretic. It is because of this that it has been the most successful choice in ascites, with most patients losing 0.5L/day on this agent, allowing systemic resorption of ascitic fluid to keep pace.
Is spironolactone a diuretic?
Diuretic choice in decompensated liver disease. Spironolactone has long been favored in the setting of decompensated liver disease; the effective control of “secondary aldosteronism” is usually given as the reason for this in textbooks.
Does spironolactone inhibit renal ammonia excretion?
Theorectically, spironolactone directly inhibits this process. As a final aside, avoid acetazolamide (Diamox) in patients with cirrhosis. Renal ammonia excretion requires protonation of NH3 in the proximal tubule, an event that depends entirely upon bicarbonate resorption.
Can cirrhotic patients have bacteremia?
Cirrhotic patients often have bacteremia and high levels of endotoxin levels without clinically significant infection. [ 78] . Bacteremia is most often from intestinal bacterial overgrowth, [ 79] but may also result from bacteriuria or intravascular catheters. [ 70] .
Should urinary tract infections be treated before dissemination?
Treatment and eradication of local infections should be undertaken before dissemination. Bacteriuria is common, especially in women. All patients should be screened and treated for urinary tract infections even in the absence of symptoms. Urinary catheters should be avoided.
Should you avoid urinary catheters?
Urinary catheters should be avoided . Intravascular catheters cause between 4% and 20% of bacteremic episodes and their use should also be minimized. [ 70] Patients who have had previous episodes of SBP should receive long-term antibiotic prophylaxis because of high rates of recurrence.
What are the subclasses of diuretics?
The sub-classes of diuretics include: Thiazides (eg, bendroflumethiazide, hydrochlorothiazide and the thiazide-like diuretic indapamide) are used mainly in low dose in the treatment of hypertension but also, in the case of metolazone, in combination with loop diuretics to treat severe heart failure.
How long does it take for thiazides to work?
Onset and duration of action of diuretics. Thiazides - onset of diuresis within 1-2 hours of oral administration. Duration varies with drug - bendroflumethiazide 6-12 hours, chlortalidone 24-72 hours. They are usually prescribed mane in order to avoid night-time disruption.
What is mannitol used for?
Osmotic diuretics (mannitol) are used in a hospital setting for the treatment of cerebral oedema. Carbonic anhydrase inhibitors (acetazolamide) are used for the prophylaxis of mountain sickness (unlicensed indication) and glaucoma.
Can thiazide cause hypokalaemia?
Hypokalaemia can occur with loop or thiazide diuretics. The risk of hypokalaemia is related to duration of action as well as potency, so is actually greater with an equipotent dose of thiazide compared to loop diuretic.
Can thiazide be used in refractory heart failure?
Thiazide and loop diuretic - indicated in refractory heart failure where there is an inadequate response to a loop diuretic alone. This combination can cause dramatic diuresis with resultant dehydration, hypovolaemia, hyponatremia and hypokalaemia. In the past, it has tended to be initiated in hospital but NICE Clinical Knowledge Summaries' guidance suggests that it may be done in primary care under specialist supervision. Dose titration should be gradual with adequate clinical and biochemical monitoring. Heart failure specialist nurses may be helpful in this situation.
Is eplerenone a potassium diuretic?
Potassium-sparing diuretics (eg, amiloride, triamterene) are weak diuretics, whereas spironolactone and eplerenone are used in the treatment of hypertension, for oedema of liver failure and in heart failure. NB: spironolactone and eplerenone are also called aldosterone antagonists.
Can spironolactone be used for ascites?
Spironolactone can also be used to treat malignant ascites. NB: diuretics are sometimes abused by sportsmen and sportswomen who need to lose weight rapidly to make a weight class - eg, in boxing or horse racing.