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13: Adding Drug Therapy Ethacrynic acid in .NET framework
13: Adding Drug Therapy Ethacrynic acid
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Ethacrynic acid (Edecrin Tablets) is similar in structure to furosemide but is slightly less potent It shares the problems of this powerful group of diuretics and should probably not be used during pregnancy or breast-feeding Ethacrynic acid comes in 25- and 50-mg tablets taken one to three times a day as needed For high blood pressure, 25 mg should be taken after a meal It usually starts to work within 30 minutes and lasts for about eight hours
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Torsemide (Demadex) has three times the potency of furosemide The liver does most of the metabolizing of this drug, so torsemide is particularly dangerous in the presence of severe liver disease Torsemide is available as 5-, 10-, 20-, and 100-mg tablets taken once a day Patients can take it at any time (no need to consider meal times); it usually begins to work in an hour and lasts about eight hours High blood pressure patients usually take the lowest dose for the first four to six weeks before the doctor reevaluates the dosage Ten milligrams is usually the maximum dose for the treatment of high blood pressure
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Bumetanide (Bumex, Bumetanide Tablets) is similar in structure and side effects to furosemide but is 40 times more potent This drug has been associated with severe dehydration and loss of blood electrolytes like sodium and potassium Older patients are especially at risk for severe dehydration It hasn t been tested on children under age 18, so it s not recommended for this group Bumetanide is available as 05-, 1-, and 2-mg tablets It usually begins to work in 30 to 60 minutes and lasts about six hours Patients usually take it once a day in the morning, but if a single dose doesn t work long enough, your doctor may prescribe a second dose later in the day (before 6 pm to avoid waking up to urinate)
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Potassium-sparing diuretics have little effect on salt and water or lowering blood pressure, but in combination with other diuretics, they conserve the body s potassium Therefore, they re often manufactured with a diuretic Their ability to conserve potassium is also their greatest danger an abnormal elevation of the blood-potassium level so they should never be used when the potassium is already high People with diseases such as kidney failure are at a particularly high risk for this complication These drugs also decrease the loss of calcium and magnesium associated with the other diuretics
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Part III: Treating (Or Preventing) High Blood Pressure Amiloride
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Amiloride (Midamor Tablets, Amiloride HCl Tablets) is used only with another diuretic to reverse the tendency of the other diuretic to excrete potassium in the urine It also conserves magnesium Amiloride is eliminated almost equally by the kidneys and the liver; in the presence of kidney failure or liver disease, it can accumulate to dangerous, toxic levels Amiloride may also cause excessive potassium retention, so blood potassium levels must be monitored (Muscle weakness, swelling of the abdomen, and diarrhea are symptomatic of excessive potassium retention) Patients who have diabetes mellitus (see 4) are especially sensitive to the potassiumsparing effect of amiloride even when they don t have kidney disease Note: Using salt substitutes and taking amiloride may put a patient at greater risk because salt substitutes contain potassium chloride instead of sodium chloride Amiloride isn t recommended during pregnancy or breast-feeding It can decrease the excretion of lithium in the urine leading to lithium toxicity This drug comes in a 5-mg tablet, the usual dose It starts to act in two hours and continues its activity for 24 hours
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Triamterene (Dyrenium) differs in structure from amiloride and has only onetenth of amiloride s potency It accomplishes the same task of conserving potassium in the patient taking a diuretic that causes potassium loss Because it leaves the body in the urine, triamterene shouldn t be taken when kidney failure or liver disease exists Just like amiloride, it has to be monitored with frequent tests of blood potassium, especially in people with diabetes and the elderly (who are more likely to have high blood potassium levels) It s also not recommended during pregnancy and breast-feeding Triamterene comes as 50- and 100-mg tablets, usually starts to act in two to four hours, and lasts up to nine hours As a result, patients usually need to take it twice a day, which is a disadvantage It s taken after meals to avoid stomach upset
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