pharma fouda 1_p110-111.pdf

Advantages and disadvantages of diuretics in some Part 3: edematous conditions █ CONGESTIVE HEART FAILURE (CHF) Patients with CHF have ↓COP due to weak cardiac muscle, fluid retention, and lung congestion. Many patients have also high blood pre...

Advantages and disadvantages of diuretics in some Part 3: edematous conditions █ CONGESTIVE HEART FAILURE (CHF) Patients with CHF have ↓COP due to weak cardiac muscle, fluid retention, and lung congestion. Many patients have also high blood pressure. Advantages of diuretics: – Correction of fluid retention. – Lowering of blood pressure. – Decrease preload (venodilatation and ↓ venous return) and afterload (due to arterial VD) leads to improvement of cardiac contraction. – Decrease lung congestion causes improvement of tissue oxygenation. – Recent evidence showed that spironolactone reduces morbidity and mortality rates in patients with advanced heart failure. Disadvantages of diuretics: Recommendation: – Excessive hypovolemia can ↓ COP. Combination – Diuretic-induced acid-base and electrolyte between a K+ sparing diuretic and imbalance may impair cardiac function. loop diuretic is the – Diuretic-induced hypokalemia can predispose to best choice. digitalis toxicity and cardiac arrhythmia. █ CHRONIC KIDNEY DISEASES The majority of patients with chronic renal diseases (e.g. chronic renal failure, diabetic nephropathy, etc.) have fluid retention, hypertension, hyperkalemia, and acidosis. Advantages of diuretics: Recommendation: – Correction of fluid retention. Loop diuretics are – Reduction of hyperkalemia. best choice. – Reduction of hypertension. Disadvantages of diuretics: – Thiazides are ineffective when GFR is