COMMON AGENTS

The major loop diuretics are listed in the plate.

INDICATIONS

The major indications for loop diuretics include:

• Peripheral or pulmonary edema
  
• Hypertension

ADVERSE EFFECTS

The major adverse effects of thiazide diuretics include:

• Ototoxicity, manifest as tinnitus, vertigo, or hearing loss
  
• Hypokalemia
  
• Hypomagnesemia
  
• Hyponatremia. By inhibiting solute reabsorption in the TAL, loop diuretics prevent maximal urine dilution. In addition, significant fluid losses can trigger release of antidiuretic hormone (see Plate 3-17)
  
• Hyperuricemia, which may precipitate gout attacks
  
• Hypotension, if excessive extracellular fluid is lost
  
• Metabolic alkalosis, resulting from aldosterone release secondary to volume losses and, if hypokalemia is present, an increase in proximal tubular ammoniagenesis
  
• Impaired glucose tolerance or diabetes mellitus secondary to multiple mechanisms, including catecholamine release (secondary to activation of the sympathetic nervous system resulting from volume depletion), as well as reduced insulin secretion (secondary to hypokalemia)
  
• Hyperlipidemia, through mostly unknown mechanisms
  
• Photosensitivity
  
• Paresthesia