Diuretics- thiazide, and thiazide-like

Question 1

What are indications?

Answer 1

Hypertension/ HF if CCB not suitable.

Add-on for hypertension if BP not properly controlled

Question 2

What is their MOA?

Answer 2

Inhibit the Na+/Cl− co-transporter in the distal convoluted tubule of the nephron.

This prevents reabsorption of sodium and its osmotically associated water.

Leading to diuresis

Question 3

What are important side effects?

Answer 3

Hyponatraemia
Hypokalaemia - more K+ lost which may cause cardiac arrhythmias

Increases glucose conic
LDL
Triglycerides
(more cardio protective overall)
impotence in men

Question 4

What are important warnings?

Answer 4

Avoided in hypokalaemia and hyponaetremia
gout-reduce uric acid excretion
Arrhythmia
DM
Dyslipidaemia

Question 5

What are important interactions?

Answer 5

NSAIDs- not aspirin
potassium lowering drugs

Question 6

Give examples of thiazide like diuretics

Answer 6

Indapamide
Chlortalidone

Question 7

Give examples of thiazide diuretic.

Answer 7

Bendroflumethaizide

Question 8

What are dosages of Bendro for each indication?

Answer 8

Oedema: 5-10mg

Hypertension:
2.5mg OD

Question 9

What are dosages for thiazide like diuretics for hypertension?

Answer 9

Indapamide 25mg OD
Chlortalidone 12.5-25mg

Question 10

What are monitoring requirements?

Answer 10

Electrolytes- before and during treatment

Question 11

Why are thiazide and ACEi/ARBs prescribed together?

Answer 11

ACEi/ARBs- hyPERkalaemia
Thiazides-hyPOkalaemia

Thiazides activate RAS
ACEi/ARB- blocks RAS

Work synergistically together to improve BP control and to maintain neutral K+ balance.