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Therapeutics: diuretics

icanis

Synonym(s): potassium sparing; loop diuretic; aldosterone antagonist


Introduction

  • Different types of diuretics act in different parts of the nephron and can, therefore, have various effects on electrolyte and acid-base balance as well as water loss.  
  • Diuretics are often used to treat congestive heart failure. They can also be used to manage cerebral herniation (mannitol) and ascites due to hepatic disease (spironolactone).  
  • They can be used in combination in congestive heart failure to provide sequential nephron blockade. 
  • Tolerance, especially to furosemide, can develop at higher doses.  
  • Renal and electrolyte parameters should be monitored when diuretics are used for long periods of time.  

Furosemide

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Torasemide

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Spironolactone

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Thiazide diuretics

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Mannitol

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Carbonic anhydrase inhibitors

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Chetboul, V, Pouchelon, J L, Menard J et al (2017) Short-term efficacy and safety of torasemide and furosemide in 366 dogs with degenerative mitral valve disease: the TEST study. JVIM 31 (6), 1629-1642 PubMed.
  • Hofmeister E H, Brainard B M, Egger C M et al (2009) Prognostic indicators for dogs and cats with cardiopulmonary arrest treated by cardiopulmonary cerebral resuscitation at a university teaching hospital. JAVMA 235 (1), 50-57 PubMed.
  • Sayer M B, Atkins C E, Fujii Y et al (2009) Acute effect of pimobendan and furosemide on the circulating renin-angiotensin-aldosterone system in healthy dogs. J Vet Intern Med 23 (5), 1003-1006 PubMed.
  • Jeunesse E, Woehrle F, Schneider M et al (2007) Effect of spironolactone on diuresis and urine sodium and potassium excretion in healthy dogs. J Vet Cardiol (2), 63-68 PubMed.
  • Thomason J D, Rockwell J E, Fallaw T K et al (2007) Influence of combined angiotensin-converting enzyme inhibitors and spironolactone on serum K+, Mg2+, and Na+ concentrations in small dogs with degenerative mitral valve disease. J Vet Cardiol (2), 103-108 PubMed.
  • Falk T, Jönsson L, Olsen L H et al (2006) Arteriosclerotic changes in the myocardium, lung and kidney in dogs with chronic congestive heart failure and myxomatous mitral valve disease. Cardiovasc Pathol 15 (4), 185-193 PubMed.
  • Palmieri E A, Biondi B, Fazio S (2002) Aldosterone receptor blockade in the management of heart failure. Heart Fail Rev (2), 205-219 PubMed.
  • Gelatt K N, MacKay E O (2001) Changes in intraocular pressure associated with topical dorzolamide and oral methazolamide in glaucomatous dogs. Vet Ophthalmol (1), 61-67 PubMed.

Other sources of information

  • European Medicines Evaluation Agency. Prilactone Summary of Product Characteristics http://www.ema.europa.eu/.
  • Kochevar D (2009) Diuretics. In: Riviere J E, Papich M G. Veterinary Pharmacology and Therapeutics.9th edition. Chichester, Wiley-Blackwell pp. 647-670.
  • Miller M W, Adams R H (2009) Digitalis, Positive Inotropes, and Vasodilators. In: Riviere J E, Papich M G. Veterinary Pharmacology and Therapeutics. 9th edition. Chichester, Wiley-Blackwell pp. 541-574.
  • Falk T et al (2007) Correlation of cardiac pathology and clinical findings in dogs with naturally occurring congestive heart failure. ACVIM abstracts 233, 636.
  • Bonagura J D, Lehmkuhl L B, de Morais H A (2002) Fluid and diuretic therapy in heart failure. In: DiBartola S P Fluid Therapy in Small Animal Practice. 2nd edition, Philadelphia: WB Saunders, pp 387-409.
  • Jackson E K (1996) Diuretics. In: Hardman J G, Limbard L E, Goodman & Gilman The Pharmacologic Basis of Therapeutics.9th edition, New York: McGraw Hill, pp 685-713.

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