The Proper Use of Newer Diuretics

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Abstract
Different diuretic agents not only differ in potency, but also induce different patterns of electrolyte excretion from which information was derived about the nature and the sites of their action in the nephron. Diuretic agents may be grouped into the following pharmacologic species: organomercurials, carbonic anhydrase inhibitors, chloruretic sulfonamides (thiazides), aldosterone antagonists, other potassium retaining natriuretic agents, -triampterine and pyrazinoyl guanidines, ethacrynic acid and furosemide. Ethacrynic acid and furosemide are 2 potent diuretics. They are especially valuable in the therapy of acute pulmonary edema and in the treatment of more resistant or refractory patients. Their use requires understanding and anticipation of the major derangements which they may induce. Ethacrynic acid and furosemide, like thiazide agents, are best used intermittently. Other measures which may be indicated are the use of maintenance therapy with spirolactone, triampterene or amiloride, all of which block aldosterone directed ion transport and the addition of Cl or K supplements The total experience indicates that these various types of diuretic agents act to block a number of different transport processes, some of which may be located at entirely different sites in the tubule and which may be under the guidance of different hormonal or hemodynamic signals.