Felis ISSN 2398-2950

Therapeutics: diuretics

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

Contributor(s): Jonathon Elliot, Linda Horspool, Lauren Trepanier

Furosemide

  • Potent loop diuretic Furosemide (formerly known as frusemide).
  • Blocks active chloride, sodium, and potassium co-transport in thick ascending limb of the loop of Henle.
  • Leads to loss of sodium, chloride, potassium, calcium, and magnesium and water in urine.
  • After IV administration, increases venous capacitance and decreases pre-load via a prostaglandin-dependent mechanism.
    • Therefore, when possible, IV administration is preferred for fulminant congestive heart failure.
  • Hypokalemia Hypokalemia  common in cats.
  • Induces calciuresis; can be used to treat hypercalcemia Hypercalcemia: overview of any etiology in cats once hydration is established.
  • Pre-renal azotemia Pre-renal azotemia  and metabolic alkalosis Acid base imbalance common after moderate to high dosage.
  • May potentiate ototoxicity and nephrotoxicity of aminoglycoside antibiotics.
  • High dosages can be used to increase urine output in hydrated patients with oliguric renal failure.

Mannitol

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Carbonic anhydrase inhibitors

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Spironolactone

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Thiazide diuretics

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Further Reading

Publications

Refereed papers

  • Recent references from VetMed Resource and PubMed.
  • Hofmeister E H et al (2009) Prognostic indicators for dogs and cats with cardiopulmonary arrest treated by cardiopulomary cerebral resuscitation at a university teaching hospital. JAVMA235(1), 50-57 PubMed.
  • MacDonald K A et al (2008) Effect of spironolactone on diastolic function and left ventricular mass in Maine Coon cats with familial hypertrophic cardiomyopathy. JVIM 22(2), 335-341PubMed.
  • Hezel A et al (2007) Influence of hydrochlorothiazide on urinary calcium oxalate relative supersaturation in healthy young adult female domestic shorthaired cats. Vet Ther 8(4), 247-254 PubMed.
  • Plummer C E, MacKay E O, Gelatt K N (2006) Comparison of the effects of topical administration of a fixed combination of dorzolamide-timolol to monotherapy with timolol or dorzolamide on IOP, pupil size, and heart rate in glaucomatous dogs. Vet Ophthalmol 9(4), 245-249 PubMed.
  • Ash R A, Harvey A M, Tasker S J (2005) Primary hyperaldosteronism in the cat: a series of 13 cases. J Feline Med Surg 7(3), 173-182 PubMed.
  • Palmieri E A, Biondi B & Fazio S (2002) Aldosterone receptor blockade in the management of heart failure. Heart Fail Rev 7(2) 205-219 PubMed.
  • Gelatt K N & MacKay E O (2001) Changes in intraocular pressure associated with topical dorzolamide and oral methazolamide in glaucomatous dogsVet Ophthalmol 4(1) 61-67 PubMed.
  • Pitt B et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failureN Eng J Med 341(10) 709-717 PubMed.

Other sources of information

  • Kochevar D (2009) Diuretics. In: Riviere J E, Papich M G Veterinary Pharmacology and Therapeutics. 9th edition Chichester, Wiley-Blackwell, pp 647-670.
  • Bonagura J D, Lehmkuhl L B & de Morais H A (2002) Fluid and diuretic therapy in heart failure. In: DiBartola  SP,  Fluid Therapy in Small Animal Practice. 2nd edition, Philadelphia: WB Saunders, pp 387-409.
  • Jackson E K (1996) Diuretics. In: Hardman JG, Limbard LE,  Goodman & Gilmans The Pharmacologic Basis of Therapeutics 9th edition, New York: McGraw Hill, pp 685-713.


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