HTN case no 1.Diuretics

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ডায়াবেটিস + হাইপারটেনশনের পেশেন্ট কে যখন Diuretics দিবেন, তখন তাকে Hydrochlorothiazide না দিয়ে indapamide দিবেন।

what is diuretics?

Answer is:-Diuretics ― also known as water pills ― are medicines that help you move extra fluid and salt out of your body. They make you pee more frequently, which is why you should take them in the morning if you can. You may need to take diuretics once or twice a day at the same time each day.

Types of diuretics include:

Thiazide diuretics, such as hydrochlorothiazide (Microzide® or Oretic®) or chlorthalidone (Hygroton® or Thalitone®)Loop diuretics, such as

Furosemide or bumetanide. Potassium-sparing diuretics, such as Triamterene or Amiloride. A mixture of two types in one pill, like Hydrochlorothiazide.

Diuretics side effects:-

Selected side effects:

Headache.
Loss of appetite.
Hair loss.Dizziness.
Diarrhea.
Upset stomach.
Gas.
Nausea.
Headache.

How do diuretics work?

Diuretics make your kidneys take away your body’s extra salt and water by putting them into your urine (pee).

What do diuretics treat?

Diuretic medications can help with:

High blood pressure.
Heart Failure
Cardiomyopathy
Pulmonary edema.
Asciates
Renal Failur
Nephrotic Symptroms
diabetics incipidus
High intraocular pressure.

Hydrochlorothiazide used for:- Indications:-

Edema associated with congestive heart failure, hepatic cirrhosis, premenstrual tension and oedema due to various forms of renal dysfunction (i.e. nephrotic syndrome, acute glomerulonephritis, chronic renal failure). Hypertension, either alone or as an adjunct to other antihypertensive drugs.

Tablet1:-Acuren 50 mg

AS A Hydrochlorothiazide Thiazide diuretics & related drugs.

Side Effects OF Hydrochlorothiazide:-

Gastro-intestinal system: Anorexia, gastric irritation, nausea, vomiting, cramps, diarrhoea, constipation, jaundice (intrahepatic cholestatic jaundice), pancreatitis, salivary gland inflammation.

Central nervous system: Dizziness, vertigo, paraesthesiae, headache, yellow vision.

Heamatological: Leucopenia, agranulocytosis, thrombocytopenia, aplastic anaemia, haemolytic anaemia.

Cardiovascular: Hypotension, including orthostatic hypotension.

Hypersensitivity: Purpura, photosensitivity, rash, urticaria, necrotising angiitis (vasculitis, cutaneous vasculitis), fever, respiratiory distress including pneumonitis and pulmonary oedema, anaphylactic reactions, toxic epidermal necrolysis.

Metabolic: Hyperglycaemia, glycosuria, hyperuricaema, electrolyte imbalance including hyponatraemia and hypokalaemia.

Renal: Renal dysfunction, interstitial nephritis, renal failure.

Other: Muscle spasm, weakness, restlessness, transient blurred vision, impotence. Whenever side-effects are moderate to severe, thiazide dosage should be reduced or therapy was withdrawn.

Hydrochlorothiazide গুলি ARBs এর সাথে কম্বিনেশন হয়ে ব্যবহার হয়ে থাকে, যেমন Losart Plus (এখানে Losartan + Hydrochlorothiazide আছে।

Tablet 2. Losart Plus 50MG As a (50mg+12.5mg)

(AS A Losartan Potassium and with Hydrochlorothiazide ) AS A Combined antihypertensive preparations.

Indications of Losartan:-

Losart Plus is indicated for the treatment of hypertension. It is also indicated to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy.

Side Effects OF Losartan potassium:-

Side-effects are usually mild. Symptomatic hypotension including dizziness may occur, particularly in patients with intravascular volume depletion (e.g. those taking high-dose diuretics). Hyperkalaemia occurs occasionally; angioedema has also been reported with some angiotensin-II receptor antagonists. Vertigo; less commonly gastro-intestinal disturbances, angina, palpitation, oedema, dyspnoea, headache, sleep disorders, malaise, urticaria, pruritus, rash; rarely hepatitis, atrial fibrillation, cerebrovascular accident, syncope, paraesthesia; also reported pancreatitis, anaphylaxis, cough, depression, erectile dysfunction, anaemia, thrombocytopenia, hyponatraemia, arthralgia, myalgia, renal impairment, rhabdomyolysis, tinnitus, photosensitivity, and vasculitis (including Henoch-Schonlein purpura)

কেনো ডায়াবেটিস পেশেন্ট কে hydrochlorothiazide দিবেন না? আর indapamide দেওয়ার সুবিদা কি?

Thiazide diuretics গুলির Molecular structure এর মধ্যে benzothiadiazine molecules থাকে, এই Benzothiadiazine এর কাজ হচ্ছে ব্লাড গ্লুকোজ বৃদ্ধি করা,

তথা impaired glucose tolerance করে।

অপরদিকে Diuretics এর আপডেট ভার্সন হচ্ছে indapamide, এর গাঠনিক স্ট্রাকচারে Benzothiadiazine molecules নাই, তাই এইটা গ্লুকোজ এর উপর কোনো ইফেক্ট ফেলেনা। এমনকি Thiazide diuretics এর কারণে gout হতে পারে, তবে indapamide এ এইসব সাইড ইফেক্ট নাই,

যখন কোনো DM +HTN পেশেন্ট এর ARBs + CCB এর কম্বিনেশনে ব্লাড প্রেশার কন্ট্রোল হচ্ছেনা, তখন তাদের diuretics add হবে indapamide.

Indapamide SR form এ পাওয়া যায়,

Tab- Hypen SR 1.5 mg once Daily at morning

(AS A Indapamide AS A Thiazide diuretics & related drugs.)

Indications OF HYPEN SR:-

Hypen SR is indicated in the treatment of essential hypertension . It is effective in treating hypertension in patients with renal function impairment, although its diuretic effect is reduced. Hypen SR is also indicated for the treatment of salt and fluid retention associated with congestive heart failure.

Side Effects OF HYPEN SR:-

Side effects of Hypen SR include headache, anorexia, gastric irritation,nausea, vomiting, constipation, diarrhoea etc.

Pregnancy & Lactation

There are no adequate and well-controlled studies in pregnant women and so Indapamide is not recommended. Mothers taking Indapamide should not breast feed.

Raiyyan Tahsan

Articale made by Raiyyan Tahsan date:26-10-2024.time 10.11 pm

Raiyyan Tahsan

Raiyyan Tahsan