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Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)

4- Diuretics

➢ Diuretics relieve pulmonary congestion and peripheral edema.

➢ Reducing the symptoms of volume overload, including orthopnea and paroxysmal
nocturnal dyspnea.
➢ plasma volume ➔ venous return to the heart (preload).

 This decreases the cardiac workload and the oxygen demand.
➢ afterload by reducing plasma volume ➔ blood pressure.

Thiazide diuretics Loop diuretics

used for patients who require
relatively mild diuretics and lose extensive diuresis and those with

efficacy if patient creatinine clearance renal insufficiency most commonly
is less than 50 mL/min.
used diuretics in HF

5- Direct Vasodilators

 Hyperpolarization➔ VD ➔  peripheral resistance ➔  cardiac work.

 Nitrates are commonly used venous dilators for patients with congestive HF.
 If the patient is intolerant of ACE inhibitors or β-blockers, or if additional vasodilator
response is required, a combination of hydralazine and isosorbide dinitrate may be

used.
 Such a combination is quite effective in black patients with HF.
 Hydralazine decreases afterload, and organic nitrate reduces preload.

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