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Generic Name Diuretics, Thiazide. Handbook Hemodynamic Monitoring' title='Handbook Hemodynamic Monitoring' />All applicants must meet the following criteria 1. Have a high school diploma or general education diploma at the time of application. Fulfill one 1 of the. This monograph includes information on the following 1 Bendroflumethiazide. Chlorothiazide  3 Chlorthalidone. Hydrochlorothiazide. Hydroflumethiazide  6 Methyclothiazide. Metolazone. 8 Polythiazide  9 Quinethazone  1. Trichlormethiazide  INN Chlorthalidone Chlortalidone. VA CLASSIFICATIONPrimary CV7. Secondary CV4. 09 GU9. Commonly used brand names Apo Chlorthalidone. Apo Hydro. 4 Aquatensen. Diucardin. 5 Diuchlor H4 Diulo. Diuril. 2 Duretic. Enduron. 6 Esidrix. Hydro D4 Hydro chlor. Hydro. DIURIL4 Hydromox. Hygroton. 3 Metahydrin. Microzide. 4 Mykrox. Naqua. 10 Naturetin. Neo Codema. 4 Novo Hydrazide. Novo Thalidone. 3 Oretic. Renese. 8 Saluron. Thalitone. 3 Trichlorex. Uridon. 3 Urozide. Zaroxolyn. 7. Note For a listing of dosage forms and brand names by country availability, see Dosage Forms sections. Not commercially available in Canada. Category Diureticantihypertensiveantidiuretic central and nephrogenic diabetes insipidusantiurolithic calcium calculiIndications. Note Bracketed information in the Indications section refers to uses that are not included in U. S. product labeling. Accepted. Edema treatmentIndications include edema associated with congestive heart failure, hepatic cirrhosis with ascites, corticosteroid and estrogen therapy, and some forms of renal function impairment including nephrotic syndrome, acute glomerulonephritis, and chronic renal failure. However, prompt metolazone tablets are not indicated for treatment of edema because a safe and effective diuretic dosage has not been established. Hypertension treatmentThiazide diuretics are indicated either alone or as adjunctive therapy 0. For additional information on initial therapeutic guidelines related to the treatment of hypertension, see Appendix III. Diabetes insipidus, central or nephrogenic treatment1Thiazide diuretics are used in the treatment of central and nephrogenic diabetes insipidus. Renal calculi, calcium prophylaxis 1Thiazide diuretics are also used for prevention of calcium containing renal stones. Not included in Canadian product labeling. PharmacologyPharmacokinetics. Note Although they are not chemically the same, chlorthalidone, metolazone, and quinethazone have the same actions as the thiazide diuretics. Physicochemical characteristics Molecular weightBendroflumethiazide 4. Chlorothiazide 2. Chlorthalidone 3. Hydrochlorothiazide 2. Hydroflumethiazide 3. Methyclothiazide 3. Metolazone 3. 65. Polythiazide 4. 39. Quinethazone 2. 89. Trichlormethiazide 3. KaBendroflumethiazide 8. Chlorothiazide 6. Chlorthalidone 9. Hydrochlorothiazide 7. Hydroflumethiazide 8. Methyclothiazide 9. Metolazone 9. 7. Quinethazone 9. Trichlormethiazide 8. Mechanism of actionEffect DiureticThiazide diuretics increase urinary excretion of sodium and water by inhibiting sodium reabsorption in the early distal tubules 0. They increase the rate of delivery of tubular fluid and electrolytes to the distal sites of hydrogen and potassium ion secretion, while plasma volume contraction increases aldosterone production. The increased delivery and increase in aldosterone levels promote sodium reabsorption at the distal tubules, thus increasing the loss of potassium and hydrogen ions. AntihypertensiveDiuretics lower blood pressure initially by reducing plasma and extracellular fluid volume cardiac output also decreases. Eventually, cardiac output returns to normal. Thiazide diuretics decrease peripheral resistance by a direct peripheral effect on blood vessels. AntidiureticThe antidiuretic effect of thiazide diuretics is a result of mild sodium and water depletion leading to increased reabsorption of glomerular filtrate in the proximal renal tubule and reduced delivery of tubular fluid available for excretion. Corel Draw Logo Design Tutorials Pdf more. Antiurolithic calcium calculiThiazide diuretics decrease urinary calcium excretion by a direct action on the distal tubule, which may prevent recurrence of calcium containing renal calculi. Absorption Thiazide diuretics are absorbed relatively rapidly after oral administration. MetolazoneThe time to peak concentration is 8 hours for extended metolazone tablets and 2 to 4 hours for prompt metolazone tablets 0. In addition, prompt metolazone tablets have higher bioavailability 0. Protein binding BendroflumethiazideVery high 9. ChlorothiazideLow to high 2. ChlorthalidoneHigh 7. HydroflumethiazideHigh 7. MetolazoneVery high 9. PolythiazideHigh 8. Elimination Unchanged almost totally via the kidneys, 0. Drug        Half lifehr        Diuretic Effect hr        Onset        Peak        Duration        Bendroflumethiazide        8. Chlorothiazide        12        2        4        61. Chlorthalidone        3. Hydrochlorothiazide        5. Hydroflumethiazide        1. Methyclothiazide         2        6         2. Metolazone        1. Polythiazide         2        6        2. Quinethazone         2        6        1. Trichlormethiazide         2        6        2. Information on diuretic effect applies to extended metolazone tablets. Note In the absence of edema, negative sodium balance induced by 5. Extracellular fluid volumes remain steady thereafter, although at a lower concentration and volume than before initiation of therapy. The antihypertensive effects of the thiazide diuretics may be noted after 3 to 4 days of therapy, although up to 3 to 4 weeks may be required for optimal effect. Antihypertensive effects persist for up to 1 week after withdrawal of therapy. Precautions to Consider. Cross sensitivity andor related problems. Install Tamil Font In Adobe Photoshop here. Patients sensitive to other sulfonamide type medications, bumetanide, furosemide, or carbonic anhydrase inhibitors may be sensitive to this medication also. CarcinogenicityMutagenicity. BendroflumethiazideStudies have not been done in either animals or humans. ChlorothiazideCarcinogenicity studies have not been done in either animals or humans. Chlorothiazide was not found to be mutagenic in the Ames microbial mutation test, dominant lethal assay, or a test in Aspergillus nidulans. HydrochlorothiazideCarcinogenicity studies have not been done in either animals or humans. Hydrochlorothiazide was not found to be mutagenic in vitro in the Ames microbial mutation test or on examination of urine from patients who received hydrochlorothiazide however, it did induce nondisjunction in Aspergillus nidulans. HydroflumethiazideStudies have not been done in either animals or humans. MethyclothiazideStudies have not been done in either animals or humans. MetolazoneStudies in mice and rats for 1. MRHD found no evidence of carcinogenicity. TrichlormethiazideStudies have not been done in either animals or humans. PregnancyReproduction. FertilityHydrochlorothiazide No adverse effects on fertility were found in rats given doses up to 2 times the maximum recommended human dose of hydrochlorothiazide. Methyclothiazide No adverse effects on fertility were found in rats given methyclothiazide in doses up to 4 mg per kg of body weight mgkg per day at least 2. Metolazone A study in which male rats were given metolazone at doses of 2, 1. Furthermore, decreased fetal weight and reduced pregnancy rate were observed in dams mated with males from the 1. In mice, there was no evidence that metolazone alters reproductive capacity. PregnancyThiazide diuretics cross the placenta and appear in cord blood.