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Plasma potassium concentration should be determined Post Date: Wed, 15 Oct 2008 8:12:17 +0000 As a group they can be designated as the "benzo-thiadiazide," or "thiazide," diuretics. The relation-ship between structure and activity is complex and depends not only on the chemical configuration of the compound but also on many physiologicalreported with purpura, dermatitis with pho-tosensitivity, depression of the formed ele-ments of the blood, and necrotizing vasculitis (see Harber et al, 1959; Bjornberg and Gisslen, 1965; Kutti and Weinfeld, 1968).Plasma potassium concentration should be determined periodically in patients who receive thiazide diuretics for extended periods. Autor of the post: Undefined It is preferable to prescribe Post Date: Wed, 15 Oct 2008 7:59:51 +0000 In order to avoid a negative potassium balance, the thiazides are often prescribed in combination with potassium chloride. The use of enteric-coated combinations of potassium chloride and thiazide has been associated with a high incidence of ulceration of the distal jejunum or ileum. It is preferable to prescribe a palatable solution of potassium chloride, several of which are available. Autor of the post: Undefined Borderline renal and/or hepatic insufficiency may Post Date: Wed, 15 Oct 2008 7:45:38 +0000 Alternatively, thiazide diuretics have been prescribed in combination with an aldosterone antagonist or other potassium-sparing diuretic (see below) in order to obtain an additive diuretic effect with maintenance of potassium balance. The plasma uric acid is frequently elevated and in susceptible patients may be associated with attacks of gout.Borderline renal and/or hepatic insufficiency may be unpredictably aggravated by the thiazides. Autor of the post: Undefined In cirrhosis of the liver Post Date: Wed, 15 Oct 2008 7:31:05 +0000 The mechanisms are not well understood. In patients, particularly those with hypertensive disease and decreased renal reserve, the manifestations of renal insufficiency may be aggravated after intensive or prolonged courses of thiazides that lead to excessive depletion of fluid and electrolyte. In cirrhosis of the liver, deterioration of mental function, including the onset of coma, has been attributed to thiazide therapy. Autor of the post: Undefined The relationship between these findings Post Date: Wed, 15 Oct 2008 7:13:32 +0000 Many observers have noted a correlation with hypokalemia and alkalosis. Increased concentrations of blood ammonia have been reported. The relationship between these findings, the reported signs and symptoms, and the action of the thiazides is not clearly established. Autor of the post: Undefined Several mechanisms have been proposed Post Date: Wed, 15 Oct 2008 7:02:43 +0000 Cholestatic hepatitis has also been reported.The thiazides may induce hyperglycemia and aggravate preexisting diabetes mellitus (Dollery, 1973). Several mechanisms have been proposed, including inhibition of pancreatic release of insulin and blockade of peripheral glucose utilization. Autor of the post: Undefined Preparations and Dosage Post Date: Wed, 15 Oct 2008 6:45:43 +0000 However, the exact mechanism is in doubt and may involve several factors. The disturbance in carbohydrate metabolism is relatively commonand is probably unrelated to the much rarer toxic reaction of acute pancreatitis.Preparations and Dosage. Autor of the post: Undefined In a few instances, preparations Post Date: Wed, 15 Oct 2008 6:26:20 +0000 The thiazides are available as tablets for oral administration. The wide range of dosage is indicated in Table 39-3. In a few instances, preparations of the sodium salt are avail-able for intravenous administration. Autor of the post: Undefined Trichlormethiazide, chlorthalidone, and polythiazide should Post Date: Wed, 15 Oct 2008 6:08:01 +0000 However, this route offers no advantage for most therapeutic pur-poses.Most of the thiazides are given in divided daily doses for the treatment of hypertension, but a single daily dose may be preferable for the mobilization of edema fluid. Trichlormethiazide, chlorthalidone, and polythiazide should be given less frequently, since they have a duration of action longer than 24 hours. Autor of the post: Undefined Combinations in a fixed-dose ratio Post Date: Wed, 15 Oct 2008 5:56:10 +0000 The action of quinethazone and metolazone may also persist up to 24 hours. The thiazides are available as the pure preparations and should be administered as such. Combinations in a fixed-dose ratio with other diuretics or with other antihypertensive agents or potassium supplements are usually not recommended. 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