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Calculus formation and ureteral colic Post Date: Wed, 15 Oct 2008 10:39:45 +0000 Hypersensitivity reactions are relatively rare. They consist in fever, skin reactions, bone-marrow depression, and sulfonamide-like renal le-sions. Calculus formation and ureteral colic have been attributed to the marked reduction in urinary citrate produced by acetazolamide associated with either no change or even a rise in urinary calcium (Gordon and Sheps, 1957). Autor of the post: Undefined THERAPEUTIC USESAlthough undoubtedly effective in evoking Post Date: Wed, 15 Oct 2008 10:27:46 +0000 Acetazolamide depresses the uptake of iodine by the thyroid gland. However, drugs of this class are not therapeutically useful as antithyroid agents.THERAPEUTIC USESAlthough undoubtedly effective in evoking a diu-resis, the carbonic anhydrase inhibitors are relatively ineffective compared to newer and more efficacious agents. Autor of the post: Undefined Neither of these applications Post Date: Wed, 15 Oct 2008 10:16:24 +0000 Acetazolamide has been given to reduce in-traocular pressure in the management of glaucoma. It may also be employed for its anticonvulsant action for both grand mal and particularly petit mal epi-lepsy. Neither of these applications has gained wide acceptance. Autor of the post: Undefined In acute situations Post Date: Wed, 15 Oct 2008 9:58:53 +0000 There are several conditions in which alkaliniza-tion of the urine may itself be an appropriate thera-peutic goal For example, chronic alkalinization is useful to prevent precipitation and calculus forma-tion in cystinuria. To maintain electrolyte balance, sodium bicarbonate should be employed, rather than acetazolamide. In acute situations, of which salicy-late poisoning is the prototype, alkalinization may be used to increase the renal excretion of lipid-soluble weak organic acids. Autor of the post: Undefined The early superimposed respiratory alkalosis Post Date: Wed, 15 Oct 2008 9:42:32 +0000 The question of the relative merits of acetazolamide and sodium bicarbonate has been a subject of controversy. Theoretical objections to acetazolamide include its neurological actions and its direct inhibition of the renal tubular secretion of organic acids. The early superimposed respiratory alkalosis seen in some cases is a theoretical objection to the use of sodium bicarbonate, particularly in large doses. Autor of the post: Undefined Aceta-zolamide is also effective Post Date: Wed, 15 Oct 2008 9:31:47 +0000 The concurrent use of acetazolamide and sodium bicarbonate has provided a satisfactory clinical response (Morgan and Polak, 1969) and has been studied experimentally in detail (Reimold et al, 1973). For reasons that are totally obscure, aceta-zolamide appears to have a beneficial effect in the management of periodic paralysis even when associ-ated with hypokalemia (Griggs et at, 1970). Aceta-zolamide is also effective in ameliorating the symp-toms of acute mountain sickness (Gray et al, 1971). Autor of the post: Undefined This useful and important class Post Date: Wed, 15 Oct 2008 9:20:45 +0000 A radioactive complex has been proposed for renal scanning (Halpern et al, 1972).BENZOTHIADIAZIDESHistory. This useful and important class of diu-retics has an interesting history and provides an instructive example of the manner in which newly synthesized agents may be endowed with unantici-pated pharmacological properties. Autor of the post: Undefined This not only increased diuretic Post Date: Wed, 15 Oct 2008 9:01:22 +0000 They were first synthesized as an outgrowth of studies on carbonic anhydrase inhibitors. In the examination of certain benzenedisulfonamides, ring closure was found to occur between an acylamino group and the sulfamyl group ortho to it. This not only increased diuretic action but also changed fundamental characteristics of the diuresis. Autor of the post: Undefined Chlorothiazide was the first member Post Date: Wed, 15 Oct 2008 8:42:09 +0000 The voided urine contained increased amounts of chloride, a response significantly differ-ent from that evoked by the parent compounds, which were characteristic carbonic anhydrase in-hibitors {see Beyer, 1958). Subsequent studies indi-cated that the benzothiadiazides have a direct effect on the renal tubular transport of sodium and chloride independent of carbonic anhydrase inactivation (Maren and Wiley, 1964).Chlorothiazide was the first member of this class to be extensively studied. Autor of the post: Undefined Most compounds of this group Post Date: Wed, 15 Oct 2008 8:23:05 +0000 Although many analogs have been subsequently prepared, the basic phar-macological action is the same as for chlorothiazide.Chemistry and Structure-Activity Relationship.Most compounds of this group are analogs of 1,2,4-benzothiadiazine-l,l-dioxide (see Table 39-3 for the parent structural formula and the substituents of the analogs that have received the most intensive study). 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