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cardio:diuretics:chlorthalidone

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cardio:diuretics:chlorthalidone [2026/02/15 14:59] – andrew2393cnscardio:diuretics:chlorthalidone [2026/03/15 17:05] (current) – Create Chlorthalidone page wilkie
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-====== Albuterol (ProAir®, Ventolin®, Proventil®) ====== +====== Chlorthalidone (Hygroton®) ======<WRAP right 340px><WRAP infobox>| | {{ :cardio:diuretics:chlorthalidone_structure.svg |}} |^ Chlorthalidone || Brand Names | Hygroton® || Drug Class | [[cardio:diuretics:thiazide:start|Thiazide-Like Diuretic]] || Primary Indications | [[cardio:hypertension:start|Hypertension]]; Edema || Blood Pressure Effect | ↓ BP (chronic) || Mortality Benefit | No (BP control) || Elimination | Renal || Black Box Warning | No || FDA Approval | 1960 |</WRAP></WRAP>===== Overview =====Chlorthalidone is a thiazide-like diuretic that inhibits the Na-Cl cotransporter in the distal convoluted tubule. It has a longer half-life and stronger BP reduction than HCTZ.<WRAP clear></WRAP>----===== Mechanism of Action =====**Primary Molecular Target**  * Na-Cl cotransporter (NCC) in distal convoluted tubule**Segment Effects**  * ↓ NaCl reabsorption in DCT  * ↑ Ca2+ reabsorption  * Mild natriuresis**Net Physiologic Outcomes**  * ↓ blood pressure (long-term)  * Mild diuresis  * ↓ urinary calcium----===== Indications =====  * First-line hypertension (preferred thiazide-like)  * Mild edema----<WRAP blackbox>===== Black Box Warning =====No black box warning.</WRAP>----<WRAP contra>===== Contraindications =====Absolute:  * AnuriaRelative / Caution:  * Gout  * Hyponatremia  * Hypokalemia  * Sulfonamide allergy (severe)</WRAP>----<WRAP details>===== Dosing =====Hypertension:  * 12.5–25 mg daily (typical)  * Max: 50 mg dailyEdema:  * 25–100 mg daily or divided</WRAP>----<WRAP details>===== Pharmacokinetics =====Absorption:  * OralBioavailability:  * ~65%Metabolism:  * MinimalHalf-life:  * ~40–60 hoursElimination:  * Renal</WRAP>----<WRAP details>===== Adverse Effects =====Common:  * Hypokalemia  * Hyponatremia  * Hyperuricemia  * HyperglycemiaSerious:  * Severe hyponatremia  * Arrhythmias from hypokalemia</WRAP>----<WRAP details>===== Drug Interactions =====Increased risk:  * Lithium (↑ levels)  * NSAIDs (↓ effect)Avoid combination:  * Other QT-prolonging meds if severe hypokalemia</WRAP>----<WRAP monitoring>===== Monitoring =====Labs:  * Electrolytes (Na+, K+)  * Uric acid  * GlucoseVitals:  * Blood pressureClinical:  * Gout symptoms  * Orthostasis</WRAP>----<WRAP pearls>===== Clinical Pearls =====  * Longer half-life than HCTZ  * Preferred in guidelines for BP control  * Increases calcium reabsorption</WRAP>----===== Comparison Within Class =====Compared to other [[cardio:diuretics:thiazide:start|thiazide diuretics]]:  * Longer duration than HCTZ  * More potent BP lowering  * Higher hypokalemia risk----===== Related =====  * [[cardio:diuretics:thiazide:start|Thiazide Diuretics]]  * [[cardio:hypertension:start|Hypertension]]  * [[cardio:diuretics:start|Diuretics]]
- +
-<WRAP right 340px> +
-<WRAP infobox> +
-^ Albuterol | {{:cardio:diuretics:albuterol-teaser.png?200|}} | +
-| Brand Names | ProAir®, Ventolin®, Proventil® | +
-| Drug Class | [[respiratory:beta2_agonists:start|Short-Acting β2 Agonist (SABA)]] | +
-| Primary Indication | Acute bronchospasm | +
-| Receptor Target | β2 adrenergic receptor | +
-| Mechanism | ↑ cAMP → Bronchodilation | +
-| Onset | ~3–5 minutes | +
-| Duration | 4–6 hours | +
-| Route | Inhaled (MDI, DPI, Neb) | +
-| Potassium Effect | ↓ Serum K⁺ (cellular shift) | +
-| FDA Approval | 1981 | +
-</WRAP> +
-</WRAP> +
- +
-===== Overview ===== +
- +
-Albuterol is the first-line rescue bronchodilator for acute bronchospasm in asthma and COPD. +
- +
-It provides rapid airway smooth muscle relaxation but does **not treat airway inflammation**, making it a symptom reliever rather than a controller medication. +
- +
-Frequent use indicates poorly controlled disease and need for anti-inflammatory therapy such as [[respiratory:inhaled_corticosteroids:start|Inhaled Corticosteroids]]. +
- +
-<WRAP clear></WRAP> +
- +
----- +
- +
-===== Mechanism of Action ===== +
- +
-**Receptor Activated** +
-  * β2 adrenergic receptor   +
- +
-**Cellular Effects** +
-  * ↑ cAMP +
-  * Smooth muscle relaxation +
-  * ↓ mediator release from mast cells +
-  * ↑ mucociliary clearance +
- +
-**Systemic Effect** +
-  * Drives potassium intracellularly +
- +
-Net effect: +
-  * Rapid bronchodilation and relief of airflow obstruction +
- +
----- +
- +
-===== Indications ===== +
- +
-  * Acute asthma symptoms +
-  * Exercise-induced bronchospasm prevention +
-  * COPD rescue therapy +
-  * Temporary treatment of hyperkalemia +
- +
-Often used with: +
-  * [[respiratory:inhaled_corticosteroids:start|Inhaled Corticosteroids]] +
-  * [[respiratory:antimuscarinics:start|Antimuscarinics]] +
- +
----- +
- +
-<WRAP contra> +
-===== Contraindications ===== +
- +
-Absolute: +
-  * Hypersensitivity to albuterol +
- +
-Relative / Caution: +
-  * Tachyarrhythmias +
-  * Ischemic heart disease +
-  * Hyperthyroidism +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Dosing ===== +
- +
-Metered-Dose Inhaler: +
-  * 1–2 puffs every 4–6 hours PRN +
- +
-Nebulizer: +
-  * 2.5 mg every 4–6 hours PRN +
- +
-Exercise prevention: +
-  * 2 puffs 15 minutes prior to activity +
- +
-Frequent use (>2 days/week): +
-  * Indicates uncontrolled asthma +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Pharmacokinetics ===== +
- +
-Onset: +
-  * 3–5 minutes +
- +
-Peak: +
-  * ~30 minutes +
- +
-Duration: +
-  * 4–6 hours +
- +
-Elimination: +
-  * Hepatic metabolism and renal excretion +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Adverse Effects ===== +
- +
-Adrenergic: +
-  * Tremor +
-  * Tachycardia +
-  * Palpitations +
-  * Anxiety +
- +
-Metabolic: +
-  * Hypokalemia +
-  * Hyperglycemia (mild) +
- +
-Other: +
-  * Headache +
- +
-Dose dependent — more common with frequent use. +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Drug Interactions ===== +
- +
-Beta-blockers: +
-  * Reduced bronchodilator effect +
- +
-MAO inhibitors / stimulants: +
-  * Increased tachycardia +
- +
-Diuretics: +
-  * Increased hypokalemia risk +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP monitoring> +
-===== Monitoring ===== +
- +
-  * Rescue inhaler use frequency +
-  * Symptom control +
-  * Heart rate (high doses) +
-  * Potassium (continuous nebs) +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP pearls> +
-===== Clinical Pearls ===== +
- +
-  * First drug used in asthma exacerbation +
-  * Frequent use = need controller therapy +
-  * Spacer significantly improves lung delivery +
-  * Nebulizer easier to inhale — not stronger +
-  * Useful temporary treatment for hyperkalemia +
- +
-</WRAP> +
- +
----- +
- +
-===== Comparison Within Class ===== +
- +
-Compared to [[respiratory:beta2_agonists:levalbuterol|Levalbuterol]]: +
-  * Less selective β2 activity +
-  * More tremor/tachycardia +
-  * Lower cost +
- +
-Compared to [[respiratory:beta2_agonists:formoterol|Formoterol]]: +
-  * Shorter duration +
-  * Used for rescue rather than maintenance +
- +
----- +
- +
-===== Related ===== +
- +
-  * [[respiratory:beta2_agonists:start|β2 Agonists]] +
-  * [[respiratory:inhaled_corticosteroids:start|Inhaled Corticosteroids]] +
-  * [[respiratory:asthma|Asthma]] +
-  * [[respiratory:copd|COPD]]+
cardio/diuretics/chlorthalidone.txt · Last modified: by wilkie