Medical Therapeutic - Pharmacology         Classification: BENZOTHIAZINE These diuretics have a tendency to produce uric acid retention with the possibility of precipitating an accute attack of gout. These diuretics have shown impairment of carbonhydrate metabolism, resulting in a decreased glucose tolerance and hyperglycemia. Elevation of blood amonia fro  benzothiadiazine may precipitate hepatic coma in patients with cirrhosis of the liver.   Is administration of the benzothiadiazine safe for pregnant women? In much situations, administration of these drugs should de approched cautiously since they do cross the placental barrier and appear in the cord blood and in breast milk. This may result in neonatal jaundice, bone marrow depression, and thrombocytopenia. Role of thiazide in the treatment of hypertension. When used alone/it causes more than a 10% drop in blood pressure and is suitable for control of mild cases only. LASIX(FUROSEMIDE) Indicated when a rapid onset of diuresis is desired, as in pulmonary, as in pulomonary edema, and when patients are refractory to other diuretic drugs.   For what adverse reactions should the nurse be alert as a consequence of therapy with lasix or ethacrinic acid? These drugs may produce too vigorous diuresis, as evidenced by rapid and excessive weight loss, dehydration, and orthostatic hypotension that may lead to a reduction of blood volume and circulatory collapse. In elderly cardiac patients, rapid contraction of plasma volume and hemoconcentration may result in thromboembolic episodes.   Severe hypokalemia may also result. Ethacrinic acid has also been known to produce ototoxicity.   Less severe side effects include: GI, anorexia, nausea, vomiting and mild diarrhea. CLASSIFICATION   HYPNOTICS/SEDATIVES Because their act on serves to maintain a high urine volume, osmotic diuretics can be used to prevent anuria following a hemolytic reaction, extensive surgery or trauma, and hemorrhage. Why should the nurse be cautious in administering osmotic diuretics to patients with congestive heart failure?   The large volumes necessary to reach high doses may result in increased plasma volume and intensify congestive heart failure and pulmonary edema. BENZOTHIAZIDES   To what class of drugs are Benzothiazides related? The Benzothiazides are synthetic drugs that are chemically related to sulfonamides.  The nurse should be aware that patients who are highly allergic to sulfonamides may manifest an allergic reaction to benzothiazides. For what kind of toxic reactions should the nurse be observant in patients receiving benzothiazides. Toxic reactions to benzothiazides result from electrolyte imbalances:  hypokalemia, fall in arterrial pressure.  The tendancy for these drugs to cause potassium depletion is especially important for patient receiving cardiac glycosides, since a loss of potassium may precipitate digitalis intoxication   SIGNS AND SYMPTOMS that lead a nurse to suspect that a patient may be hypokalemic Anorexia, nausea, weakness, and drowsiness are indications of hypokalemic state. Why should the nurse be careful of enteric coated potassium tablets? Patients receiving benzothiazidiaxides together with potassium supplement in enteric coated form may develop nonspecific bowel lesions that may result in: obstruction, hemorrhage, and perforation Enteric coated tablets should be discontinued if abdominal pain, distention, nausea, vomiting or GI bleeding.  Liquid potassium supplements are recommended instead of enteric coated tablets.   List of common benzothiadiazine diuretics chlorothiazide(Diuril)is the prototype.