DIURETICS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1 Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Diuretics: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84396-1 1. Diuretics-Popular works. I. Title.
iii
Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.
iv
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on diuretics. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
v
About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
vi
About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
vii
Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON DIURETICS ................................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Diuretics ....................................................................................... 5 E-Journals: PubMed Central ....................................................................................................... 22 The National Library of Medicine: PubMed ................................................................................ 23 CHAPTER 2. NUTRITION AND DIURETICS ....................................................................................... 39 Overview...................................................................................................................................... 39 Finding Nutrition Studies on Diuretics ...................................................................................... 39 Federal Resources on Nutrition ................................................................................................... 41 Additional Web Resources ........................................................................................................... 42 CHAPTER 3. ALTERNATIVE MEDICINE AND DIURETICS ................................................................. 47 Overview...................................................................................................................................... 47 The Combined Health Information Database............................................................................... 47 National Center for Complementary and Alternative Medicine.................................................. 48 Additional Web Resources ........................................................................................................... 53 General References ....................................................................................................................... 70 CHAPTER 4. DISSERTATIONS ON DIURETICS ................................................................................... 71 Overview...................................................................................................................................... 71 Dissertations on Diuretics ........................................................................................................... 71 Keeping Current .......................................................................................................................... 71 CHAPTER 5. CLINICAL TRIALS AND DIURETICS ............................................................................. 73 Overview...................................................................................................................................... 73 Recent Trials on Diuretics ........................................................................................................... 73 Keeping Current on Clinical Trials ............................................................................................. 73 CHAPTER 6. PATENTS ON DIURETICS.............................................................................................. 75 Overview...................................................................................................................................... 75 Patents on Diuretics .................................................................................................................... 75 Patent Applications on Diuretics................................................................................................. 94 Keeping Current ........................................................................................................................ 106 CHAPTER 7. BOOKS ON DIURETICS ............................................................................................... 107 Overview.................................................................................................................................... 107 Book Summaries: Federal Agencies............................................................................................ 107 Book Summaries: Online Booksellers......................................................................................... 113 Chapters on Diuretics ................................................................................................................ 115 CHAPTER 8. PERIODICALS AND NEWS ON DIURETICS ................................................................. 117 Overview.................................................................................................................................... 117 News Services and Press Releases.............................................................................................. 117 Newsletter Articles .................................................................................................................... 119 Academic Periodicals covering Diuretics................................................................................... 122 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 123 Overview.................................................................................................................................... 123 U.S. Pharmacopeia..................................................................................................................... 123 Commercial Databases ............................................................................................................... 126 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 129 Overview.................................................................................................................................... 129 NIH Guidelines.......................................................................................................................... 129 NIH Databases........................................................................................................................... 131 Other Commercial Databases..................................................................................................... 133 APPENDIX B. PATIENT RESOURCES ............................................................................................... 135
viii Contents
Overview.................................................................................................................................... 135 Patient Guideline Sources.......................................................................................................... 135 Finding Associations.................................................................................................................. 144 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 147 Overview.................................................................................................................................... 147 Preparation................................................................................................................................. 147 Finding a Local Medical Library................................................................................................ 147 Medical Libraries in the U.S. and Canada ................................................................................. 147 ONLINE GLOSSARIES................................................................................................................ 153 Online Dictionary Directories ................................................................................................... 155 DIURETICS DICTIONARY......................................................................................................... 157 INDEX .............................................................................................................................................. 233
1
FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with diuretics is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about diuretics, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to diuretics, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on diuretics. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to diuretics, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on diuretics. The Editors
1
From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
3
CHAPTER 1. STUDIES ON DIURETICS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on diuretics.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and diuretics, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “diuretics” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Managing Acute Renal Failure: Do Vasodilators and Diuretics Have a Role?: The Evolving Approach to a Difficult Problem Source: Journal of Critical Illness. 13(11): 709-714. November 1998. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Greenwich, CT 06831-0010. (203) 661-0600. Summary: Acute renal failure (ARF), particularly in the intensive care unit (ICU), is associated with considerable morbidity and mortality. Supportive care is still the mainstay of treatment for patients who have established ARF. In this article, the author first reviews the incidence and pathogenesis of ARF and briefly discusses the components of supportive care. The author then summarizes the experience acquired to date with drug therapies, including dopamine, atrial natriuretic peptide, and diuretics.
4
Diuretics
There are theoretical grounds for hoping that vasodilators or diuretics might alter the course of ARF or reduce attendant morbidity and mortality, but there is little compelling evidence that these agents are effective, either in treatment or in prevention of the condition. Dopamine may have a role to play in the prevention of ischemic ARR; evidence is mixed, but a protective effect of dopamine has been seen in patients exposed to radiocontrast agents. A trial of diuretic therapy is warranted for oliguric patients (patients who are not passing urine), given the evident advantages of conversion to the nonoliguric state. The author stresses that it is not always easy to establish the cause of ARF or to assess the degree to which prerenal factors contribute to the overall reduction in renal function. However, physicians can be alert to these prerenal factors, including decreased cardiac output, hypotension, and sepsis, because they are treatable. 1 table. 60 references. (AA-M). •
Management of Ascites in Patients with Cirrhosis: What to Do When Diuretics Fail Source: Postgraduate Medicine. 92(8): 155-158, 161-166. December 1992. Summary: Dietary restrictions and diuretics are usually effective therapy for ascites in patients with cirrhosis. However less than 30 percent of patients with ascites refractory to treatment with diuretics live as long as 1 year. In this article, the authors describe the proper implementation of diuretic therapy and discuss the treatment options that remain when it fails. Specific topics include general management principles; the mechanisms of ascites development and disturbed body-fluid regulation; renal handling of sodium and water; diet and diuretics; therapeutic paracentesis; and the surgical management of refractory ascites. 2 figures. 2 tables. 35 references. (AA-M).
•
New Insights into Diuretic Use in Patients with Chronic Renal Disease Source: JASN. Journal of the American Society of Nephrology. 13(3): 798-805. March 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: Patients with chronic renal (kidney) insufficiency (CRI) or the nephrotic syndrome (fluid accumulation, protein in the urine, low levels of protein in the blood, and susceptibility to infection) frequently manifest diuretic resistance. This review article highlights new findings concerning the pharmacodynamics (drug action), kinetics (drug disposition in the body), and rational clinical use of diuretics in patients with CRI and the nephrotic syndrome. Factors limiting diuretic responsiveness in patients with CRI may include a reduced basal level of fractional sodium reabsorption that places an upper limit on diuretic response, and enhanced sodium chloride reabsorption in downstream segments, combined with a reduced delivery of diuretic to the kidney. Diuretic responsiveness in patients with the nephrotic syndrome is limited by avid sodium reabsorption by the terminal nephron. Strategies to improve loop diuretic responsiveness include increasing diuretic dosage, concurrent use of a thiazide diuretic to inhibit downstream sodium chloride reabsorption and attempts to maximally reduce albumin excretion. Strategies to limit albumin excretion include the use of an ACE inhibitor or an angiotensin receptor blocker and appropriate limitation of protein intake. These measures are more logical, effective, and less expensive than infusion of albumin (protein) solutions. 1 figure. 3 tables. 48 references.
•
Excess Mortality Associated With Diuretic Therapy in Diabetes Mellitus Source: Archives of Internal Medicine. 151(7): 1350-1356. July 1991.
Studies
5
Summary: This article reports on a study undertaken to determine whether the high mortality among patients with diabetes receiving treatment for hypertension can be explained by associated risk factors or must be attributed to a deleterious effect of antihypertensive treatment. Participants were 759 outpatients with diabetes and severe retinopathy; they were aged 35 to 69 years and had normal serum creatinine levels at the baseline examination. Patients were classified into five groups according to information recorded at the baseline and first annual follow-up examinations. After adjusting for differences in risk factors, cardiovascular mortality was 3.8 times higher in patients treated with diuretics alone than in patients with untreated hypertension. The authors conclude that, until there is a clinical trial showing a beneficial effect of diuretic treatment in patients with diabetes, there is urgent need to reconsider its continued usage in this population. 1 figure. 5 tables. 43 references. (AA-M).
Federally Funded Research on Diuretics The U.S. Government supports a variety of research studies relating to diuretics. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to diuretics. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore diuretics. The following is typical of the type of information found when searching the CRISP database for diuretics: •
Project Title: AFRICAN HYPERTENSION
AMERICAN
STUDY
OF
KIDNEY
DISEASE
IN
Principal Investigator & Institution: Rostand, Stephen G.; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 19-AUG-1994; Project End 30-JUN-2003 Summary: The first goal of this application is to initiate a Clinical Center for the Full Scale phase of the "African-American Study of Kidney Disease and Hypertension". This study is a cooperative, multicenter, prospective, double-masked, randomized study that will follow a three by two factorial design. This study will be limited to about 900 African-Americans recruited from 14 Clinical Centers. Eligibility for participation will be determined by strict inclusion and exclusion criteria. Only those with seated diastolic blood pressure equal to or more than 95 mmHg and with glomerular filtration rate (GFR) 25 - 70 mmHg/1.73m2, without malignant hypertension or systemic disease and who are willing to cooperate will be considered. This study will consist of three phases: (l) Recruitment (24 months); (2) Intervention and follow-up (45 months); (3) Data 2
Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
6
Diuretics
analysis, close-out, results reporting (12 months). The second goal of this study is to test whether one of three different initial randomized drugs: angiotensin converting enzyme inhibitor (ACEi), calcium channel blocker (CCB) or beta blocker. better reduces the rate of decline of UFR in African-Americans with renal insufficiency attributed to hypertension. A third goal is to examine if one of two levels of blood pressure control (equal to or less than 92 mmHg vs. 102-107 mmHg, mean arterial pressure) is better at preserving renal function. Assignment to treatment and blood pressure groups will be randomized and the treatment regimen will be double-masked. Subsequent to assignment. no other ACEis, CCBs or beta- blockers will be used. If a blood pressure goal is not reached in a participant on maximal doses of the assigned drugs, additional antihypertensives will be used in the following order: (l) diuretics (furosemide); (2) alpha-blocker (doxazosin); (3) central alpha2 agonist (clonidine); (4) minoxidil or hydralazine. This study has major health related implications for disease prevention in that it will try to examine if renal failure due to hypertension that occurs in an extremely high risk African-American population can be slowed or prevented, thereby reducing the need for dialysis and renal transplantation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ALLHAT--ANTIHYPERTENSIVE & LIPID LOWERING TREATMENT TO PREVENT HEART ATTACK Principal Investigator & Institution: Lawton, William J.; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002 Summary: The goals of the study are to determine whether the incidence of fatal coronary heart disease and non-fatal myocardial infarction differs between subjects treated with diuretics versus treatment with a calcium antagonist, ACE inhibitor, or alpha blocker. The study will also determine whether lowering serum cholesterol with Pravastatin reduces death from all causes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: BEDSIDE SYSTEM FOR COMBINED RNA AND PACIN HEART FAILURE Principal Investigator & Institution: Lacy, Jeffrey L.; Proportional Technologies, Inc. Houston, Tx 77054 Timing: Fiscal Year 2001; Project Start 27-SEP-2001; Project End 31-MAY-2004 Summary: (Provided by Applicant): One of the most significant current health care challenges is treatment of heart failure (HF). There are approximately 5 million Americans currently diagnosed with this condition, and there are 400,000-700,000 new cases annually. The direct costs of treatment are estimated at $10-$38 billion with the majority of this cost attributable to patients with New York Heart Association Class III or IV disease. Much of this cost is a result of repeat hospitalization, which occurs in many cases because of inappropriate therapeutic drug regimen. This proposal seeks to develop a technology for combined bedside radionuclide angiography (RNA) and pulmonary artery catheterization (PAC) that can be employed in this population at reasonable cost in the CCU. By merging RNA and PAC, this system will yield LV and RV ejection fractions, right heart, pulmonary, and left atrial pressures, cardiac output, stroke volume, wall motion, pulmonary blood volume, and, most significantly, absolute RV and LV volume curves, so that pressure-volume relations can be examined. By providing this wealth of additional clinical data, which can be obtained repeatedly at
Studies
7
low cost through use of a short-lived radiotracer, this system will enable much more thorough evaluation of such patients, including quantitative examination of the effects of interventions, such as dobutamine and IV diuretics, as well as assessments of response to therapeutic dose levels. It will therefore lead to improved diagnosis, allow drug dose levels to be more accurately determined, and improve prognostic assessment. Since much of the cost of this disease is attributable to the need for repeated hospitalization of decompensated patients, substantial reduction of overall cost can be realized. Improved prognostic evaluation can also have a profound benefit by more accurately identifying patients who are suitable for heart transplantation and/or coronary artery bypass. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CELLULAR CALCIUM TRANSPORT IN URINARY EPITHELIA Principal Investigator & Institution: Friedman, Peter A.; Professor; Pharmacology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-SEP-1998; Project End 31-MAR-2003 Summary: The long-term objective of our work is directed toward a complete understanding of the cellular mechanisms and regulation of calcium transport by renal tubular epithelial cells. Although most calcium absorption proceeds in proximal tubules, distal tubules are the site of the physiological regulation of calcium transport by parathyroid hormone (PTH), calcitonin and vitamin D3. The specific aims of the present proposal are to: 1) characterize the mechanism of calcium entry across apical plasma membranes of distal convoluted tubule (DCT) cells; 2) evaluate the participation and regulation of Na+/Ca2+ exchange in mediating calcium efflux; and, 3) define the signaling pathways activated by PTH and calcitonin in DCT cells, and to examine the coordinate regulation of PTH-dependent calcium transport by 1,25(OH)2 vitamin D3 and estradiol. We identified and partially characterized a novel calcium channel that mediates calcium entry. To acquire additional information about these channels we will: 1) characterize the properties of these channels with regard to their ion selectivity, pharmacologic sensitivity and voltage- dependence; 2) determine the regulation of these calcium channels by protein kinases; 3) define the participation of G-proteins in regulating calcium entry channels; and, 4) identify and clone calcium channel transcripts. Extrusion of calcium across basolateral plasma membranes of distal tubules is mediated by Na+/Ca2+ exchange and by /ca2+-ATPase. Pilot studies suggest that Na+/Ca2+ exchange is the dominant efflux mechanism in DCT cells. We will: 1) Test the hypothesis that thiazide diuretics can inhibit Na+/Ca2+ exchange; and 2) Characterize the stimulatory effects of PTH on Na+/Ca2+ exchange. Calcium transport in distal nephrons is regulated by PTH, calcitonin and 1,25(OH)2 vitamin D3. The following studies will evaluate the mechanism mediating the hormonal regulation of calcium transport in DCT cells. The goals of these experiments are to: 1) Characterize the signaling pathways with particular regard to the phospholipases responsible for activating PKA and PKC and characterize the temporal sequence in which PKA and PKC are activated. We will test the hypothesis that PTH and calcitonin activate PKC via phospholipase D. 2) Identify the mechanism by which PTH activates C1- channels, a primary event in membrane hyperpolarization and stimulation of calcium transport in DCT cells. We will test the hypothesis that these chloride channels are regulated by the PKA limb of the PTH-activated signaling pathway. 3) Examine the regulation of vitamin D3 and estradiol accelerate PTH dependent calcium transport by up-regulating PTH receptor expression. The specific aims will be achieved by applying single cell
8
Diuretics
fluorescence, patch clamp, tracer flux measurements, biochemical and molecular techniques to a DCT cell line that we developed, which expresses an appropriate phenotype. In selected studies, primary cell cultures of proximal or distal tubule cells will be used to verify results in transformed cells or as controls. All procedures are established in our lab. Results from the proposed experiments will provide new information on the mechanism and regulation of calcium transport in the kidney under normal conditions, but also in calcium-wasting syndromes including hyperparathyroidism, renal failure, osteoporosis and malignancy- associated hypercalcemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: VITAMIN B1
CHARACTERIZATION
OF
INTESTINAL
ABSORPTION
OF
Principal Investigator & Institution: Said, Hamid M.; Professor and Senior Research Career Sci; Medicine; University of California Irvine Irvine, Ca 926977600 Timing: Fiscal Year 2002; Project Start 01-AUG-1999; Project End 31-JUL-2004 Summary: This proposal deals with characterization of the absorption process of vitamin B1(thiamine) in the human intestine at the cellular and molecular levels. Thiamine, a water-soluble vitamin, plays an essential role in different cellular metabolic reactions. The importance of thiamine to normal human health and well being is manifested by the serious clinical abnormalities that occur in thiamine deficiency which include cardiovascular and neurological disorders. Thiamine deficiency represents a significant nutritional problem in developed countries and occur in alcoholics, diabetics, coeliac disease patients, renal disease patients, the elderly, in inborn errors of thiamine metabolism, and in long-term users of diuretics. Humans and other mammals can not synthesize thiamine, and thus, must obtain the vitamin from exogenous sources via intestinal absorption. Therefore, the intestine plays a critical role in determining and regulating thiamine normal body homeostasis. Thiamine is presented to the human intestine from two sources: the diet, and as a product of bacterial synthesis by the normal microflora in the large intestine. Very little is known about the absorption mechanism of dietary thiamine in the human small intestine, and no information is available regarding the mechanism of absorption of the bacterially synthesized thiamine in the large intestine. Transport of thiamine across the functionally polarized small intestinal and colonic epithelial cells represents transport of the vitamin across two structurally and functionally different membrane domains (i.e., the luminal and basolateral membrane domains). We propose to characterize the mechanism(s) of thiamine transport across the individual membrane using purified luminal and basolateral membrane vesicle preparations. Intestinal transport processes of variety of nutrients have been shown in recent years to be regulated by specific intracellular protein kinase-mediated pathways, and by extracellular substrate levels. Very little, however, is known about the cellular regulation of the thiamine absorption process in the human intestine. We propose to address this issue in this application. The molecular characteristics of the intestinal thiamine transport process is not known. We propose to clone and characterize the human intestinal thiamine transporters(s) using a method that is based on the strategy of complementation with a human cDNA library of the yeast S. cerevisiae NKC6, a yeast mutant defective in thiamine transport activity. We also propose to clone and characterize the 5'-regulatory region of the human intestinal thiamine transporter(s) gene. Variety of physiological and molecular biology techniques will be used in these studies. Valuable information are expected to emerge from these investigations regarding the cellular/molecular mechanisms and regulation of thiamine
Studies
9
absorption in the human intestine. This should ultimately assist us in designing effective strategies to optimize thiamine body homeostasis, and help us understand the causes of aberrations that occur in thiamine nutrition under certain pathophysiological conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CLINICAL PHARMACOLOGY OF LOOP DIURETICS Principal Investigator & Institution: Brater, D Craig.; Chairman and Professor; Medicine; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2002; Project Start 01-APR-1988; Project End 31-AUG-2005 Summary: (adapted from Investigator's abstract) During the past grant period, the investigators performed a variety of studies asking clinically pertinent questions about more effective uses of diuretics. In the current proposal, they propose two large new studies that logically extend their previous work. The aim of the first study is to delineate the mechanism of the pharmacodynamic resistance to loop diuretics that occurs in patients with congestive heart failure (CHF). This resistance could occur by increased proximal tubular reabsorption of sodium, increased distal reabsorption of sodium and/or a change in the dynamics of the interaction of the loop diuretic with the Na-K-2Chl transporter of the loop of Henle. The answers to these questions should illuminate the mechanisms of sodium retention in CHF and thus allow more rational and effective use of diuretic combinations. This study will entail using diuretics with sites of action at different portions of the nephron as probes of this pathophysiology. They will employ methods familiar to them in clinical studies designed to systematically examine the role of different nephron sites in causing diuretic resistance. They will also perform a clinic-based study in which they will attempt to define causes for clinical deterioration in patients with CHF. This study will utilize a unique electronic medical record at the University of Indiana, the Regenstreif Medical Record System (RMRS). This system captures a wealth of clinical data that will be extracted and linked with compliance data, plasma renin and aldosterone activity and quality of life assessments obtained during this study to answer a series of focused questions. Each patient studied will be followed for at least one year. The investigators will perform multivariate analyses to determine causes of clinical deterioration. These data will provide insights into the causes and pathophysiology of decompensation in patients with CHF, thus enhancing our understanding of this increasingly prevalent disease and leading to better therapeutic strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: EXPPRESSION AND FUNCTION HORMONAL REGULATION OF NEPHRON
OF
TWO
PARACRINE
Principal Investigator & Institution: Lalouel, Jean-Marc M.; Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002 Summary: (Adapted from the applicant's abstract) Expression of both a reninangiotensin system (RAS) and a kallilrein-kinin system (KKS) in tubular lumen of the nephron must impact on circulatory homeostasis through renal handling of sodium and water. Hypotheses regarding the regulation and function of these systems will be tested using the mouse as an experimental model. They have proposed that a paracrine RAS operates along the entire nephron that involves angiotensinogen (AGT) of proximal
10
Diuretics
tubule (PT) origin and renin synthesized and secreted by connecting tubule (CNT). In subsequent work, they have found that renin and tissue kallikrein are expressed by the same cells of CNT. The main hypothesis is that tubular RAS and KKS exert closely interrelated paracrine functions in the regulation of final sodium excretion; these two systems are thereafter referred to as renin- kallikrein system (RKS). They will test specific hypotheses concerning (1) the regulation of hormone precursors of the RKS by dietary sodium, (2) the genetic basis for strain-specific differences in response to dietary salt, and (3) the significance of both PT angiotensinogen expression and genetic background in arterial pressure (AP) regulation. The relationship between these hormonal components and renal handling of sodium and water will be tested through the following experiments: (1) sodium balance will be disrupted by manipulations of dietary sodium with concordant or discordant alteration of plasma volume; (2) segmental sodium and fluid delivery at various sites along the nephron will be manipulated by selective alteration of reabsorption with diuretics; (3) the significance of the tubular RKS in renal sodium handling will be probed by specific pharmacological inhibition. Concordant strain variation in the amiloride-dependance of both sodium taste and CNT renin expression suggest the hypothesis of a genetic difference among strains in one or more genes involved in or regulated by sodium entry in epithelial cells. They propose to map such genes by linkage analysis in backcrosses of select strains and to identify the causal mutations following a candidate gene strategy. To test the significance of PT angiotensinogen and genetic background for baseline AP, the response of the tubular RKS to sustained alterations of dietary sodium will be examined in transgeneic animals expressing one to three AGT genes in two distinct backgrounds. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GENES OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM AND BLOOD PRESSURE RESPONSE Principal Investigator & Institution: Turner, S T.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002 Summary: This NIH-funded project is a collaboration with investigators at Emory University, Altanta, Georgia, to determine genetic predictors of antihypertensive blood pressure response to thiazide diuretics. A sample of 300 antihypertensive whites from Rochester and a sample of 300 African-American hypertensives from Atlanta will be enrolled in the study. Dr. Stephen Turner of the Mayo Clinic is the PI of the project and is responsible for the overall conduct of the project and is carrying out the study in the non-Hispanic whites in Rochester. Dr. W. Dallas Hall, Program Director of the Emory University GCRC, is a co-investigator on the project and is responsible for carrying out the study protocol in African-Americans in Atlanta. Subjects are studied in the respective GCRCs. The Mayo GCRC grant is supporting laboratory ancillary tests on both studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: GENETIC DETERMINANTS OF HIGH BLOOD PRESSURE IN THREE RACIAL GROUPS Principal Investigator & Institution: Turner, Stephen T.; Professor of Medicine; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002
Studies
11
Summary: Essential hypertension is a common disorder that contributes to morbidity, mortality, and cost of health care in the population-at-large, particularly among AfricanAmericans. Although thiazide diuretics are commonly prescribed for treatment of hypertension, blood pressure decreases in response to diuretic therapy individuals within each ethnic group. The overall objective of the proposed research is to determine whether direct measures of gene variation will improve our ability to predict interindividual differences in blood pressure response to diuretic therapy in AfricanAmericans and in non-Hispanic Whites. Blood pressure response to diuretic therapy is in part dependent on the counterregulatory response of the renin-angiotensinaldosterone (RAA) system to sodium and volume loss. Individuals who respond to diuretic therapy with a decrease in blood pressure are characterized by a low plasma renin activity that increases minimally in response to sodium and volume loss. Although responses of the RAA system and blood pressure to sodium and volume loss are known to be influenced by genetic variation, the specific genes responsible have not been identified. The proposed research will determine whether measured variation in genes coding for components of the RAA system predicts interindividual differences in blood pressure response to diuretic therapy in 300 hypertensive African-Americans and in 300 hypertensive non-hispanic Whites (600 individuals, total). We will conduct a standardized clinical study protocol in which hypertensive individuals, ages 30-59.9 years, are treated with the diuretic hydrochlorothiazide, 25 mg/day, for four weeks. We will measure interindividual variation in five RAA system genes: angiotensinogen, renin, angiotensin-I converting enzyme, angiotensin-II receptor, and aldosterone synthase; activity of the RAA system as reflected in levels of plasma angiotensinogen, renin activity, aldosterone, serum angiotensin-I converting enzyme, and urinary aldosterone excretion; concomitant variables; and blood pressure levels. The following specific aims will be accomplished in each ethnic group: to determine whether variation in genes of the RAA system predicts interindividual differences in blood pressure to diuretic therapy; determine whether variation in genes of the RAA system predicts interindividual differences in baseline measures of the endocrine RAA system or response of these measures to diuretic therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GENETIC EPIDEMIOLOGY OF BLOOD PRESSURE TO DIURETICS Principal Investigator & Institution: Chapman, Arlene B.; Professor of Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: The overall objective of this research is to determine whether measured variation in four loci in each of five genes coding for components of the reninangiotensin-aldosterone (RAA) system predicts interindividual differences in blood pressure response to diuretic therapy in 300 hypertensive African Americans and in 300 hypertensive non-Hispanic whites. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: GENETICS, BARTTER'S, GITELMAN'S AND PHA-II Principal Investigator & Institution: Lifton, Richard P.; Chairman, Department of Genetics; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002 Summary: (Adapted from the applicant's abstract) In the previous funding period, these workers have identified the molecular basis of four inherited forms of salt wasting with
12
Diuretics
hypokalemic alkalosis and diminished blood pressure: Gitelman's syndrome,. Bartter's syndromes type I, type II and type III. In addition, they have mapped tow genes causing the Mendelian form of hypertension pseudohypoaldosteronism type II. They have collected a very large cohort of patients with these disease and in the current project will investigate the genes and phenotypes in these diseases. Specific Aim 1 will determine the spectrum of mutations in these genes in patients with Gitelman's and Bartter's syndromes. These studies will characterize functional domains of these proteins and will also identify specific mutations in families that can be used to track disease alleles through individual kindreds. These studies will also permit comparison of clinical phenotypes arising from mutations in different of these genes. Moreover, they will identify kindreds in whom no mutation is present, providing opportunity to identify new blood pressure-altering genes. Finally, these studies will provide clinical substrate for investigation of extended families of index cases who inherit 0, 1 or 2 copies of mutant genes. Preliminary results demonstrate effects of these genes on blood pressure, calcium homeostasis and bone density. Furthermore clinical studies will determine the impact of inheritance of homozygous of homeostasis, bone density and response to diuretics. Using families that are unlinked to known genes, they will also perform analysis of linkage to attempt to identify new genes causing these phenotypes. Finally, they will pursue the positional cloning of the genes for PHAII. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HYPERTENSION PHARMACOGENETICS Principal Investigator & Institution: Johnson, Julie A.; Professor and Chair, Pharmacy Practice; Pharmacy Practice; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Hypertension (HTN) is the most common chronic disease in the United States, and is a leading cause of stroke, acute myocardial infarction (MI), heart failure and kidney failure. There are numerous effective antihypertensive drug classes, but only about half of patients have a good response to any given drug. Pharmacogenetics might significantly improve BP control and outcomes, as geneticallyguided drug therapy selection could dramatically increase the number of patients who receive the best drug for their HTN. We propose to test pharmacogenetic hypotheses that center on BP response and outcomes (death, MI, stroke) in HTN, using 5,871 genomic DNA samples we have collected from participants in INVEST, a large, international trial in patients with HTN and ischemic heart disease. We propose to test the following hypotheses: Hypothesis 1: Genetic variability in the proteins important to verapamil's pharmacologic action contribute to interpatient variability in verapamil's antihypertensive effect. Specific Aim 1A. Identify sequence variability in the genes for the major L-type Ca channel (LTCC) subunits alpha1C and beta, the sarcoplasmlc retlculum Ca2+-ATPase 2, the Ca2+-activated K channel, and critical portions of the ryanodine receptor by resequencing the genes in Corriel DNA from 60 individuals. Predict those polymorphisms most likely to be functionally significant using various bioinformatics techniques. Specific Aim lB. Perform in vitro functional studies, including ion channel patch-clamp studies, to test for functional significance of polymorphisms in the LTCC a1C subunit. Specific Aim 1C. Determine the association between verapamil's antihypertensive effect and genetic polymorphisms of interest, as identified in Aim 1A. Hypothesis 2: Antihypertensives that target the underlying molecular/genetic basis of a patient's HTN will result in better outcomes than antihypertensives that do not target the underlying pathophysiology. Specific Aim 2. Determine whether drug therapy that is targeted at a "drug response" polymorphism or
Studies
13
haplotype results in better patient outcomes (specifically fewer deaths, strokes, MIs) than therapy that does not target the "drug response" polymorphism(s). This hypothesis will be tested for all four study drugs: atenolol, verapamil, hydrochlorothiazide and trandolapril. Because of the diversity of the INVEST genetics sample (47% Hispanic (mostly Puerto Ricans), 38% Caucasian and 11% African American), we will test Hypothesis 3: Use of molecular markers to define genetic heterogeneity in the study population is superior to race/ethnicity information in genetic associations with drug response. Specific Aim 3A. Determine whether models of genetic association with drug response perform better with use of genetic marker-defined population cluster and individual ancestral proportion information than with clinician-defined information on race/ethnicity. Specific Aim 3B. Document that any positive associations between drug response and genotype are not the result of population stratification or admixture. These aims will be accomplished by genotyping patients for at least 50 Ancestral Informative Markers. The proposed studies will provide considerable new evidence regarding the pharmacogenetics of verapamil, and will significantly further our understanding of the pharmacogenetics of p-blockers, thiazide diuretics, and ACE inhibitors. They will substantially enhance our understanding of the genetic variability in proteins important to Ca ++ regulation and response to CCBs and other drugs, and the functional significance of this genetic variability. Finally, the proposed studies will increase our understanding of the role of molecular markers for defining population stratification and admixture in pharmacogenetic studies. The proposed studies should add substantial new information about antihypertensive pharmacogenetics, and could influence how antihypertensive medications are prescribed in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IATRONGENIC CAUSES OF CANCER Principal Investigator & Institution: Ross, Ronald K.; Professor; Preventive Medicine; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2002; Project Start 01-APR-1979; Project End 31-JAN-2004 Summary: This proposal requests continued support for a Program Project Grant (PPG) to conduct epidemiologic and biostatistical research on iatrogenic causes of cancer by investigators at the Kenneth Norris Jr. (University of Southern California) Comprehensive Cancer Center. This PPG is currently in its 16th year of continuous funding. The professional staff of this Program consists of 11 epidemiologists and statisticians with major research interests in iatrogenic exposures and cancer. The Scientific Program of the current application consists of 3 case-control studies. The successful conduct of these 3 projects depends on 5 core resources. The 4 projects include the following: (1) A continuation of an ongoing case-control study of the relationship of hormone replacement therapy and breast cancer risk in postmenopausal women. An expanded study will allow more detailed and precise evaluation of duration and latency effects, the evaluation of interactions and adequate adjustment for confounding factors; (2) A continuation of an ongoing case- control study of analgesics and diuretics and renal cell carcinoma. Preliminary results suggest that acetaminophen is associated with a greater increment in risk than aspirin, but the strong correlation between different formulations requires larger sample sizes to determine independent effects; and A continuation of an ongoing case-control study of diagnostic radiation and acute myelogenous leukemia. Preliminary data suggest a dose response relationship between trunk x-rays and risk but results are not statistically significant. The major core resource for this PPG is the Cancer Surveillance Program, a rapid ascertainment population-based tumor registry. Other core resources include a Medical Record
14
Diuretics
Retrieval Core for validating self-reported prescription medications, diagnostic and therapeutic radiation, a Control Identification Core for identifying neighborhood controls for case-control studies, a Statistical Core for developing strategies for analyzing the types of studies described above and an Administrative Core for overseeing the scientific direction of the PPG and handling its fiscal administration. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INHALED NO IN PREVENTION OF CHRONIC LUNG DISEASE Principal Investigator & Institution: Ballard, Roberta A.; Chief, Division of Neonatology; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-MAR-2000; Project End 28-FEB-2005 Summary: Respiratory morbidity, particularly chronic lung disease (CLD), remains a major cause of long-term morbidity and mortality for preterm infants. Although surfactant replacement has decreased acute respiratory morbidity and mortality, it has not reduced the incidence of CLD. A number of other approaches, including antenatal thyrotropin releasing hormone in conjunction with corticosteroids, postnatal steroid administration, as well as administration of Vitamin E, diuretics, and bronchodilators, have not resulted in clinically important decreases in CLD. Infants with the most severe CLD go on to develop findings suggestive of pulmonary hypertension with cor pulmonale. There is preliminary evidence in the preterm infant with severe chronic lung disease that low-dose inhaled nitric oxide may significantly attenuate the disease and decrease mortality. We propose a multi-center, controlled and blinded trial to investigate the hypothesis that low-dose inhaled nitric oxide administered to preterm infants between 500 and 1250 grams birth weight who continue to require mechanical ventilation at 10 days of age will increase survival without CLD at 36 weeks post menstrual age. Demonstrating an increase from 50 percent to 60 percent survival without CLD requires 726 randomized infants to have 80 percent power to detect this difference while controlling for a one-sided alpha of 0.05 and allowing for one interim analysis at one-third of outcome data available. Secondary outcomes are duration of ventilation, oxygen requirement and duration of hospitalization. We expect, in addition, that there will be improvement in infant respiratory status (ventilatory support, airway resistance and compliance) associated with inhaled nitric oxide treatment. Indicators of inflammation and oxidant stress will be assessed by measurements of specific cytokines and protein modifications in tracheal aspirate and plasma samples, respectively. We also will evaluate safety of this therapy by assessing toxicity as measured by clinical bleeding, including intraventricular hemorrhage as well as the incidence of other morbidities of the preterm infant (necrotizing enterocolitis, retinopathy of prematurity and infection) and assess neurodevelopmental outcome through two years of age. In summary, this clinical trial will assess the efficacy and safety of inhaled nitric oxide for amelioration of a major disease of premature infants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: INSULIN, RENAL SODIUM TRANSPORT AND BLOOD PRESSURE Principal Investigator & Institution: Ecelbarger, Carolyn A.; Professor; Medicine; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2007 Summary: (provided by applicant): Hyperinsulinemia has been linked to hypertension in both animals and humans. Furthermore, insulin has been shown to result in sodium retention by the kidney. In cell culture, insulin directly increases sodium transport
Studies
15
capacity of the amiloride-sensitive sodium channel (ENaC), normally located in the renal connecting tubule and collecting duct. Inappropriate retention of sodium in the distal portion of the tubule could result in expanded extracellular fluid volume and hypertension. However, it is not clear what are direct versus indirect effects of hyperinsulinemia with regard to sodium balance. Furthermore, the impact of hyperinsulinemia on the expression and regulation of specific renal sodium transporters and/or channels has not been aqequately studied. Antibodies against many of these proteins have only recently become available. In this proposal, we plan to test the overall hypothesis that insulin and "insulin sensitizing agents", such as PPAR-gamma agonists, will, as a whole, increase the protein abundances of several critical sodium transport proteins expressed in the kidney. We will examine both chronic and acute changes in the abundance and cellular location of these proteins by semi-quantitative immunoblotting and immunohistochemistry. For specific aim 1, we plan to assess the direct effect of increased circulating insulin levels on the relative abundances of the two primary apical sodium transport proteins of the postmacula densa portion of the renal tubule: 1) the amiloride-sensitive epithelial sodium channel (ENaC); and 2) the thiazidesensitive Na-CI cotransporter (NCC). In specific aim 2, we will evaluate the correlation of changes in ENaC subunit and NCC protein abundances with changes in rat blood pressure, and sensitivity to transporter or channel selective diuretics, i.e., amiloride and polythiazide. In specific aim 3, we will address candidate cellular mechanisms for the increase in ENaC subunit or NCC protein abundances observed with insulin infusion. In specific aim 4 we will evaluate relative changes in cellular distribution of both NCC and ENaC subunits in response to acute and chronic insulin exposure. Finally, in specific aim 5, we will investigate the impact of dietary PPAR-gamma agonists on the regulation of all of the major renal sodium transporter proteins in normal rats and insulin resistant, obese Zucker rats. These studies will, hopefully, provide us with an enlightened understanding of the role of insulin in sodium balance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOLECULAR PHYSIOLOGY AND STRUCTURE OF AQUAPORINS Principal Investigator & Institution: Van Hoek, Alfred N.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 01-SEP-1998; Project End 31-AUG-2004 Summary: In mammalian tissues water transport is of critical importance for osmotic balance and is facilitated by aquaporins (AQPs), which are integral membrane proteins forming aqueous pores. The existence of 9 identified homologous aquaporins with diversive and complex tissue distributions, distinct biophysical, biochemical, physiological and morphological properties, appeals to novel insights of water and solute transport, which could lead to alternative treatments of hypertension, congestive heart failure, cirrhosis, the nephrotic syndrome, and other edema forming states. This proposal addresses a detailed analysis of the molecular physiology of solvent/solute transport by functional domain exchange between water selective AQP4 channels and poly-selective AQP9 channels in combination with a scanning site-directed mutagenesis program. The production of active chimeras (specific aim 1) with mixed functional (selectivity for water and solute, sensitivity to phloretin and HgCI2) and structural (formation of orthogonal array aggregates or tetramers) properties will be studied in chimera-expressing oocytes. By osmotic volume flow and tracer studies water and solute transport will be measured. Freeze fracture in combination with immunogold surface labeling will be utilized to investigate morphology. A second focus will be the purification of over-expressed AQP9 and mutant AQP9 proteins in baculovirus infected
16
Diuretics
insect cells (specific aim 2) for the establishment of the molecular organization of AQP9 by 2-dimensional (2- D) crystallography. Antibodies raised against a synthetic AQP9-Cterminal peptide will be utilized as a marker in SDS gels and Western blots analyses. The procedures for isolation include stripping and extraction by detergents, chromatographic maneuvers, and are similar to those used to purify AQP4. Because purified functional AQP4 is already available, low resolution 2-D crystallography of AQP4 will commence first and will be carried out as has been done for AQP1. The prospect of detailed structural data of AQP4 and AQP9 is attractive and will lead to a better understanding of pore structure and permselectivity, diversity and distinct roles of aquaporins, and may also facilitate the design of water channel diuretics or "aquaretic" agents that could induce a diuresis in situations where present diuretics, such as furosemide, are ineffective. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NA+/K+/CL- AND K+/CL- COTRANSPORTERS IN MAMMALIAN KIDNEY Principal Investigator & Institution: Forbush, Bliss; Professor and Director of Graduate Studi; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: The Na-K-CI and K-CI co-transporters play vital roles in transepithelial salt transport and cellular volume and electrolyte balance. The Na-K-CI co-transporter is a key element in the process of NaCI reabsorption across the mammalian renal epithelium in the thick ascending limb of the loop of Henle (TAL), where it is the site of action of diuretics such as furosemide. The K-CI co-transporter has been proposed to be involved in Na CI reabsorption in the proximal tubule and TAL as well as in K secretion in the distal tubule, but lacking specific inhibitors and molecular probes, it has until now been impossible to confirm these roles. Within the last several years, cDNAs encoding the NaK-CI co-transporter (NKCC1 and NKCC2) and K-CI co-transporter (KCC1) have been cloned in this laboratory, enabling molecular examination of the transport process. The goal of this project is to understand the mechanisms that underly the function of the NaK-CI and K-CI co-transporters in the mammalian kidney, and to understand the significance of the co-transporters to overall renal function. The proposed studies will be carried out with knockout mouse models of NKCC2 and KCC1, as well as with rabbit tissues, and with recombinant NKCC and KCC protein expressed in tissue culture cells. Specifically: 1) Structure-function relationships in the renal Na-K-CI co- transporter (NKCC2) will be addressed, examining four hypotheses: that NKCC2b in the macula densa is central to tubuloglomerular feedback; that the three splice variants of NKCC2 convey different ion affinities and that these differences are functionally significant; and that NKCC2 is regulated by direct phosphorylation. 2) The domain of the co-transporter protein that directs apical/basolateral sorting in polarized epithelia will be determined by expression of chimeric NKCC1/NKCC2 constructs in an epithelial cell line. 3) The renal distribution of KCC1 will be determined, and the functional significance of the cotransporter will be assessed in a knockout mouse model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: PHARMACOGENETICS AND CARDIOVASCULAR EVENTS Principal Investigator & Institution: Psaty, Bruce M.; Professor, Medicine and Epidemiology; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105
Studies
17
Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Team and data from on-going. studies. This RFA response represents a collaborative effort among scientists from several institutions, including the University of Washington, Vanderbilt University, and Group Health Cooperative (GHC). Nested within the GHC population are several on-going population-based case-control studies designed to assess drug-gene interactions on the outcomes of myocardial infarction (MI), stroke, and new-onset atrial fibrillation (AF). The 3 case groups share a single population-based control group. GHC's computerized pharmacy database provides complete information on all prescription medications. Data collection is funded through 2004, by which time 1053 MI cases, 565 stroke cases, 800 AF cases, and 3249 controls will have been recruited. With resources largely devoted to recruitment, the typical grant included only 1 single nucleotide polymorphism (SNP) per gene in each of a few candidate genes-an approach that ignores the complexity of the underlying linkage disequilibrium or haplotype structure of candidate genes. Aims. The primary aim of this study is to assess interactions between selected cardiovascular medications and the major candidate-gene variants or haplotypes on the incidence of MI, stroke and AF. The candidate-gene sets-selected on the basis of biology, pharmacology, and information from genome-wide scans-include: (1) 10 genes in the renin-angiotensin system; (2) 10 genes involved in renal sodium transport; (3) 8 genes encoding alpha and beta adrenergic receptors; (4) 8 other genes, including G-proteins, estrogen receptors, and the alpha-1C subunit of the L-type calcium channel. The products of these genes represent the sites of action for many cardiovascular drugs: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, all classes of diuretics, alpha blockers, beta-blockers, central alpha agonists, calcium antagonists, and estrogens. Both hypothesis-testing and hypothesis-generating analyses are planned. For selected SNPs studied in vitro or in small clinical populations, several specific drug-gene interactions are plausible, and these associations will be evaluated in an hypothesistesting manner. This component of the study has good to excellent power. The use of single SNPs often fail to capture important components of genetic variation, and the hypothesis-generating part of the study relies on SNP discovery. Already planned for 20 of the 36 genes, SNP discovery will be done in another 16 genes as part of this project. Genotyping an average of 6 to 7 SNPs in each of these 36 genes will allow us to identify the common haplotypes. With the aid new analytic methods such as logic regression, we plan to use these SNP to and haplotype data to evaluate drug-gene interactions on the incidence of MI, stroke, and AF in a systematic fashion. Secondary aims include plans to collect whole-blood mRNA, which will be used to assess the relative expression of different alleles within the same person. While SNP discovery for haplotypes redresses the limited genetic information available from single-SNP studies, multiples testing remains a limitation. The primary defense is replication: we would therefore welcome collaboration from others in the Pharmacogenetics Network in validation efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PREVENTION OF K AND MG DEPLETION BY KMAG CITRATE Principal Investigator & Institution: Pak, Charles Yc.; Professor of Internal Medicine; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: The overall goal of this study is to assess the value of potassium- magnesium citrate in preventing hypokalemia and magnesium depletion in patients taking diuretics. The hypothesis to be tested is that K-Mag citrate is capable of meeting these objectives because of its high bioavailability. When the above goal is met, an ancillary
18
Diuretics
goal will be to examine the effect of K-Mag citrate in magnesium depletion of nondiuretic use (chronic alcoholism). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RCT TO REDUCE PRESCRIBING ERRORS IN HYPERTENSION Principal Investigator & Institution: Soumerai, Stephen B.; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, Ma 02481 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-MAR-2004 Summary: (After the Application): Suboptimal choice of medications for primary care is a significant source of prescribing errors that can compromise patient safety. Prescribing calcium channel blockers for hypertension, for example, instead of firstline, evidencebased agents such as diuretics and beta blockers, is a prescribing error that can lead not only to higher costs of medical care but also to higher rates of morbidity and mortality. An educational intervention to reduce prescribing errors in hypertension could therefore result in improved patient outcomes and patient safety. In 1995, Harvard Community Health Plan (HCHP), a large HMO in New England, began an internallyfunded, pilot educational program that implemented three different strategies to reduce primary care physicians? errors in prescribing antihypertensive medications. These interventions, carried out as a randomized controlled trial in three managed care settings (2 different staff-model divisions of the HMO, and a group-model division of the HMO), were 1) mailed dissemination of educational materials (control); 2) mailed dissemination plus group academic detailing, and 3) mailed dissemination plus individual academic detailing. The study population comprised approximately 5,000 hypertensive patients who received care from 104 primary care physicians. For purposes of later evaluation, this program randomly assigned three comparable group practices, one in each of three HCHP divisions (nine total physician groups) to one of three experimental groups (control, group detailing, individual detailing). This application describes a comprehensive evaluation of the educational program by collecting, merging, validating, and analyzing data from ambulatory encounters, outpatient claims, and pharmacy dispensing databases from the three divisions of HCHP to measure the effects of the study interventions on reducing prescribing errors in hypertension. The principal analyses will examine the immediate and long-term effects of the educational interventions on 1) incident prescribing of sub-optimal agents; and 2) switching from sub-optimal agents to first-line agents. This study will also analyze the program costs and medication cost savings. Dissemination will capitalize on collaboration with AHRQ, and the HMO Research Network?s Center for Education and Research on Therapeutics (CERT). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: REGULATION OF KAPPA OPIOID RECEPTORS Principal Investigator & Institution: Liu-Chen, Lee-Yuan; Professor; Pharmacology; Temple University 406 Usb, 083-45 Philadelphia, Pa 19122 Timing: Fiscal Year 2002; Project Start 15-FEB-1999; Project End 31-JAN-2004 Summary: Kappa opioid receptors (KORs) mediate many effects of opioid drugs, including analgesia, dysphoria and water diuresis. Kappa agonists may be useful as analgesics, water diuretics and antipruritic agents. Repeated or continuous administration of kappa agonists leads to tolerance, part of which can be accounted for at the receptor level. The applicant's long-term objectives are to understand at the molecular level the biochemical events that occur following chronic exposure to opioid
Studies
19
drugs. The following are the hypotheses for proposed studies. Following chronic exposure to an agonist, the human KOR undergoes desensitization, sequestration and down-regulation. Desensitization is due to agonist- induced phosphorylation of the receptor by G protein-coupled receptor kinases (GRKs) followed by binding of betaarrestin, leading to the uncoupling of the receptor from G proteins. Binding of betaarrestin to phosphorylated receptors initiates receptor sequestration into cells via clathrin-coated vesicles. Some internalized receptors are degraded resulting in downregulation. Certain amino acid residues or sequence motifs in the receptor play important roles in these. Kappa agonist treatment regulates levels of certain regulators of G protein signaling (RGS) proteins, which are negative regulators of the KOR signaling. Specific aims are as follows. (1) To determine whether there are differences between the human and rat KORs in agonist-induced desensitization, sequestration, down-regulation and phosphorylation. (2) To determine the roles of GRKs, protein kinase A and protein kinase C in agonist-induced desensitization and phosphorylation of the human KOR by expression of GRKs, beta-arrestin GRK mutants and activation and inhibition of protein kinases A and C. (3) To determine the amino acid residue(s) of the human KOR that are phosphorylated upon desensitization by site-directed mutagenesis studies. (4) To investigate molecular mechanisms of agonist-induced sequestration of the kappa receptor by expression of beta-arrestin and dynamin mutants and to determine the motif important for sequestration by site-directed mutagenesis studies. (5) To determine the amino acid residue(s) of the kappa receptor that are important in down-regulation by site-directed mutagenesis studies. (6) To determine whether RGS proteins regulate signal transduction of the KOR. Elucidation of the mechanisms involved in agonist-induced regulation of the KOR will lead to a better understanding of tolerance to kappa agonist, which will help in the development of better kappa agonists as useful drugs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REGULATION OF THIAZIDE SENSITIVE NACL TRANSPORT Principal Investigator & Institution: Ellison, David H.; Associate Professor; Medicine; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-MAR-2004 Summary: (Adapted from the Applicant's Abstract): The thiazide-sensitive Na-Cl cotransporter (NCC) reabsorbs 5-10% of the filtered Na+ and Cl load in the kidney. Dysregulation of the NCC, either iatrogenic from diuretic use, or inherited, in Gitelman's syndrome, causes human disease. Gitelman's form of Bartter's syndrome results from mutations at any of several different sites within the transport protein; the Gitelman's phenotype is believed to result because mutations in the carboxy-terminal cytoplasmic domain of the NCC inactivates or strongly down-regulates its NaCl transporting capacity when expressed in Xenopus oocytes. Other preliminary experiments have identified three kidney proteins that bind to the NCC carboxyterminal tail. The long term goal of these experiments is to delineate factors that regulate the thiazide-sensitive Na-Cl cotransporter, specifically the role of the carboxy-terminal domain of NCC. The first group of experiments in this proposal will examine the effects of mutations along the terminal 60 amino acids of the NCC on its capacity to transport Na+ and Cl, its binding affinity for Na+ and Cl, and its affinity for thiazide diuretics. For these studies, normal and mutated clones will be expressed in Xenopus oocytes. The mechanisms by which carboxy-terminal mutations reduce transport activity will be assessed by cloning a FLAG epitope into the protein and determining rates of protein synthesis and insertion into the plasma membrane. These experiments will test the
20
Diuretics
hypothesis that carboxy-terminal mutations of NCC reduce its activity without altering NCC synthesis, protein processing, or insertion into the plasma membrane. In preliminary experiments the yeast two hybrid system was used to identify 3 proteins from a mouse kidney cDNA library that bind to the carboxy-terminal region of NCC. These proteins were identified as Erp60, aldolase, and a novel protein, thiabindin. One of these proteins, Erp60, was found to co-localize with NCC at the apical membrane of distal convoluted tubule cells. Preliminary data show that Erp60 can be precipitated from kidney cortical membranes with an anti-NCC antibody. Thus, the second group of experiments will investigate interactions between Erp60 and NCC. Regions of NCC that interact with Erp60 will be identified using a combinations of forward and reverse yeast two hybrid approaches. The effects of mutations that inhibit protein-protein interactions will then be assessed by expressing the mutated proteins in Xenopus oocytes. The underlying hypothesis of these experiments is that some Gitelman's mutations impair protein-protein interactions that are crucial for maintenance of transport activity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TARGETING RENAL OUTER MEDULLARY K+ CHANNEL ROMK FOR NEW CLASS OF DIURETICS Principal Investigator & Institution: Brown, Arthur M.; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002 Summary: Mutations in the renal outer medullary K+ channel ROMK produce an antenatal variant of Bartter's syndrome manifested by hypokalemic alkalosis, polyuria and hypotension. We have shown that ROMK mutations reduce K+ flux and propose this as the pathogenesis for the disease. A corollary is that ROMK blockers should act as diuretics and our long-term goal is to develop such blockers. Our specific aims are: 1) characterize the ROMK mutations that produce Bartter's syndrome to identify important functional domains in the protein and to design mutation-specific therapy; 2) use phage display to generate peptide ligands which regulate ROMK channel function and which will serve as ROMK tags; and 3) determine the status of ROMK glycosylation in kidney using either antibodies or high affinity ligands that we will develop. Aim 3 derives from our finding that K+ currents in un-glycosylated ROMK are markedly reduced. The project will not only provide therapy for the ROMK variant of Bartter's but will also provide a new class of loop diuretics. Experiments are designed to test the effects of ROMK mutations on K+ currents and assembly, trafficking, phosphorylation and proteolysis of ROMK channels. We will map the functional changes to a topological model of ROMK that we have developed using glycosylation site insertion mutagenesis. To discover ROMK-specific peptide ligands we will screen phage display libraries by biopanning with cells expressing ROMK1. To provide another rationale for altering ROMK currents we will examine the glycosylation of ROMK in kidney cells using biochemical and immunocytochemical methods. The research methods include: recombinant DNA to engineer Bartter's mutant, expression of recombinant proteins in Spodoptera frugiperda (Sf9) cells; patch-clamp measurements of K+ currents; biochemical methods for analysis of protein; screening phage display libraries by biopanning; sequencing isolated clones; and immunocytochemistry for localization of ROMK protein in kidney and Sf9 cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies
•
21
Project Title: THEORY OF SOLUTE AND WATER TRANSPORT ACROSS EPITHELIA Principal Investigator & Institution: Weinstein, Alan M.; Professor of Medicine and Physiology; Physiology and Biophysics; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2003; Project Start 01-AUG-1981; Project End 31-JAN-2006 Summary: A mathematical model of the mammalian distal nephron will be developed, comprised of cellular models of ascending Henle limb, distal tubule, and collecting duct. The model will represent sodium, potassium, and acid/base transport under normal and pathological conditions, and will predict renal excretion from distal delivery. The project begins with models of the three collecting duct segments; it will require development of two distal tubule segments plus an ascending limb, and then concatenation of all segments into a distal nephron. The segmental models will incorporate representations of specific membrane transporters: in distal tubule, the NaCI cotransporter, and in ascending limb, the luminal Na-K-2CI and peritubular K-CI cotransporters. Segment-specific issues, as well as segmental interactions will be considered. For the collecting duct, proposed lesions underlying distal renal tubular acidosis (ATPase failure, base-exit defects, or paracellular leak) will be examined, and clinical tests for identifying these lesions will be simulated. In this, the objective is to examine the rationalization for the clinical taxonomy of distal tubular acidosis. The distal tubule model will be used to examine flow- dependence of potassium secretion, to estimate the component attributable to luminal gradient attenuation. This will be preliminary to quantifying the alkalinizing and potassium-wasting effect of thiazide diuretics, which act on distal tubule. In the ascending limb, an important focus will be identifying the modulated transporters responsible for cellular homeostasis, specifically, mechanisms used to accommodate large reabsorptive fluxes of sodium and ammonium, while preserving cell volume and pH. In ascending limb, the three different transport defects which all present as Bartter's syndrome will be simulated, to understand the potassium depletion alkalosis common to all three. The full distal nephron model will be required to critically examine the proposal that medullary interstitial potassium concentration modulates overall renal potassium and acid excretion: namely, that by blunting ascending limb sodium reabsorption, peritubular potassium sends more sodium to distal tubule and collecting duct where potassium secretion and base reabsorption depend on sodium delivery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: TIPS VS. PARACENTESIS FOR REFRACTORY ASCITES(NASTRA) Principal Investigator & Institution: Kowdley, Kris V.; Professor of Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002 Summary: This is a multicenter, randomized, controlled trial designed to determine if treatment with transjugular intrahepatic portosystemic shunts (TIPS) is superior to high volume paracentesis (total paracentesis) for the treatment of refractory ascites due to cirrhosis. Subjects will be randomized to either receive total paracentesis (TP) alone or TP followed by TIPS within 48 hours. Both groups will be maintained on a sodium restricted diet. Subjects receiving TP alone will be started on diuretics within 36 hours, whereas those receiving TIPS after TP will be started on diuretics if they gain more than 20 pounds. Subjects will be followed for a minimum of one year. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
22
Diuretics
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “diuretics” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for diuretics in the PubMed Central database: •
Back to thiazide-diuretics for hypertension: reflections after a decade of irrational prescribing. by Fretheim A.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=317300
•
Cockroach diuretic hormones: Characterization of a calcitonin-like peptide in insects. by Furuya K, Milchak RJ, Schegg KM, Zhang J, Tobe SS, Coast GM, Schooley DA.; 2000 Jun 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=18626
•
Diuretics: again the first step in the treatment of most patients with hypertension. by Fuchs FD.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=59527
•
In vitro antistreptococcal activity of the potassium-sparing diuretics amiloride and triamterene. by Giunta S, Galeazzi L, Turchetti G, Sampaoli G, Groppa G.; 1985 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=180264
•
Pharmacokinetics and safety of multiple-dose valaciclovir in geriatric volunteers with and without concomitant diuretic therapy. by Wang LH, Schultz M, Weller S, Smiley ML, Blum MR.; 1996 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163061
•
Should hypertension be treated with angiotensin-converting-enzyme inhibitors, calcium-channel blockers or diuretics? by Myers KA.; 2003 Apr 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=151997
•
Thiazide diuretic drug receptors in rat kidney: identification with [3H]metolazone. by Beaumont K, Vaughn DA, Fanestil DD.; 1988 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=279981
3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
Studies
23
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with diuretics, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “diuretics” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for diuretics (hyperlinks lead to article summaries): •
A comparison of outcomes with angiotensin-converting enzyme inhibitors and diuretics for hypertension in the elderly. Author(s): Kaplan NM, Vidt DG. Source: Current Hypertension Reports. 2003 October; 5(5): 362-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12948426&dopt=Abstract
•
A comparison of outcomes with angiotensin-converting enzyme inhibitors and diuretics for hypertension in the elderly. Author(s): Weber MA, Sica DA. Source: Current Hypertension Reports. 2003 August; 5(4): 319-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12844466&dopt=Abstract
•
A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly. Author(s): Wing LM, Reid CM, Ryan P, Beilin LJ, Brown MA, Jennings GL, Johnston CI, McNeil JJ, Macdonald GJ, Marley JE, Morgan TO, West MJ; Second Australian National Blood Pressure Study Group. Source: The New England Journal of Medicine. 2003 February 13; 348(7): 583-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584366&dopt=Abstract
•
ACE and alpha-adducin polymorphism as markers of individual response to diuretic therapy. Author(s): Sciarrone MT, Stella P, Barlassina C, Manunta P, Lanzani C, Bianchi G, Cusi D. Source: Hypertension. 2003 March; 41(3): 398-403. Epub 2003 February 24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623934&dopt=Abstract
6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
24
Diuretics
•
ALLHAT finds diuretics best for initial hypertension therapy. Author(s): Traynor K. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 February 1; 60(3): 222, 224. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12613228&dopt=Abstract
•
Angiotensin II AT1 receptor antagonism prevents detrimental renal actions of acute diuretic therapy in human heart failure. Author(s): Chen HH, Redfield MM, Nordstrom LJ, Cataliotti A, Burnett JC Jr. Source: American Journal of Physiology. Renal Physiology. 2003 May; 284(5): F1115-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676739&dopt=Abstract
•
Angiotensin-converting-enzyme inhibitors and diuretics for hypertension. Author(s): Esnault VL. Source: The New England Journal of Medicine. 2003 July 3; 349(1): 90-3; Author Reply 90-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846229&dopt=Abstract
•
Angiotensin-converting-enzyme inhibitors and diuretics for hypertension. Author(s): Reese AM, Talbert RL, Bussey HI. Source: The New England Journal of Medicine. 2003 July 3; 349(1): 90-3; Author Reply 90-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846228&dopt=Abstract
•
Angiotensin-converting-enzyme inhibitors and diuretics for hypertension. Author(s): Krut LH. Source: The New England Journal of Medicine. 2003 July 3; 349(1): 90-3; Author Reply 90-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846227&dopt=Abstract
•
Angiotensin-converting-enzyme inhibitors and diuretics for hypertension. Author(s): Davis BR, Wright JT Jr, Cutler JA. Source: The New England Journal of Medicine. 2003 July 3; 349(1): 90-3; Author Reply 90-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846226&dopt=Abstract
•
Angiotensin-converting-enzyme inhibitors and diuretics for hypertension. Author(s): Pickering TG. Source: The New England Journal of Medicine. 2003 July 3; 349(1): 90-3; Author Reply 90-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12840099&dopt=Abstract
Studies
25
•
Are diuretics helpful in acute renal failure? Author(s): Dybedock L, Kane K. Source: The Journal of Family Practice. 2003 March; 52(3): 188, 190. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12620168&dopt=Abstract
•
Are thiazide diuretics preferred as first-line therapy for hypertension? An appraisal of The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Author(s): Scott I, Stowasser M. Source: Internal Medicine Journal. 2003 July; 33(7): 327-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823686&dopt=Abstract
•
Association between adherence to diuretic therapy and health care utilization in patients with heart failure. Author(s): Chui MA, Deer M, Bennett SJ, Tu W, Oury S, Brater DC, Murray MD. Source: Pharmacotherapy. 2003 March; 23(3): 326-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12627931&dopt=Abstract
•
Attenuated renal excretion in response to thiazide diuretics in Gitelman's syndrome: a case report. Author(s): Yeum CH, Kim SW, Ma SK, Ko JH, Nah MY, Kim NH, Choi KC. Source: Journal of Korean Medical Science. 2002 August; 17(4): 567-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172059&dopt=Abstract
•
Balancing diuretic therapy in heart failure: loop diuretics, thiazides, and aldosterone antagonists. Author(s): Paul S. Source: Congestive Heart Failure (Greenwich, Conn.). 2002 November-December; 8(6): 307-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12461320&dopt=Abstract
•
By the way, doctor. When I was first diagnosed with hypertension, my doctor (who knew that I was a competitive cyclist) prescribed an ACE inhibitor. I wondered for some time why he didn't prescribe diuretics, since all the articles I've read recommend that as a beginning step. Then I read in a bicycling magazine that ACE inhibitors are the only hypertension medicine that doesn't interfere with aerobic performance. Is that true? And did my doctor do the right thing? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2003 June; 28(8): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835145&dopt=Abstract
26
Diuretics
•
Choice of diuretics for treatment of essential hypertension. Author(s): Rayner B. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2002 July; 92(7): 524-5. Erratum In: S Afr Med J 2002 September; 92(9): 669. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197191&dopt=Abstract
•
Combined effects of vasopressin V2 receptor antagonist and loop diuretic in humans. Author(s): Shimizu K. Source: Clinical Nephrology. 2003 March; 59(3): 164-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653258&dopt=Abstract
•
Combined furosemide and human albumin treatment for diuretic-resistant edema. Author(s): Elwell RJ, Spencer AP, Eisele G. Source: The Annals of Pharmacotherapy. 2003 May; 37(5): 695-700. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708949&dopt=Abstract
•
Comparison between conventional cystometry and stimulated filling cystometry by diuretics in a neurogenic bladder after spinal cord injury. Author(s): Ko HY, Lee JZ, Park HJ, Kim H, Park JH. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 October; 81(10): 731-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12362112&dopt=Abstract
•
Continued importance of diuretics and beta-adrenergic blockers in the management of hypertension. Author(s): Moser M, Setaro J. Source: The Medical Clinics of North America. 2004 January; 88(1): 167-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14871058&dopt=Abstract
•
Cortical, medullary, and pelvocaliceal MR renography with and without diuretic modification. Author(s): Katzberg RW, Ivanovic M, Buonocore MH, Brock JM, Ryan JM. Source: Academic Radiology. 2003 July; 10(7): 725-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12862282&dopt=Abstract
•
Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics. Author(s): Hoch I, Heymann AD, Kurman I, Valinsky LJ, Chodick G, Shalev V. Source: Journal of the American Medical Informatics Association : Jamia. 2003 November-December; 10(6): 541-6. Epub 2003 August 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925546&dopt=Abstract
Studies
27
•
Current evidence supporting the role of diuretics in heart failure: a meta analysis of randomised controlled trials. Author(s): Faris R, Flather M, Purcell H, Henein M, Poole-Wilson P, Coats A. Source: International Journal of Cardiology. 2002 February; 82(2): 149-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11853901&dopt=Abstract
•
Dehydration in black and white older adults using diuretics. Author(s): Lancaster KJ, Smiciklas-Wright H, Heller DA, Ahern FM, Jensen G. Source: Annals of Epidemiology. 2003 August; 13(7): 525-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932628&dopt=Abstract
•
Development, implementation and cost-effectiveness of a protocol for review of combination diuretic prescribing. Author(s): Morgan JD, Wright DJ, Chrystyn H, George B, Booth AC, Shoesmith DJ. Source: British Journal of Clinical Pharmacology. 2003 March; 55(3): 317-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630985&dopt=Abstract
•
Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD). Author(s): Domanski M, Norman J, Pitt B, Haigney M, Hanlon S, Peyster E; Studies of Left Ventricular Dysfunction. Source: Journal of the American College of Cardiology. 2003 August 20; 42(4): 705-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932605&dopt=Abstract
•
Diuretic versus alpha-blocker as first-step antihypertensive therapy: final results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Author(s): Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. Source: Hypertension. 2003 September; 42(3): 239-46. Epub 2003 August 18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925554&dopt=Abstract
•
Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. Author(s): Brion LP, Primhak RA, Ambrosio-Perez I. Source: Cochrane Database Syst Rev. 2002; (1): Cd001817. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11869608&dopt=Abstract
•
Diuretics and dopamine for the prevention and treatment of acute renal failure: a critical reappraisal. Author(s): Gambaro G, Bertaglia G, Puma G, D'Angelo A. Source: Journal of Nephrology. 2002 May-June; 15(3): 213-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113589&dopt=Abstract
28
Diuretics
•
Diuretics are better first-line antihypertensive therapy than calcium channel blockers and ACE inhibitors. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2003 January 24; 14(2): 5-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776699&dopt=Abstract
•
Diuretics in CLD. Author(s): Pai VA, Pai B. Source: Archives of Disease in Childhood. Fetal and Neonatal Edition. 2002 November; 87(3): F232. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12391004&dopt=Abstract
•
Diuretics in critically ill patients with acute renal failure. Author(s): Emmett M. Source: Jama : the Journal of the American Medical Association. 2003 March 19; 289(11): 1379; Author Reply 1380-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12636450&dopt=Abstract
•
Diuretics in critically ill patients with acute renal failure. Author(s): Unnikrishnan D, Lanewala A, Krishnan S. Source: Jama : the Journal of the American Medical Association. 2003 March 19; 289(11): 1379-80; Author Reply 1380-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12636449&dopt=Abstract
•
Diuretics in critically ill patients with acute renal failure. Author(s): Tedesco JV. Source: Jama : the Journal of the American Medical Association. 2003 March 19; 289(11): 1379; Author Reply 1380-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12636448&dopt=Abstract
•
Diuretics in critically ill patients with acute renal failure. Author(s): Stefanec T. Source: Jama : the Journal of the American Medical Association. 2003 March 19; 289(11): 1380; Author Reply 1380-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12636447&dopt=Abstract
•
Diuretics in critically ill patients with acute renal failure. Author(s): Kalantar-Zadeh K. Source: Jama : the Journal of the American Medical Association. 2003 March 19; 289(11): 1380; Author Reply 1380-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12636446&dopt=Abstract
Studies
29
•
Diuretics in the therapy of hypertension. Author(s): Reyes AJ. Source: Journal of Human Hypertension. 2002 March; 16 Suppl 1: S78-83. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986901&dopt=Abstract
•
Diuretics in the treatment of patients who present congestive heart failure and hypertension. Author(s): Reyes AJ. Source: Journal of Human Hypertension. 2002 March; 16 Suppl 1: S104-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986906&dopt=Abstract
•
Diuretics vs. ACE inhibitors. Author(s): Ravina A, Slezak S. Source: Isr Med Assoc J. 2003 October; 5(10): 759. No Abstract Available. Erratum In: Isr Med Assoc J. 2003 November; 5(11): 839. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14719483&dopt=Abstract
•
Diuretics, mortality, and nonrecovery of renal function in acute renal failure. Author(s): Mehta RL, Pascual MT, Soroko S, Chertow GM; PICARD Study Group. Source: Jama : the Journal of the American Medical Association. 2002 November 27; 288(20): 2547-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444861&dopt=Abstract
•
Diuretics, the most critical therapy in heart failure, yet often neglected in the literature. Author(s): Futterman LG, Lemberg L. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 2003 July; 12(4): 376-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12882071&dopt=Abstract
•
Diuretics. Author(s): Clark A. Source: Prof Nurse. 2002 April; 17(8): 484. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11997963&dopt=Abstract
•
Do diuretics and aldosterone receptor antagonists improve ventricular remodeling? Author(s): Pitt B. Source: Journal of Cardiac Failure. 2002 December; 8(6 Suppl): S491-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555163&dopt=Abstract
30
Diuretics
•
Do hypertension and diuretic treatment in pregnancy increase the risk of schizophrenia in offspring? Author(s): Sorensen HJ, Mortensen EL, Reinisch JM, Mednick SA. Source: The American Journal of Psychiatry. 2003 March; 160(3): 464-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611826&dopt=Abstract
•
Do thiazide diuretics confer specific protection against strokes? Author(s): Messerli FH, Grossman E, Lever AF. Source: Archives of Internal Medicine. 2003 November 24; 163(21): 2557-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14638555&dopt=Abstract
•
Dose-effect relations of loop- and thiazide-diuretics on calcium homeostasis: a randomized, double-blinded Latin-square multiple cross-over study in postmenopausal osteopenic women. Author(s): Rejnmark L, Vestergaard P, Pedersen AR, Heickendorff L, Andreasen F, Mosekilde L. Source: European Journal of Clinical Investigation. 2003 January; 33(1): 41-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492451&dopt=Abstract
•
Effect of intensive diuretic treatment over right ventricular behaviour: evidence provided from colour and pulsed-wave Doppler echocardiography. Author(s): Moreno R, Corros C, Zamorano J, Macaya C. Source: European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology. 2003 September; 4(3): 226-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928029&dopt=Abstract
•
Effect of low-dose thiazide diuretics on plasma lipids: results from a double-blind, randomized clinical trial in older men and women. Author(s): Ott SM, LaCroix AZ, Ichikawa LE, Scholes D, Barlow WE. Source: Journal of the American Geriatrics Society. 2003 March; 51(3): 340-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12588577&dopt=Abstract
•
Effects of forced diuresis achieved by oral hydration and oral diuretic administration on uroflowmetric parameters and clinical waiting time of patients with lower urinary tract symptoms. Author(s): Ozturk B, Cetinkaya M, Oztekin V, Inal G, Adsan O, Ugurlu O, Ozden C. Source: Urologia Internationalis. 2003; 71(1): 22-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845255&dopt=Abstract
Studies
31
•
Effects of non-steroidal anti-inflammatory drugs on hypertension control using angiotensin converting enzyme inhibitors and thiazide diuretics. Author(s): Bhagat K. Source: East Afr Med J. 2001 October; 78(10): 507-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11921591&dopt=Abstract
•
Electrocardiographic J wave as a result of hypercalcemia aggravated by thiazide diuretics in a case of primary hyperparathyroidism. Author(s): Topsakal R, Saglam H, Arinc H, Eryol NK, Cetin S. Source: Japanese Heart Journal. 2003 November; 44(6): 1033-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14711198&dopt=Abstract
•
Evaluating routine diuretics after coronary surgery: a prospective randomized controlled trial. Author(s): Lim E, Ali ZA, Attaran R, Cooper G. Source: The Annals of Thoracic Surgery. 2002 January; 73(1): 153-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11834004&dopt=Abstract
•
Furosemide challenge in patients with heart failure and adverse reactions to sulfacontaining diuretics. Author(s): Earl G, Davenport J, Narula J. Source: Annals of Internal Medicine. 2003 February 18; 138(4): 358-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585844&dopt=Abstract
•
Gas-phase behaviour of negative ions produced from thiazidic diuretics under electrospray conditions. Author(s): Garcia P, Popot MA, Fournier F, Bonnaire Y, Tabet JC. Source: Journal of Mass Spectrometry : Jms. 2002 September; 37(9): 940-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12271437&dopt=Abstract
•
How should diuretic-refractory, volume-overloaded heart failure patients be managed? Author(s): Kensey K. Source: J Invasive Cardiol. 2003 December; 15(12): A17. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14712798&dopt=Abstract
•
How should diuretic-refractory, volume-overloaded heart failure patients be managed? Author(s): Sackner-Bernstein JD, Obeleniene R. Source: J Invasive Cardiol. 2003 October; 15(10): 585-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14519893&dopt=Abstract
32
Diuretics
•
Hypokalemic rhabdomyolysis aggravated by diuretics complicating Conn's syndrome without acute renal failure. Author(s): Ozgur B, Kursat S. Source: Clinical Nephrology. 2002 January; 57(1): 89-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11837808&dopt=Abstract
•
Iatrogenic hypercalcemia due to vitamin D3 ointment (1,24(OH)2D3) combined with thiazide diuretics in a case of psoriasis. Author(s): Kawaguchi M, Mitsuhashi Y, Kondo S. Source: The Journal of Dermatology. 2003 November; 30(11): 801-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14684937&dopt=Abstract
•
Impaired drainage on diuretic renography using half-time or pelvic excretion efficiency is not a sign of obstruction in children with a prenatal diagnosis of unilateral renal pelvic dilatation. Author(s): Amarante J, Anderson PJ, Gordon I. Source: The Journal of Urology. 2003 May; 169(5): 1828-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12686855&dopt=Abstract
•
Improvement of impaired coronary vasodilator reserve in hypertensive patients by low-dose ACE inhibitor/diuretic therapy: a pilot PET study. Author(s): Mourad JJ, Hanon O, Deverre JR, Camici PG, Sellier P, Duboc D, Safar ME. Source: J Renin Angiotensin Aldosterone Syst. 2003 June; 4(2): 94-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806590&dopt=Abstract
•
Incidence of new coronary events in older persons with prior myocardial infarction and systemic hypertension treated with beta blockers, angiotensin-converting enzyme inhibitors, diuretics, calcium antagonists, and alpha blockers. Author(s): Aronow WS, Ahn C. Source: The American Journal of Cardiology. 2002 May 15; 89(10): 1207-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12008178&dopt=Abstract
•
Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease. Author(s): Brion LP, Primhak RA. Source: Cochrane Database Syst Rev. 2002; (1): Cd001453. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11869600&dopt=Abstract
Studies
33
•
Long-term cardiovascular consequences of diuretics vs calcium channel blockers vs angiotensin-converting enzyme inhibitors. Author(s): Ong HT. Source: Jama : the Journal of the American Medical Association. 2003 April 23-30; 289(16): 2068; Author Reply 2069-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709460&dopt=Abstract
•
Long-term cardiovascular consequences of diuretics vs calcium channel blockers vs angiotensin-converting enzyme inhibitors. Author(s): Rifkin W. Source: Jama : the Journal of the American Medical Association. 2003 April 23-30; 289(16): 2068; Author Reply 2069-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709459&dopt=Abstract
•
Long-term cardiovascular consequences of diuretics vs calcium channel blockers vs angiotensin-converting enzyme inhibitors. Author(s): Yarows SA. Source: Jama : the Journal of the American Medical Association. 2003 April 23-30; 289(16): 2068-9; Author Reply 2069-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709458&dopt=Abstract
•
Long-term cardiovascular consequences of diuretics vs calcium channel blockers vs angiotensin-converting enzyme inhibitors. Author(s): Messerli FH, Weber MA. Source: Jama : the Journal of the American Medical Association. 2003 April 23-30; 289(16): 2067-8; Author Reply 2069-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709457&dopt=Abstract
•
Long-term cardiovascular consequences of diuretics vs calcium channel blockers vs angiotensin-converting enzyme inhibitors. Author(s): Chikamori T. Source: Jama : the Journal of the American Medical Association. 2003 April 23-30; 289(16): 2066; Author Reply 2069-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709456&dopt=Abstract
•
Long-term cardiovascular consequences of diuretics vs calcium channel blockers vs angiotensin-converting enzyme inhibitors. Author(s): Palmer CR, Brown MJ, Mancia G, Ruilope LM; INSIGHT Steering Committee. Source: Jama : the Journal of the American Medical Association. 2003 April 23-30; 289(16): 2066-7; Author Reply 2069-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709455&dopt=Abstract
34
Diuretics
•
Long-term cardiovascular consequences of diuretics vs calcium channel blockers vs angiotensin-converting enzyme inhibitors. Author(s): Houghton JL. Source: Jama : the Journal of the American Medical Association. 2003 April 23-30; 289(16): 2066; Author Reply 2069-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709454&dopt=Abstract
•
Loop diuretics for patients with acute renal failure: helpful or harmful? Author(s): Lameire N, Vanholder R, Van Biesen W. Source: Jama : the Journal of the American Medical Association. 2002 November 27; 288(20): 2599-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444868&dopt=Abstract
•
Loop diuretics: from the Na-K-2Cl transporter to clinical use. Author(s): Shankar SS, Brater DC. Source: American Journal of Physiology. Renal Physiology. 2003 January; 284(1): F11-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12473535&dopt=Abstract
•
Major outcomes in high-risk hypertensive patients randomized to angiotensinconverting enzyme inhibitors or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Author(s): Siragy HM. Source: Current Hypertension Reports. 2003 August; 5(4): 293-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12844462&dopt=Abstract
•
Mechanisms and management of diuretic resistance in congestive heart failure. Author(s): De Bruyne LK. Source: Postgraduate Medical Journal. 2003 May; 79(931): 268-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782772&dopt=Abstract
•
Neurohormonal activation rapidly decreases after intravenous therapy with diuretics and vasodilators for class IV heart failure. Author(s): Johnson W, Omland T, Hall C, Lucas C, Myking OL, Collins C, Pfeffer M, Rouleau JL, Stevenson LW. Source: Journal of the American College of Cardiology. 2002 May 15; 39(10): 1623-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12020489&dopt=Abstract
Studies
35
•
Only weak vasorelaxant properties of loop diuretics in isolated resistance arteries from man, rat and guinea pig. Author(s): Pickkers P, Russel FG, Thien T, Hughes AD, Smits P. Source: European Journal of Pharmacology. 2003 April 18; 466(3): 281-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694811&dopt=Abstract
•
Pharmacogenomics of diuretic drugs: data on rare monogenic disorders and on polymorphisms and requirements for further research. Author(s): Vormfelde SV, Burckhardt G, Zirk A, Wojnowski L, Brockmoller J. Source: Pharmacogenomics. 2003 November; 4(6): 701-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14596636&dopt=Abstract
•
Pharmacotherapy in congestive heart failure: drug absorption in the management of congestive heart failure: loop diuretics. Author(s): Sica DA. Source: Congestive Heart Failure (Greenwich, Conn.). 2003 September-October; 9(5): 287-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14564148&dopt=Abstract
•
Prescription patterns of diuretics in chronic heart failure: a contemporary background as a clue to their role in treatment. Author(s): Faggiano P, Opasich C, Tavazzi L, Achilli F, Gentile A, De Biase L, De Maria R, Pozzi R, Tarantini L, Gonzini L, Maggioni AP; IN-CHF Investigators. Source: Journal of Cardiac Failure. 2003 June; 9(3): 210-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12815571&dopt=Abstract
•
Present status of diuretics in the management of hypertension. Author(s): Mittal SR, Mittal B, Khanna S, Mathur D. Source: J Assoc Physicians India. 1998 July; 46(7): 640-4. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12152852&dopt=Abstract
•
Rational diuretic management in congestive heart failure: a case-based review. Author(s): Paul RV. Source: Critical Care Nursing Clinics of North America. 2003 December; 15(4): 453-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14717390&dopt=Abstract
•
Re: Diuretics in the treatment of bronchial casts in congenital heart disease. Author(s): Menahem S. Source: Cardiology in the Young. 2002 January; 12(1): 86-7; Author Reply 87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11922452&dopt=Abstract
36
Diuretics
•
Re: Impaired drainage on diuretic renography using half-time or pelvic excretion efficiency is not a sign of obstruction in children with a prenatal diagnosis of unilateral renal pelvic dilatation. Author(s): Kuyvenhoven JD, Ham HR, Piepsz A. Source: The Journal of Urology. 2004 February; 171(2 Pt 1): 806. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14713825&dopt=Abstract
•
Revisiting salt and water retention: new diuretics, aquaretics, and natriuretics. Author(s): Costello-Boerrigter LC, Boerrigter G, Burnett JC Jr. Source: The Medical Clinics of North America. 2003 March; 87(2): 475-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12693735&dopt=Abstract
•
Screening for 18 diuretics and probenecid in doping analysis by liquid chromatography-tandem mass spectrometry. Author(s): Deventer K, Delbeke FT, Roels K, Van Eenoo P. Source: Biomedical Chromatography : Bmc. 2002 December; 16(8): 529-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12474217&dopt=Abstract
•
Severe heart failure in the elderly: potential benefits of high-dose and continuous infusion diuretics. Author(s): Howard PA, Dunn MI. Source: Drugs & Aging. 2002; 19(4): 249-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12038877&dopt=Abstract
•
Severe hyponatremia associated with the combined use of thiazide diuretics and selective serotonin reuptake inhibitors. Author(s): Rosner MH. Source: The American Journal of the Medical Sciences. 2004 February; 327(2): 109-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14770031&dopt=Abstract
•
Studies on the metabolic fate of M17055, a novel diuretic (6). Assessment for drugdrug interactions of M17055 in metabolism, distribution and excretion. Author(s): Nakajima H, Nakanishi T, Naba H, Nakai K, Matsumoto S, Nagasawa K, Ida K, Ogihara T, Ohzawa N. Source: Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 2002 December; 32(12): 1161-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593763&dopt=Abstract
•
Switching from ACE inhibitors, beta-blockers, calcium antagonists or diuretics to candesartan improves efficacy and tolerability. Author(s): Porcellati C, Omboni S. Source: Blood Pressure. 2002; 11(5): 310-9. Erratum In: Blood Press. 2003; 12(2): 128. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12458654&dopt=Abstract
Studies
37
•
The 99mTc-DMSA renal scan and 99mTc-DTPA diuretic renogram in children and adolescents with incidental diagnosis of horseshoe kidney. Author(s): Kao PF, Sheih CP, Tsui KH, Tsai MF, Tzen KY. Source: Nuclear Medicine Communications. 2003 May; 24(5): 525-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717069&dopt=Abstract
•
The ALLHAT and the cardioprotection conferred by diuretics in hypertensive patients: a connection with uric acid? Author(s): Reyes AJ, Leary WP. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 2002 December; 16(6): 485-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12797357&dopt=Abstract
•
The ALLHAT Trial. Diuretics are still the preferred initial drugs for high blood pressure. Author(s): Vidt DG. Source: Cleve Clin J Med. 2003 March; 70(3): 263-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12678218&dopt=Abstract
•
The eating disorders medicine cabinet revisited: a clinician's guide to appetite suppressants and diuretics. Author(s): Roerig JL, Mitchell JE, de Zwaan M, Wonderlich SA, Kamran S, Engbloom S, Burgard M, Lancaster K. Source: The International Journal of Eating Disorders. 2003 May; 33(4): 443-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658674&dopt=Abstract
•
The increase in serum uric acid induced by diuretics could be beneficial to cardiovascular prognosis in hypertension: a hypothesis. Author(s): Reyes AJ, Leary WP. Source: Journal of Hypertension. 2003 September; 21(9): 1775-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12923414&dopt=Abstract
•
The rational use of diuretics in heart failure. Author(s): Ravnan SL, Deedwania PC. Source: Current Cardiology Reports. 2003 May; 5(3): 237-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691643&dopt=Abstract
•
The verdict from ALLHAT--thiazide diuretics are the preferred initial therapy for hypertension. Author(s): Appel LJ. Source: Jama : the Journal of the American Medical Association. 2002 December 18; 288(23): 3039-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479770&dopt=Abstract
38
Diuretics
•
Thiamin, selenium, and copper levels in patients with idiopathic dilated cardiomyopathy taking diuretics. Author(s): da Cunha S, Albanesi Filho FM, da Cunha Bastos VL, Antelo DS, Souza MM. Source: Arquivos Brasileiros De Cardiologia. 2002 November; 79(5): 454-65. English, Portuguese. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12447496&dopt=Abstract
•
Thiazide diuretics and the risk for hip fracture. Author(s): Schoofs MW, van der Klift M, Hofman A, de Laet CE, Herings RM, Stijnen T, Pols HA, Stricker BH. Source: Annals of Internal Medicine. 2003 September 16; 139(6): 476-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13679324&dopt=Abstract
•
Treatment of uncomplicated hypertension: are ACE inhibitors and calcium channel blockers as effective as diuretics and beta-blockers? Author(s): Saseen JJ, MacLaughlin EJ, Westfall JM. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2003 March-April; 16(2): 156-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665182&dopt=Abstract
39
CHAPTER 2. NUTRITION AND DIURETICS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and diuretics.
Finding Nutrition Studies on Diuretics The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “diuretics” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
40
Diuretics
The following is a typical result when searching for recently indexed consumer information on diuretics: •
Magnesium depletion and diuretics. Source: Nutrition-and-the-M.D (USA). (December 1989). volume 15(12) page 4-5.
Additional consumer oriented references include: •
Diuretics and vitamin B1: are diuretics a risk factor for thiamin malnutrition? Author(s): Medical Policlinic, University Hospital, Zurich, Switzerland. Source: Suter, P M Vetter, W Nutr-Revolume 2000 October; 58(10): 319-23 0029-6643
•
Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ACE inhibitor compared with a diuretic/beta-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project. Author(s): Department of Medicine, University of Kuopio, Kuopio, Finland.
[email protected] Source: Niskanen, L Hedner, T Hansson, L Lanke, J Niklason, A Diabetes-Care. 2001 December; 24(12): 2091-6 0149-5992
The following information is typical of that found when using the “Full IBIDS Database” to search for “diuretics” (or a synonym): •
Effects of herbal diuretics on total serum protein, blood urea nitrogen and dropping's moisture percentage of the broilers. Author(s): University of Agriculture, Faisalabad (Pakistan). Coll. of Veterinary Sciences Source: Omer, M.O. Sabir, M. Ali, M.R. Hashmi, H.A. Pakistan-Journal-of-BiologicalSciences (Pakistan). (June 2000). volume 3(6) page 975-976.
Additional physician-oriented references include: •
Balancing diuretic therapy in heart failure: loop diuretics, thiazides, and aldosterone antagonists. Author(s): Heart Failure Clinic, Medical University of South Carolina, Charleston, SC, USA.
[email protected] Source: Paul, S Congest-Heart-Fail. 2002 Nov-December; 8(6): 307-12 1527-5299
•
Combined effect of captopril and thiazide diuretic on serum lipid profile in hypertensive women. Author(s): Department of Pharmacology, Fatima Jinnah Medical College, Lahore. Source: Karim, S Karim, S Begum, A Javed, N J-Ayub-Med-Coll-Abbottabad. 2001 JanMarch; 13(1): 19-21
•
Diuretic activity of alcoholic extract and decoction of Achyranthes aspera Linn. in rats. Author(s): Adhiparasakthi Coll. of Pharmacy, Melmaruvathur (India) Source: Vetrichelvan, T. Jegadeesan, M. Hamdard-Medicus (Pakistan). (Jul-September 2001). volume 44(3) page 38-41. rats drug plants amaranthaceae plant extracts alcohol content diuretics 0250-7188
•
Diuretic, laxative and toxicity studies of Cocculus hirsutus aerial parts. Author(s): Department of Pharmaceutical Sciences, Andhra University, Visakhapatnam, A.P. 530003, India.
[email protected]
Nutrition
41
Source: Ganapaty, S Dash, G K Subburaju, T Suresh, P Fitoterapia. 2002 February; 73(1): 28-31 0367-326X •
Evaluation of the diuretic activity of Boerhaavia verticillata. Source: Bajpai, A. Ojha, J.K. Pharm-biol. Lisse, the Netherlands : Swets & Zeitlinger, c1998-. October 2000. volume 38 (4) page 258-261. 1388-0209
•
Plasma electrolyte concentrations in dogs receiving diuretic therapy for cardiac failure. Source: Cobb, M. Michell, A.R. J-Small-Anim-Pract. London : British Veterinary Association. November 1992. volume 33 (11) page 526-529. 0022-4510
•
Study on the diuretic activity of Strychnos potatorum Linn. seed extract in albino rats. Author(s): Department of Pharmaceutical Technology, Jadavpur University, Calcutta, India. Source: Biswas, S Murugesan, T Maiti, K Ghosh, L Pal, M Saha, B P Phytomedicine. 2001 November; 8(6): 469-71 0944-7113
•
Thiamin, selenium, and copper levels in patients with idiopathic dilated cardiomyopathy taking diuretics. Author(s): Hospital Universitario Pedro Ernesto, IBRAG, Geologia - UERJ, Rio de Janeiro, RJ, Brazil.
[email protected] Source: da Cunha, S Albanesi Filho, F M da Cunha Bastos, V L Antelo, D S Souza, M M Arq-Bras-Cardiol. 2002 November; 79(5): 454-65 0066-782X
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
•
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
•
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
•
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
•
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
•
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
•
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
•
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
42
Diuretics
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
•
Google: http://directory.google.com/Top/Health/Nutrition/
•
Healthnotes: http://www.healthnotes.com/
•
Open Directory Project: http://dmoz.org/Health/Nutrition/
•
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
•
WebMD®Health: http://my.webmd.com/nutrition
•
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
The following is a specific Web list relating to diuretics; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Vitamins Ascorbic Acid Alternative names: Vitamin C (Ascorbic Acid) Source: Integrative Medicine Communications; www.drkoop.com Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Thiamine Source: Integrative Medicine Communications; www.drkoop.com Vitamin B1 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B1 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B1 (Thiamine) Alternative names: Thiamine Source: Integrative Medicine Communications; www.drkoop.com Vitamin C (Ascorbic Acid) Alternative names: Ascorbic Acid Source: Integrative Medicine Communications; www.drkoop.com Vitamin D Source: Healthnotes, Inc.; www.healthnotes.com
Nutrition
43
Vitamin D Alternative names: Calciferol Source: Integrative Medicine Communications; www.drkoop.com •
Minerals Atorvastatin Source: Healthnotes, Inc.; www.healthnotes.com Calcium Source: Healthnotes, Inc.; www.healthnotes.com Calcium Source: Integrative Medicine Communications; www.drkoop.com Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Lovastatin Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: Integrative Medicine Communications; www.drkoop.com Magnesium Source: Prima Communications, Inc.www.personalhealthzone.com Magnesium Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com Paroxetine Source: Healthnotes, Inc.; www.healthnotes.com Potassium Source: Healthnotes, Inc.; www.healthnotes.com Potassium Source: Integrative Medicine Communications; www.drkoop.com Potassium Source: Prima Communications, Inc.www.personalhealthzone.com Potassium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10086,00.html
44
Diuretics
Potassium Chloride Source: Healthnotes, Inc.; www.healthnotes.com Potassium-Sparing Diuretics Source: Integrative Medicine Communications; www.drkoop.com Potassium-Sparing Diuretics Source: Prima Communications, Inc.www.personalhealthzone.com Pravastatin Source: Healthnotes, Inc.; www.healthnotes.com Simvastatin Source: Healthnotes, Inc.; www.healthnotes.com Spironolactone Source: Healthnotes, Inc.; www.healthnotes.com Spironolactone/Hydrochlorothiazide Alternative names: Aldactazide Source: Prima Communications, Inc.www.personalhealthzone.com Stinging Nettle Alternative names: Urtica dioica, Urtica urens, Nettle Source: Integrative Medicine Communications; www.drkoop.com Zinc Source: Healthnotes, Inc.; www.healthnotes.com Zinc Source: Prima Communications, Inc.www.personalhealthzone.com •
Food and Diet Atkins Diet Source: Healthnotes, Inc.; www.healthnotes.com Burdock Alternative names: Arctium lappa Source: Healthnotes, Inc.; www.healthnotes.com Burdock Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,235,00.html Hypertension Source: Healthnotes, Inc.; www.healthnotes.com Juices Source: Healthnotes, Inc.; www.healthnotes.com
Nutrition
Low-Purine Diet Source: Healthnotes, Inc.; www.healthnotes.com Low-Salt Diet Source: Healthnotes, Inc.; www.healthnotes.com
45
47
CHAPTER 3. ALTERNATIVE MEDICINE AND DIURETICS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to diuretics. At the conclusion of this chapter, we will provide additional sources.
The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “diuretics” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •
Combining Supplements and Prescription Drugs: What Your Patients Need to Know Source: Alternative and Complementary Therapies. 6(4): 177-183. August 2000. Summary: This journal article reviews what patients need to know about combining herbal supplements and prescription drugs. First, it looks at general clinical issues regarding the concomitant use of herbs and drugs. Then, it summarizes the major concerns, including the lack of knowledge about herbs, lack of quality control for herbal supplements, lack of patient communication about the use of botanicals, and lack of practitioner knowledge about potential interactions. Finally, it reviews known interactions between popular herbal supplements and commonly prescribed classes of drugs, including immunostimulant and immunosuppressive drugs, antidepressants, monoamine oxidase inhibitors, antibiotics, anticoagulants, antihypertensives and diuretics, hypoglycemics and hyperglycemics, and sedatives. The article includes a list of herb-drug combinations to avoid, a resources list, a summary of advice for patients, a recommended reading list, and 21 references.
48
Diuretics
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to diuretics and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “diuretics” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to diuretics: •
Acute diuretic, natriuretic and hypotensive effects of a continuous perfusion of aqueous extract of Urtica dioica in the rat. Author(s): Tahri A, Yamani S, Legssyer A, Aziz M, Mekhfi H, Bnouham M, Ziyyat A. Source: Journal of Ethnopharmacology. 2000 November; 73(1-2): 95-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11025144&dopt=Abstract
•
Analgesic, diuretic, and anti-inflammatory principle from Scoparia dulcis. Author(s): Ahmed M, Shikha HA, Sadhu SK, Rahman MT, Datta BK. Source: Pharmazie. 2001 August; 56(8): 657-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11534346&dopt=Abstract
•
Anti-inflammatory, spasmolytic and diuretic effects of a commercially available Solidago gigantea Herb. extract. Author(s): Leuschner J. Source: Arzneimittel-Forschung. 1995 February; 45(2): 165-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7710440&dopt=Abstract
•
Approaches to diuretic therapy and electrolyte imbalance in congestive heart failure. Author(s): Cody RJ, Pickworth KK. Source: Cardiology Clinics. 1994 February; 12(1): 37-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8181024&dopt=Abstract
•
Cardiovascular and diuretic activity of kaurene derivatives of Xylopia aethiopica and Alepidea amatymbica. Author(s): Somova LI, Shode FO, Moodley K, Govender Y. Source: Journal of Ethnopharmacology. 2001 October; 77(2-3): 165-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11535360&dopt=Abstract
•
Chronic diuretic effect of the water extract of Spergularia purpurea in normal rats. Author(s): Jouad H, Lacaille-Dubois MA, Eddouks M. Source: Journal of Ethnopharmacology. 2001 May; 75(2-3): 219-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11297855&dopt=Abstract
Alternative Medicine 49
•
Diuretic action of an aqueous extract of Lepidium latifolium L. Author(s): Navarro E, Alonso J, Rodriguez R, Trujillo J, Boada J. Source: Journal of Ethnopharmacology. 1994 January; 41(1-2): 65-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8170161&dopt=Abstract
•
Diuretic action of aqueous Orthosiphon extract in rats. Author(s): Englert J, Harnischfeger G. Source: Planta Medica. 1992 June; 58(3): 237-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1409978&dopt=Abstract
•
Diuretic activity of an aqueous extract of Phyllanthus sellowianus. Author(s): Hnatyszyn O, Mino J, Gorzalczany S, Opezzo J, Ferraro G, Coussio J, Acevedo C. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 1999 July; 6(3): 177-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10439482&dopt=Abstract
•
Diuretic activity of an Equisetum bogotense tea (Platero herb): evaluation in healthy volunteers. Author(s): Lemus I, Garcia R, Erazo S, Pena R, Parada M, Fuenzalida M. Source: Journal of Ethnopharmacology. 1996 October; 54(1): 55-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8941869&dopt=Abstract
•
Diuretic activity of Fabiana patagonica in rats. Author(s): Alvarez ME, Maria AO, Saad JR. Source: Phytotherapy Research : Ptr. 2002 February; 16(1): 71-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11807970&dopt=Abstract
•
Diuretic and urolithiatic activities of the aqueous extract of the fruit of Randia echinocarpa on rats. Author(s): Vargas Solis R, Perez Gutierrez RM. Source: Journal of Ethnopharmacology. 2002 November; 83(1-2): 145-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12413721&dopt=Abstract
•
Diuretic effect and mechanism of action of parsley. Author(s): Kreydiyyeh SI, Usta J. Source: Journal of Ethnopharmacology. 2002 March; 79(3): 353-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11849841&dopt=Abstract
•
Diuretic effects of selected Thai indigenous medicinal plants in rats. Author(s): Sripanidkulchai B, Wongpanich V, Laupattarakasem P, Suwansaksri J, Jirakulsomchok D.
50
Diuretics
Source: Journal of Ethnopharmacology. 2001 May; 75(2-3): 185-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11297849&dopt=Abstract •
Diuretic plants in the paintings of Pompeii. Author(s): Melillo L. Source: American Journal of Nephrology. 1994; 14(4-6): 423-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7847479&dopt=Abstract
•
Diuretic, hypotensive and hypoglycaemic effect of Phyllanthus amarus. Author(s): Srividya N, Periwal S. Source: Indian J Exp Biol. 1995 November; 33(11): 861-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8786163&dopt=Abstract
•
Diuretic, laxative and toxicity studies of Cocculus hirsutus aerial parts. Author(s): Ganapaty S, Dash GK, Subburaju T, Suresh P. Source: Fitoterapia. 2002 February; 73(1): 28-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11864760&dopt=Abstract
•
Do diuretics cause magnesium deficiency? Author(s): Davies DL, Fraser R. Source: British Journal of Clinical Pharmacology. 1993 July; 36(1): 1-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8373706&dopt=Abstract
•
Does Aerua lanata have diuretic properties? Author(s): Goonaratna C, Thabrew I, Wijewardena K. Source: Indian J Physiol Pharmacol. 1993 April; 37(2): 135-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8225543&dopt=Abstract
•
Effects of loop diuretics on the suppression tuning of distortion-product otoacoustic emissions in rabbits. Author(s): Martin GK, Jassir D, Stagner BB, Lonsbury-Martin BL. Source: The Journal of the Acoustical Society of America. 1998 August; 104(2 Pt 1): 97283. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9714917&dopt=Abstract
•
Evaluation of diuretic activity of the constituents of Clematis montevidensis Spreng. (Ranunculaceae) in rats. Author(s): Alvarez ME, Maria AO, Villegas O, Saad JR. Source: Phytotherapy Research : Ptr. 2003 September; 17(8): 958-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13680834&dopt=Abstract
Alternative Medicine 51
•
Experimental diuretic effects of Rosmarinus officinalis and Centaurium erythraea. Author(s): Haloui M, Louedec L, Michel JB, Lyoussi B. Source: Journal of Ethnopharmacology. 2000 August; 71(3): 465-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10940584&dopt=Abstract
•
Herbal diuretics and lithium toxicity. Author(s): Pyevich D, Bogenschutz MP. Source: The American Journal of Psychiatry. 2001 August; 158(8): 1329. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11481175&dopt=Abstract
•
Herbal diuretics revisited: from “wise women” to William Withering. Author(s): Kinne-Saffran E, Kinne RK. Source: American Journal of Nephrology. 2002 July; 22(2-3): 112-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12097727&dopt=Abstract
•
Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) root. Author(s): Andallu B, Radhika B. Source: Indian J Exp Biol. 2000 June; 38(6): 607-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11116534&dopt=Abstract
•
Interaction of biofeedback-assisted relaxation and diuretic in treatment of essential hypertension. Author(s): Jurek IE, Higgins JT Jr, McGrady A. Source: Biofeedback Self Regul. 1992 June; 17(2): 125-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1581397&dopt=Abstract
•
Josephus Andreas Jacobus Plenck - a forerunner of modern diuretic therapy. Author(s): De Santo NG, Aliotta A, De Santo RM, Aliotta G. Source: Nephron. 2002 September; 92(1): 22-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12187080&dopt=Abstract
•
Oral magnesium supplementation restores the concentrations of magnesium, potassium and sodium-potassium pumps in skeletal muscle of patients receiving diuretic treatment. Author(s): Dorup I, Skajaa K, Thybo NK. Source: Journal of Internal Medicine. 1993 February; 233(2): 117-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8381850&dopt=Abstract
•
Pearls and pitfalls in the use and abuse of diuretics for chronic congestive heart failure. Author(s): Constant J.
52
Diuretics
Source: Cardiology. 1999; 92(3): 156-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10754345&dopt=Abstract •
Pharmacologic properties of Moringa oleifera. 2: Screening for antispasmodic, antiinflammatory and diuretic activity. Author(s): Caceres A, Saravia A, Rizzo S, Zabala L, De Leon E, Nave F. Source: Journal of Ethnopharmacology. 1992 June; 36(3): 233-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1434682&dopt=Abstract
•
Plants from Reunion Island with alleged antihypertensive and diuretic effects--an experimental and ethnobotanical evaluation. Author(s): Adsersen A, Adsersen H. Source: Journal of Ethnopharmacology. 1997 November; 58(3): 189-206. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9421255&dopt=Abstract
•
Preliminary studies on the antiinflammatory, analgesic and diuretic activity of stagninol, a sesquiterpene isolated from Persicaria stagnina. Author(s): Ahmed M, Sadhu SK, Datta BK, Kunu JK, Bachar SC. Source: Pharmazie. 1997 June; 52(6): 472-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9260269&dopt=Abstract
•
Purification and bioassays of a diuretic and natriuretic fraction from garlic (Allium sativum). Author(s): Pantoja CV, Martin NT, Norris BC, Contreras CM. Source: Journal of Ethnopharmacology. 2000 April; 70(1): 35-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10720787&dopt=Abstract
•
Salidiuretic action by genistein in the isolated, perfused rat kidney. Author(s): Gimenez I, Martinez RM, Lou M, Mayoral JA, Garay RP, Alda JO. Source: Hypertension. 1998 February; 31(2): 706-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9461244&dopt=Abstract
•
Soy isoflavonoids exhibit in vitro biological activities of loop diuretics. Author(s): Martinez RM, Gimenez I, Lou JM, Mayoral JA, Alda JO. Source: The American Journal of Clinical Nutrition. 1998 December; 68(6 Suppl): 1354S1357S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9848498&dopt=Abstract
•
Studies on the individual and combined diuretic effects of four Vietnamese traditional herbal remedies (Zea mays, Imperata cylindrica, Plantago major and Orthosiphon stamineus). Author(s): Doan DD, Nguyen NH, Doan HK, Nguyen TL, Phan TS, van Dau N, Grabe M, Johansson R, Lindgren G, Stjernstrom NE.
Alternative Medicine 53
Source: Journal of Ethnopharmacology. 1992 June; 36(3): 225-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1434681&dopt=Abstract •
Study on the diuretic activity of Strychnos potatorum Linn. seed extract in albino rats. Author(s): Biswas S, Murugesan T, Maiti K, Ghosh L, Pal M, Saha BP. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2001 November; 8(6): 469-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11824523&dopt=Abstract
•
The eating disorders medicine cabinet revisited: a clinician's guide to appetite suppressants and diuretics. Author(s): Roerig JL, Mitchell JE, de Zwaan M, Wonderlich SA, Kamran S, Engbloom S, Burgard M, Lancaster K. Source: The International Journal of Eating Disorders. 2003 May; 33(4): 443-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658674&dopt=Abstract
•
The efficacy and safety of diuretics in treating hypertension. Author(s): Freis ED. Source: Annals of Internal Medicine. 1995 February 1; 122(3): 223-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7810942&dopt=Abstract
•
Thiazide diuretics affect osteocalcin production in human osteoblasts at the transcription level without affecting vitamin D3 receptors. Author(s): Lajeunesse D, Delalandre A, Guggino SE. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2000 May; 15(5): 894-901. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10804019&dopt=Abstract
•
Tribulus terrestris: preliminary study of its diuretic and contractile effects and comparison with Zea mays. Author(s): Al-Ali M, Wahbi S, Twaij H, Al-Badr A. Source: Journal of Ethnopharmacology. 2003 April; 85(2-3): 257-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639749&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
•
AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
•
Chinese Medicine: http://www.newcenturynutrition.com/
54
Diuretics
•
drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html
•
Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
•
Google: http://directory.google.com/Top/Health/Alternative/
•
Healthnotes: http://www.healthnotes.com/
•
MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
•
Open Directory Project: http://dmoz.org/Health/Alternative/
•
HealthGate: http://www.tnp.com/
•
WebMD®Health: http://my.webmd.com/drugs_and_herbs
•
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
•
Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to diuretics; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Amyloidosis Source: Integrative Medicine Communications; www.drkoop.com Benign Prostatic Hyperplasia Source: Healthnotes, Inc.; www.healthnotes.com Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Bulimia Nervosa Source: Integrative Medicine Communications; www.drkoop.com Cardiac Arrhythmia Source: Healthnotes, Inc.; www.healthnotes.com Cardiomyopathy Source: Healthnotes, Inc.; www.healthnotes.com Cardiovascular Disease Overview Source: Healthnotes, Inc.; www.healthnotes.com Carpal Tunnel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Carpal Tunnel Syndrome Source: Integrative Medicine Communications; www.drkoop.com
Alternative Medicine 55
Cirrhosis Source: Integrative Medicine Communications; www.drkoop.com Congestive Heart Failure Source: Healthnotes, Inc.; www.healthnotes.com Congestive Heart Failure Source: Integrative Medicine Communications; www.drkoop.com Congestive Heart Failure Source: Prima Communications, Inc.www.personalhealthzone.com Cutaneous Drug Reactions Source: Integrative Medicine Communications; www.drkoop.com Dysphagia Source: Integrative Medicine Communications; www.drkoop.com Eating Disorders Source: Healthnotes, Inc.; www.healthnotes.com Edema Source: Healthnotes, Inc.; www.healthnotes.com Edema Source: Integrative Medicine Communications; www.drkoop.com Fainting Source: Integrative Medicine Communications; www.drkoop.com Gastroesophageal Reflux Disease Source: Integrative Medicine Communications; www.drkoop.com Heartburn Source: Integrative Medicine Communications; www.drkoop.com High Blood Pressure Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hyperkalemia Source: Integrative Medicine Communications; www.drkoop.com Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com
56
Diuretics
Hypertension Source: Integrative Medicine Communications; www.drkoop.com Hypoparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Kidney Stones Source: Healthnotes, Inc.; www.healthnotes.com Liver Disease Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Pancreatitis Source: Integrative Medicine Communications; www.drkoop.com Photodermatitis Source: Integrative Medicine Communications; www.drkoop.com Photosensitivity Source: Healthnotes, Inc.; www.healthnotes.com PMS Source: Integrative Medicine Communications; www.drkoop.com PMS Alternative names: Premenstrual Stress Syndrome Source: Prima Communications, Inc.www.personalhealthzone.com Preeclampsia Source: Healthnotes, Inc.; www.healthnotes.com Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com Premenstrual Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com Prostate Infection Source: Integrative Medicine Communications; www.drkoop.com Prostatitis Source: Integrative Medicine Communications; www.drkoop.com Pulmonary Edema Source: Integrative Medicine Communications; www.drkoop.com
Alternative Medicine 57
Pulmonary Hypertension Source: Integrative Medicine Communications; www.drkoop.com Reiter's Syndrome Source: Integrative Medicine Communications; www.drkoop.com Rheumatoid Arthritis Source: Integrative Medicine Communications; www.drkoop.com Serum Sickness Source: Integrative Medicine Communications; www.drkoop.com Sunburn Source: Integrative Medicine Communications; www.drkoop.com Syncope Source: Integrative Medicine Communications; www.drkoop.com Urinary Tract Infection Source: Healthnotes, Inc.; www.healthnotes.com Water Retention Source: Integrative Medicine Communications; www.drkoop.com Weight Loss and Obesity Source: Healthnotes, Inc.; www.healthnotes.com •
Alternative Therapy Clean-Me-Out Program Alternative names: Arise Shine Cleanse Thyself Program Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html
•
Herbs and Supplements Aesculus Alternative names: Horse Chestnut; Aesculus hippocastanum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Aldactazide Source: Healthnotes, Inc.; www.healthnotes.com Aldoclor Source: Healthnotes, Inc.; www.healthnotes.com Aldoril Source: Healthnotes, Inc.; www.healthnotes.com
58
Diuretics
Aloe Alternative names: Aloe vera, Aloe barbadensis, Aloe ferox , Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Aloe Vera Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10001,00.html Amiloride Source: Healthnotes, Inc.; www.healthnotes.com Amiloride/Hydrochlorothiazide Alternative names: Moduretic Source: Prima Communications, Inc.www.personalhealthzone.com Apium Graveolens Source: Integrative Medicine Communications; www.drkoop.com Apresazide Source: Healthnotes, Inc.; www.healthnotes.com Arctium Alternative names: Burdock, Gobo; Arctium lappa L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Arctostaphylos Alternative names: Bearberry; Arctostaphylos uva-ursi (L.) Spreng. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Arctostaphylos Uva Ursi Source: Integrative Medicine Communications; www.drkoop.com Aristolochia Alternative names: Snakeroot, Guaco; Aristolochia sp Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Atenolol Source: Healthnotes, Inc.; www.healthnotes.com Bearberry Source: Integrative Medicine Communications; www.drkoop.com Beargrape Source: Integrative Medicine Communications; www.drkoop.com Bendroflumethiazide/nadolol Alternative names: Corzide Source: Prima Communications, Inc.www.personalhealthzone.com
Alternative Medicine 59
Bile Acid Sequestrants Source: Healthnotes, Inc.; www.healthnotes.com Bisoprolol Source: Healthnotes, Inc.; www.healthnotes.com Blood Pressure Drugs Source: Prima Communications, Inc.www.personalhealthzone.com Boldo Alternative names: Peumus boldus Source: Healthnotes, Inc.; www.healthnotes.com Buchu Alternative names: Barosma betulina, Agathosma betulina, Agathosma crenultata Source: Healthnotes, Inc.; www.healthnotes.com Buchu Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Bugleweed Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Burdock Blend Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Butcher’s Broom Alternative names: Ruscus aculeatus Source: Healthnotes, Inc.; www.healthnotes.com Calciferol Source: Integrative Medicine Communications; www.drkoop.com Calcitrol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.drkoop.com Captozide Source: Healthnotes, Inc.; www.healthnotes.com Cascara Sagrada Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10013,00.html Celery Extract Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
60
Diuretics
Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10014,00.html Celery Seed Alternative names: Apium graveolens Source: Integrative Medicine Communications; www.drkoop.com Celery Seed Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Centella Alternative names: Gotu Kola; Centella asiatica (Linn.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Chamaemelum Nobile Source: Integrative Medicine Communications; www.drkoop.com Chlorothiazide/Methyldopa Alternative names: Aldoclor Source: Prima Communications, Inc.www.personalhealthzone.com Chlorthalidone/Atenolol Alternative names: Tenoretic Source: Prima Communications, Inc.www.personalhealthzone.com Chlorthalidone/Clonidine Alternative names: Combipres Source: Prima Communications, Inc.www.personalhealthzone.com Cholecalciferol Source: Integrative Medicine Communications; www.drkoop.com Cleavers Alternative names: Galium aparine Source: Healthnotes, Inc.; www.healthnotes.com Cleavers Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Colestipol Source: Healthnotes, Inc.; www.healthnotes.com Combipres Source: Healthnotes, Inc.; www.healthnotes.com Corn Silk Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca
Alternative Medicine 61
Dandelion Alternative names: Taraxacum officinale Source: Healthnotes, Inc.; www.healthnotes.com Dandelion Alternative names: Taraxacum officinale Source: Integrative Medicine Communications; www.drkoop.com Dandelion Source: Prima Communications, Inc.www.personalhealthzone.com Dandelion Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Dandelion Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10021,00.html Digoxin Source: Healthnotes, Inc.; www.healthnotes.com Diltiazem Source: Healthnotes, Inc.; www.healthnotes.com Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Diuretics Source: Prima Communications, Inc.www.personalhealthzone.com Dyazide Source: Healthnotes, Inc.; www.healthnotes.com Enalapril Source: Healthnotes, Inc.; www.healthnotes.com Ephedra (Ma huang) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,777,00.html Equisetum Alternative names: Horsetail; Equisetum arvense L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Equisetum Arvense Alternative names: Horsetail Source: Integrative Medicine Communications; www.drkoop.com
62
Diuretics
Erocalciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.drkoop.com False Unicorn Root Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10075,00.html Fennel Alternative names: Foeniculum vulgare Source: Healthnotes, Inc.; www.healthnotes.com Fringetree Bark Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Gemfibrozil Source: Healthnotes, Inc.; www.healthnotes.com Ginkgo Biloba Source: Healthnotes, Inc.; www.healthnotes.com Ginkgo Biloba Source: Integrative Medicine Communications; www.drkoop.com Ginseng (Panax) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10029,00.html Glucosamine Source: Healthnotes, Inc.; www.healthnotes.com Glucosamine Source: Integrative Medicine Communications; www.drkoop.com Glucosamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,790,00.html Glycyrrhiza glabra Source: Integrative Medicine Communications; www.drkoop.com Glycyrrhiza Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Golden Rod Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca
Alternative Medicine 63
Goldenrod Alternative names: Solidago virgaurea Source: Integrative Medicine Communications; www.drkoop.com Gravel Root Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hawthorn Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hops Alternative names: Humulus lupulus Source: Healthnotes, Inc.; www.healthnotes.com Horseradish Alternative names: Cochlearia armoracia Source: Healthnotes, Inc.; www.healthnotes.com Horsetail Alternative names: Equisetum arvense Source: Healthnotes, Inc.; www.healthnotes.com Horsetail Alternative names: Equisetum arvense Source: Integrative Medicine Communications; www.drkoop.com Horsetail Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Horsetail Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10105,00.html Huperzia Source: Healthnotes, Inc.; www.healthnotes.com Hydralazine Source: Healthnotes, Inc.; www.healthnotes.com Hydrangea Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hydrochlorothiazide/Benazepril Alternative names: Lotensin HCT Source: Prima Communications, Inc.www.personalhealthzone.com
64
Diuretics
Hydrochlorothiazide/Bisoprolol Alternative names: Ziac Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Captopril Alternative names: Capozide Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Enalapril Alternative names: Vaseretic Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Hydralazine Alternative names: Apresazide Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Lisinopril Alternative names: Prinzide, Zestoretic Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Methyldopa Alternative names: Aldoril Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Metoprolol Alternative names: Lopressor HCT Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Moexipril Alternative names: Uniretic Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Propranolol Alternative names: Inderide Source: Prima Communications, Inc.www.personalhealthzone.com Hydrochlorothiazide/Timolol Alternative names: Timolide Source: Prima Communications, Inc.www.personalhealthzone.com Hyzaar Source: Healthnotes, Inc.; www.healthnotes.com Indapamide Source: Healthnotes, Inc.; www.healthnotes.com Inderide Source: Healthnotes, Inc.; www.healthnotes.com Isosorbide Mononitrate Source: Healthnotes, Inc.; www.healthnotes.com
Alternative Medicine 65
Jamaica Dogwood Alternative names: Piscidia erythrina, Piscidia piscipula Source: Integrative Medicine Communications; www.drkoop.com Juniper Alternative names: Juniperus communis Source: Healthnotes, Inc.; www.healthnotes.com Juniper Berries Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Juniper Berry Source: Prima Communications, Inc.www.personalhealthzone.com Kola Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Lepidium Sp Alternative names: Cress; Lepidium sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Licorice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,801,00.html Limetree Source: Integrative Medicine Communications; www.drkoop.com Linden Alternative names: Tilia cordata, Tilia platyphyllos, Limetree Source: Integrative Medicine Communications; www.drkoop.com Linden Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Loop Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Loop Diuretics Source: Integrative Medicine Communications; www.drkoop.com Loop Diuretics Source: Prima Communications, Inc.www.personalhealthzone.com
66
Diuretics
Lopressor HCT Source: Healthnotes, Inc.; www.healthnotes.com Losartan Source: Healthnotes, Inc.; www.healthnotes.com Lotrel Source: Healthnotes, Inc.; www.healthnotes.com Maidenhair Tree Source: Integrative Medicine Communications; www.drkoop.com Marshmallow Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Maxzide Source: Healthnotes, Inc.; www.healthnotes.com Metoprolol Source: Healthnotes, Inc.; www.healthnotes.com Moduretic Source: Healthnotes, Inc.; www.healthnotes.com Motherwort Alternative names: Leonurus cardiaca Source: Healthnotes, Inc.; www.healthnotes.com Nettle Source: Integrative Medicine Communications; www.drkoop.com Nettle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10048,00.html Nifedipine Source: Healthnotes, Inc.; www.healthnotes.com Nitroglycerin Source: Healthnotes, Inc.; www.healthnotes.com Oak Bark Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10108,00.html Oral Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com
Alternative Medicine 67
Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Parsley Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,869,00.html Piscidia Erythrina Source: Integrative Medicine Communications; www.drkoop.com Piscidia Piscipula Source: Integrative Medicine Communications; www.drkoop.com Plantago Major Alternative names: Plantain; Plantago major/lanceolata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Plantago Psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Plantain Alternative names: Plantago lanceolata, Plantago major Source: Healthnotes, Inc.; www.healthnotes.com Prinizide Source: Healthnotes, Inc.; www.healthnotes.com Propranolol Source: Healthnotes, Inc.; www.healthnotes.com Quinapril Source: Healthnotes, Inc.; www.healthnotes.com Quinidine Source: Healthnotes, Inc.; www.healthnotes.com Ramipril Source: Healthnotes, Inc.; www.healthnotes.com Red Clover Alternative names: Trifolium pratense Source: Healthnotes, Inc.; www.healthnotes.com Ribes Alternative names: Black Currant; Ribes nigrum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
68
Diuretics
Roman Chamomile Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.drkoop.com Rosemary Alternative names: Rosmarinus officinalis Source: Integrative Medicine Communications; www.drkoop.com Rosmarinus Alternative names: Rosemary; Rosmarinus officinalis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Rosmarinus Officinalis Source: Integrative Medicine Communications; www.drkoop.com Scouring Rush Alternative names: Horsetail Source: Integrative Medicine Communications; www.drkoop.com Sertraline Source: Healthnotes, Inc.; www.healthnotes.com Shave Grass Alternative names: Horsetail Source: Integrative Medicine Communications; www.drkoop.com Shephard's Purse Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Solidago Virgaurea Source: Integrative Medicine Communications; www.drkoop.com Sotalol Source: Healthnotes, Inc.; www.healthnotes.com Spanish Licorice Alternative names: Licorice Source: Integrative Medicine Communications; www.drkoop.com Taraxacum Officinale Alternative names: Dandelion Source: Integrative Medicine Communications; www.drkoop.com Tenoretic Source: Healthnotes, Inc.; www.healthnotes.com Thiazide Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Thiazide Diuretics Source: Integrative Medicine Communications; www.drkoop.com
Alternative Medicine 69
Thiazide Diuretics Source: Prima Communications, Inc.www.personalhealthzone.com Tilia Cordata Source: Integrative Medicine Communications; www.drkoop.com Tilia Platyphyllos Source: Integrative Medicine Communications; www.drkoop.com Timolide Source: Healthnotes, Inc.; www.healthnotes.com Timolol Source: Healthnotes, Inc.; www.healthnotes.com Triamterene Source: Healthnotes, Inc.; www.healthnotes.com Triamterene/Hydrochlorothiazide Alternative names: Dyazide, Maxzide Source: Prima Communications, Inc.www.personalhealthzone.com Tribulus Puncture Alternative names: Puncture Vine, Goathead; Tribulus terrestris L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Urtica Dioica Source: Integrative Medicine Communications; www.drkoop.com Urtica Urens Source: Integrative Medicine Communications; www.drkoop.com Uva Ursi Alternative names: Arctostaphylos uva ursi, Bearberry, Beargrape Source: Integrative Medicine Communications; www.drkoop.com Vaseretic Source: Healthnotes, Inc.; www.healthnotes.com Verapamil Source: Healthnotes, Inc.; www.healthnotes.com Yarrow Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Zestoretic Source: Healthnotes, Inc.; www.healthnotes.com Ziac Source: Healthnotes, Inc.; www.healthnotes.com
70
Diuretics
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
71
CHAPTER 4. DISSERTATIONS ON DIURETICS Overview In this chapter, we will give you a bibliography on recent dissertations relating to diuretics. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “diuretics” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on diuretics, we have not necessarily excluded non-medical dissertations in this bibliography.
Dissertations on Diuretics ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to diuretics. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •
The Effect of Diuretics on Blood Vessels: The Mechanism of the Antihypertensive Effect after Long Term Administration of Oral Diuretics by Hart, Frederick Edward; PhD from University of Toronto (Canada), 1973 http://wwwlib.umi.com/dissertations/fullcit/NK19711
Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
73
CHAPTER 5. CLINICAL TRIALS AND DIURETICS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning diuretics.
Recent Trials on Diuretics The following is a list of recent trials dedicated to diuretics.8 Further information on a trial is available at the Web site indicated. •
Diuretics, Hypertension, and Arrhythmias Clinical Trial Condition(s): Cardiovascular Diseases; Death, Sudden, Cardiac; Heart Arrest; Heart Diseases; Hypertension Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether hypertensive patients with ECG abnormalities and receiving hydrochlorothiazide diuretics were at increased risk of sudden death. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000525
Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions.
8
These are listed at www.ClinicalTrials.gov.
74
Diuretics
The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “diuretics” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
•
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
•
For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
•
For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm
•
For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
•
For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm
•
For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp
•
For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm
•
For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
•
For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
•
For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm
•
For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
•
For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm
•
For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm
•
For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials
75
CHAPTER 6. PATENTS ON DIURETICS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “diuretics” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on diuretics, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Diuretics By performing a patent search focusing on diuretics, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We
9Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
76
Diuretics
will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on diuretics: •
1-oxaspiro[4,5] decane-7,8-diaminoarylamides Inventor(s): Horwell; David C. (Cambridge, GB2), Rees; David C. (Cambridge, GB2) Assignee(s): Warner-lambert Company (morris Plains, Nj) Patent Number: 5,019,588 Date filed: October 10, 1989 Abstract: Novel 1,2-cyclohexylaminoaryl amides useful as analgesic agents having very high kappa-opioid affinity and selectivity and potency and useful as analgesics, diuretics, antiinflammatory and psychotherapeutic agents are disclosed. Methods for making the compounds and pharmaceutical compositions containing them are also disclosed. Excerpt(s): The search for strong analgesics which also possess minimal potential for dependency has been among the highest priority efforts in pharmacological research. These research efforts have, to a great extent, involved chemical modifications of the opiate structure and the discovery of chemically novel compounds which possess morphine-like activity. The concept of multiple opioid receptors has been supported by studies with nalorphine and a series of benzomorphans which display unusual pharmacological properties dissimilar from morphine, yet blocked by the opioid antagonists. [See, for example, W. R. Martin, et al., J. Pharmacol. Exp. Ther., 197:517-531 (1976)]. The existence of multiple types of opioid receptors is of importance because it suggests the possibility of separating the desirable analgesic and psychotherapeutic effects of a drug compound from the undesirable abuse potential or habituating effect. Web site: http://www.delphion.com/details?pn=US05019588__
•
7-(substituted)amino)- 8-((substituted)carbonyl)-methylamino)-1-oxaspiro[4,5]decanes as diuretics antiiflammatory, and cerebrovascular agents Inventor(s): Horwell; David C. (Cambridge, GB2), Rees; David C. (Cambridge, GB2) Assignee(s): Warner-lambert Company (morris Plains, Nj) Patent Number: 4,965,278 Date filed: April 21, 1989 Abstract: Methods for using substituted phenoxy-, 1-, and 2-naphthalenyloxy-, indenyl-, indolyl-, benzo[b]-furanyl-, and benzo[b]thienylcarboxamides of 7,8-(substituteddiamino)-1-oxaspiro[4.5]decanes as cerebrovascular, diuretic, and antiinflammatory agents are disclosed. Pharmaceutical compositions employing the compounds are also disclosed. Excerpt(s): The present invention is related to a method of using 7-((substituted)amino8-((substituted)carbonyl)-methylamino)-1-oxaspiro(4. 5)decanes and the pharmaceutically acceptable salts thereof as diuretic, antiinflammatory, and cerebrovascular agents. The compounds, processes for preparing them, and pharmaceutical compositions containing them are found in U.S. Pat. No. 4,737,493, which is herein incorporated by reference. The disclosed utility in the patent is analgesic. The compounds are also disclosed as having sedative, diuretic, and
Patents 77
corticosteroid elevating effects and therefore as being useful diuretic and psychotherapeutic agents. U.S. Pat. No. 4,598,087 covers certain substituted trans-1,2diamino-cyclohexyl amide compounds which demonstrate selective opioid receptor binding. They are disclosed as useful as analgesics, diuretics, and psychotherapeutic agents. U.S. Pat. No. 4,663,343 covers certain substituted naphthalenyloxy-1,2diaminocyclohexyl amide compounds which possess selective kappa opioid receptor site binding activity and are useful as analgesics and diuretics. Web site: http://www.delphion.com/details?pn=US04965278__ •
A1 adenosine receptor agonists and antagonists as diuretics Inventor(s): Baker; Stephen (Gainesville, FL), Belardinelli; Luiz (Gainesville, FL), Olsson; Ray (Tampa, FL), Scammells; Peter J. (Highton, AU) Assignee(s): University of Florida Research Foundation (gainesville, Fl) Patent Number: 5,446,046 Date filed: October 28, 1993 Abstract: Adenosine and xanthine derivatives, and compositions comprising those compounds, are potent selective agonists and antagonists of adenosine receptors. The derivatives and composition are used to treat conditions, including certain cardiac arrhythmias. Excerpt(s): Adenosine is an extracellular messenger generated by all cells in the body. Adenosine itself, substances that act as agonists of adenosine, and substances that antagonize its actions have important clinical applications. In the heart, an organ whose function depends critically on an adequate supply of oxygen, adenosine regulates the balance between oxygen supply (coronary blood flow) and oxygen demand (cardiac work). Adenosine released from working heart cells increases oxygen supply through coronary dilation and decreases oxygen consumption by slowing heart rate and modulating.beta.-adrenergic stimulation. The protective effects of adenosine are particularly important when cardiac oxygen supply is limited, for example, by coronary artery narrowing. Several recent reviews describe the adenosine system in detail (Belardinelli, L., J. Linden, R. M. Berne [1989] Prog. Cardiovasc. Dis. 32:73-97; Belardinelli, L., A. Pelleg [1990] J. Cardiovasc. Electrophysiol. 1:327-339; Olsson, R. A., J. D. Pearson [1990] Physiol. Rev. 70:761-845). The cardiac adenosine system consists of three processes: (1) mechanisms for adenosine formation; (2) adenosine receptors and proteins that couple them to effectors; and (3) mechanisms for the removal of adenosine. Selective modification of one or more of these systems by means of drugs such as adenosine receptor antagonists and adenosine uptake inhibitors can modify the actions of adenosine for therapeutic benefit. Adenosine formation increases when oxygen demand exceeds its supply, thereby promoting the degradation of adenosine nucleotides. The degradation of adenylates released from nerve terminals along with neurotransmitters and the degradation of S-adenosylhomocysteine, a byproduct of methylation reactions, are additional sources of adenosine in the heart. Heart muscle and coronary blood vessel cells take up very nearly all the adenosine generated in the heart, reincorporating that adenosine into the cellular nucleotide pool. Web site: http://www.delphion.com/details?pn=US05446046__
78
•
Diuretics
Benzofuran and benzothoiphene derivatives, of tetrazole and anti-hyperuricemia use thereof Inventor(s): Kubota; Koichi (Matsumoto, JP), Tomiyama; Akira (Hanishina, JP), Tomiyama; Tsuyoshi (Hanishina, JP) Assignee(s): Kotobuki Seiyaku Company Limited (nagano, Jp) Patent Number: 5,004,750 Date filed: December 6, 1988 Abstract: A new series of benzofuran and benzothiophene derivatives are disclosed. These compounds have a structure which can be obtained by substituting the third position of 2-lower alkyl-benzofuran or 2-lower alkyl-benzothiophene with a substituted benzene derivative, itaconic acid derivative or a substituted phenoxymethyl tetrazole derivative. They are useful as diuretics without side effects of elevating serum uric acid levels and can be used in the treatment of hyperuricemia. Excerpt(s): It is well known that hyperuricemia and hypertension are among major risk factors of cardiovascular diseases. In long term diuretics therapy, for example, with the thiazide type diuretics, there occurs a frequent increase in serum uric acid levels. Such an increase leads to the occurrence of serious gouty arthritis. The present invention relates to diuretics without the aforesaid side effect and discloses a series of chemical compounds effective in treating hyperuricemia. Web site: http://www.delphion.com/details?pn=US05004750__
•
Combination of an ace inhibitor and a diuretic Inventor(s): Kristianson; J. Krister (Olofsgatan 13, S-193 00, Sigtuna, SE), Wold-Olsen; Per (5 Round Top Rd. P.O. Box 61, Oldwick, NJ 08858-0061) Assignee(s): None Reported Patent Number: 5,686,451 Date filed: September 5, 1995 Abstract: Pharmaceutical formulations comprising as active ingredients an angiotensin converting enzyme (ACE) inhibitor at a dose level normally found effective as an antihypertensive and a diuretic at a dose level below its minimum effective dose, demonstrate greater efficacy than would be expected in returning the blood pressure of hypertensive patients to normotensive values. Excerpt(s): Both diuretics and ACE-inhibitors have an effect on the renin-angiotensinaldosterone system. ACE-inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II. Diuretics regulate the sodium-balance, and thereby also fluid volume. The decrease, both in sodium as well as volume, following therapy with diuretics increases plasma renin activity and thereby activates the renin-angiotensin-aldosterone system. This effect will to some degree counteract the blood-pressure lowering effect of the diuretic. When a diuretic and an ACE-inhibitor are combined the different pharmacological actions of these two drugs will, influence the effect of the other. There is accordingly a logical rationale for combining these two pharmacological principles. It is possible to establish the highest non-pharmacological active dose of diuretic, i.e. a dose that is so low that it has no effect on blood pressure, and no apparent adverse effects. The highest non-effective dose of diuretic will still trigger the renin-angiotensinaldosterone system and although it has no physiological effect of it's own, it will
Patents 79
nonetheless have a potentiating effect on an ACE-inhibitor. In a recently completed study by us of the effects of different doses of HCTZ on blood pressure and various metabolic parameters, doses ranging from 3 mg to 25 mg were investigated. 25 mg HCTZ produced significant effects on blood pressure and the metabolic parameters. 12.5 mg of HCTZ was found to be at the threshold of an effective antihypertensive response, and changes were seen in the metabolic parameters. Contrary to this, the doses of 3 and 6 mg were demonstrated not to be different from placebo in effects on blood pressure and various metabolic parameters. Web site: http://www.delphion.com/details?pn=US05686451__ •
Combination of hypertensin converting enzyme inhibitor with a diuretic for treating microcirculation disorders Inventor(s): Guez; David (Neuilly sur Seine, FR), Levy; Bernard (Paris, FR), Schiavi; Pierre (Nanterre, FR) Assignee(s): Les Laboratoires Servier (neuilly-sur-seine, Fr) Patent Number: 6,653,336 Date filed: May 18, 2000 Abstract: The present invention relates to the use of a combination of an antiotensinconverting enzyme inhibitor (CEI) and of a diuretic for the treatment of arteriolocapillary microcirculatory disorders and to pharmaceutical compositions containing the same. Excerpt(s): The present invention relates to the use of a combination of an angiotensin converting enzyme inhibitor (CEI) and of a diuretic for producing pharmaceutical compositions intended for the treatment of arteriolo-capillary microcirculatory disorders. It is known that the majority of degenerative vascular diseases, for example arterial hypertension (N. M. Kaplan, "Microvascular Rarefaction", Clinical Hypertension, 6.sup.th Ed., Baltimore, Wilkinson and Wilkins, 1994, 86; A. S. Greene et al., "Microvascular rarefaction and tissue vascular resistance in hypertension", Am. J. Physiol., 1989, 256 (Heart Circ. Physiol., 25), H 126-H 31; A. S. Izzard et al., "Hypertension and the vasculature: arterioles and the myogenic response", J. Hypertens., 1995, 13, 1-4; A. M. Heagerty et al., "Small artery structure in hypertension", Hypertension, 1993, 21, 391-7), but also vascular complications of certain metabolic diseases, for example diabetes mellitus (G. Reach et al., "Causes et mecanismes de la microangiopathie et de la neuropathie--"L'hypothese glucose" et ses implications [Causes and mechanisms of microangiopathy and neuropathy--"The glucose hypothesis" and its implications]", in: G. Tchobroutsky, G. Slama, R. Assan, P. Freychet, Paris: Pradel, 1990, 448-57), or certain dyslipidemias (J. F. Toole, "Atherosclerosis", Cerebrovascular Disorders, New York, Raven Press, 1984, 199-213) are accompanied by detrimental anatomical and/or functional changes in the arteriolo-capillary microcirculation (J. C. M. L. Le Noble et al., "A functional morphometric study of the cremaster muscle microcirculation in young spontaneously hypertensive rats", J. Hypertens., 1990, 8,741-8; I. I. H. Chen et al., "Microvascular rarefaction in spontaneously hypertensive rat cremaster muscle", Am. J. Physiol., 1981, 241, H 306-10). and, more generally, poor adjustment of the distribution of the blood in the tissues to metabolic requirements, any detrimental change capable of inducing or perpetuating a tissue hypoperfusion or an ischemia, absolute or relative (E. Vicaut, "Hypertension and the microcirculation: a brief overview of experimental studies", J. Hypertens., 1992, 10, suppl. 5, S59-S68).
80
Diuretics
Web site: http://www.delphion.com/details?pn=US06653336__ •
Compositions and methods of treatment using peat derivatives Inventor(s): Harnisch; James P. (Mercer Island, WA), Hart; Ralph M. (Lake Forest Park, WA), Jones; Herman L. (Wenatchee, WA), Jones; Veronica Lee Egelkrout (Wenatchee, WA), Kenny; Margaret A. (Edmonds, WA), Loev; Bernard (Medford, NJ), Malik; Sohail (Redmond, WA) Assignee(s): C-p Technology Limited Partnership (mill Creek, Wa) Patent Number: 6,267,962 Date filed: June 30, 1997 Abstract: Novel compositions containing at least one biologically active component derived from peat or similar composition, methods for their preparation and therapeutic uses for a variety of diseases, injuries, and conditions, including wound healing, pain, itch, inflammation, abnormal cell proliferation, or infections caused by fungal, bacterial, rickettsial or viral agents, psoriasis, allergic and other dermatitis, pruritis, eczema, actinic keratosis and similar conditions. In addition, the compositions can be used as diuretics, antiarrhythmics, and cardiac-stimulating agents, as well as for the treatment of mammalian diseases and disorders, including multiple drug resistance, cancers, asthma, rheumatoid arthritis, pain, wound healing, fungal disorders, and other inflammatory disorders. The compositions are derivable from peat or peat-related substances and may alternatively be synthetically produced. Excerpt(s): This invention relates to novel compositions, methods of isolation and synthesis, and pharmaceutical uses of materials derived from peat. These compositions may be used for the treatment of wounds and for diseases and disorders such as pruritis, psoriasis, allergic and other dermatitis, eczema, and actinic keratosis. The compositions may be suitable for accelerating wound healing; relieving pain, itch or inflammation; reducing abnormal proliferative cell growth, particularly keratinocytes, of the skin and for hyperplastic and neoplastic conditions of other epithelial systems in the human body; and providing antifungal, antiviral, or antibacterial activity. In addition, the composition can be used as a diuretic, antiarrhythmic, and cardiac-stimulating agent. It may also be used as a therapeutic agent in the treatment of multiple drug resistance, malignancies, asthma, rheumatoid arthritis, fungal infections, and inflammatory disorders. Normal skin epidermis is a complex epithelial tissue containing keratinocytes that are proliferating, differentiating, and desquamating. Many common diseases of the skin epidermis, such as psoriasis, squamous cell carcinoma, keratoacanthoma, actinic keratosis, and warts, are characterized by localized abnormal proliferation and growth that is localized. For example, in psoriasis, which is characterized by scaly, red, elevated plaques on the skin, the keratinocytes are known to proliferate much more rapidly than normal. Eczema is a superficial inflammatory process involving primarily the epidermis, marked early by redness, itching, minute papules and vesicles, weeping, oozing, and crusting, and later by scaling, lichenification, and often pigmentation. Clinical use of available treatments for diseases involving epidermal conditions is often limited by toxicity, either systemic or local. For example, methotrexate, although generally effective for treating epidermal conditions when administered orally, is rarely administered orally for fear of hepatic or bone marrow toxicity. Topical application of methotrexate has minimal or no therapeutic effect. Similarly, although topical application of 5-fluorouracil may be an effective treatment for psoriasis, it is generally considered to be unacceptably irritating. Steroid therapy,
Patents 81
though effective, is associated with adverse side effects that are potentially so numerous or serious that prolonged use is discouraged. Photochemotherapy with psoralens and ultraviolet light, or PUVA (psoralens and UV treatment), is generally effective for treatment of epidermal conditions, but it is inconvenient to administer and causes side effects and may even cause photomutagenic and photocarcinogenic reactions. Web site: http://www.delphion.com/details?pn=US06267962__ •
Dietary supplement composition Inventor(s): Ayres; James R. (Menifee, CA), Gerth; Teja D. (Los Angeles, CA), Mann; Ralph W. (Canyon Lake, CA) Assignee(s): Nova Pharmaceutical Co. (lake Elsinore, Ca) Patent Number: 5,925,377 Date filed: August 7, 1997 Abstract: A dietary supplement composition combining amino acids, minerals, vitamins, herbs, and essential nutrients along with gentle diuretics and digestive enzymes. Together, the individual elements of the composition work in a synergistic manner to promote the benefits of the individual elements. For example, DL-phenylalanine is combined with tyrosine to act as an appetite depressant while L-carnitine is combined with chromium picolinate to work as fat directors to convert stored body fat into energy. Excerpt(s): The invention relates to dietary supplements and more particularly to a dietary supplement composition. There are many dietary supplements on the market that promote general health. These supplements typically take the form of tablets, capsules, or liquids that are combined with meals as part of a healthy diet regimen. These supplements are made up individually of one or more amino acids, minerals, and/or nutrients. Certain amino acids burn fat, reduce hunger, and act as antidepressants. Amino acid compounds, for example, DL-Phenylalanine and L-Tyrosine are high ranking neurotransmitter amino acids that stimulate and modify brain activity to reduce hunger and improve memory and mental alertness. L-Glutamine is a natural form of glutamic acid that helps decrease sugar cravings. As this amino acid helps those with a "sweet tooth," it also helps fight fatigue and depression. Web site: http://www.delphion.com/details?pn=US05925377__
•
Diuretic and antinatriuretic responses produced by the endogenous opioid-like peptide, nociceptin (orphanin FQ) Inventor(s): Lippton; Howard (144 Elks Pl., Suite 1602, New Orleans, LA 70112) Assignee(s): None Reported Patent Number: 5,840,696 Date filed: September 11, 1997 Abstract: Nociceptin in a method of controlling water retention in a patient. More particularly, the use and administration of nociceptin as a free-water diuretic that produces a free-water diuresis for the control of water retention in patients. Excerpt(s): This application claims the benefit of United States Provisional Patent Application No. 06/026,000 filed Sep. 12, 1996 by Daniel R. Kapusta and Howard
82
Diuretics
Lippton, and entitled Diuretic and Antinatriuretic Responses Produced by the Endogenous Opioid-Like Peptide, Nociceptin (Orphanin FQ), which is hereby incorporated by reference in its entirety. The present invention relates to a method of controlling water retention in a patient. More particularly, the present invention relates to the use and administration of a free-water diuretic that produces a free-water diuresis. Still more particularly, the present invention relates to the administration and use of nociceptin (Orphanin FQ) as a free-water diuretic for the control of water retention in patients. Water diuretics (also known as solute free-water diuretics, or aquaretics) are required for the management of hyponatremic states such as the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or other potentially life-threatening water-retaining diseases including congestive heart failure, renal failure, liver cirrhosis with ascites, or adult respiratory distress syndrome (ARDS). Since the primary control of water homeostasis involves vasopressin (antidiuretic hormone, ADH), the development of water diuretics has been directed toward 1) inhibiting the action of vasopressin at the level of the kidneys using vasopressin V2 receptor antagonists or 2) inhibiting the secretion of vasopressin from the hypothalamus using kappa opioid agonists. Despite considerable research efforts, the development of free water diuretics by these approaches has been complicated and unsuccessful. In this regard, vasopressin antagonists have been shown to have limited potential as diuretics due to their partial agonist and species-dependent properties. In contrast, whereas kappa opioid agonists elicit a profound water diuresis in man, their clinical use is prevented by the central nervous system side effects (i.e. dysphoria) produced by this class of opioids. Thus, currently there are no free water diuretics available for clinical use in the U.S. or other countries. Web site: http://www.delphion.com/details?pn=US05840696__ •
Gem-dimethyl substituted bicyclic compounds useful as eukalemic diuretics Inventor(s): Schwartz; John A. (Macclesfield, GB) Assignee(s): Ici Americas Inc. (wilmington, De) Patent Number: 4,980,352 Date filed: May 19, 1989 Abstract: Certain gem-dimethyl substituted bicyclic phenolic pyrazines of formula III possess eukalemic diuretic properties. They are of value in treating those diseases and conditions in which a eukalemic diuretic effect is required, for example in treating edema, hypertension and/or related conditions. Excerpt(s): This invention comprises novel gem-dimethyl substituted bicyclic compounds which are useful as eukalemic diuretics. A variety of agents are available for use in treating hypertension. One particular class of such agents is diuretics. Diuretics are used for a variety of purposes, for example, reduction of fluid from the body and reduction of sodium levels in the body, for example, in the treatment of hypertension and edema. A problem with some diuretics is the reduction of serum potassium levels and complications caused from reductions of potassium beyond levels needed for maintaining physiological functions. Thus, some diuretics are used in conjunction with a potassium conserving agent such as 3,5-diamino-N(aminoiminomethyl)-6-chloropyrazine carboxamide monohydrochloride, dihydrate of formula II (formula set out, together with other formulae referred to by Roman numerals, on pages following Examples) described in U.S. Pat. No. 3,577,418 which is used in conjunction with, for example, thiazide diuretics.
Patents 83
Web site: http://www.delphion.com/details?pn=US04980352__ •
Glutaramide diuretic agents Inventor(s): Barnish; Ian T. (Ramsgate, GB), Danilewicz; John C. (Ash, GB), James; Keith (Great Mongeham, GB), Samuels; Gillian M. R. (Barham, GB), Terrett; Nicholas K. (Worth, GB), Williams; Michael T. (Deal, GB), Wythes; Martin J. (Sutton, GB) Assignee(s): Pfizer Inc. (new York, Ny) Patent Number: 5,030,654 Date filed: May 19, 1989 Abstract: A series of novel spiro-substituted glutaramide derivatives have been prepared, including the pharmaceutically acceptable salts thereof and bioprecursors therefor, wherein the spiro-substituent completes a 5- or 6-membered carbocycyclic ring and is located at the carbon atom adjacent to the carbamoyl group. These particular compounds are inhibitors of the neutral endopeptidase E.C.3.4.24.11 enzyme and are therefore useful in therapy as diuretic agents for the treatment of hypertension, heart failure, renal insufficiency and other disorders. Methods for preparing these compounds from known starting materials are provided. Excerpt(s): This invention relates to a series of spiro-substituted glutaramide derivatives which are diuretic agents having utility in a variety of therapeutic areas including the treatment of various cardiovascular disorders such as hypertension and heart failure. The compounds are inhibitors of the zinc-dependent, neutral endopeptidase E.C.3.4.24.11. This enzyme is involved in the breakdown of several peptide hormones, including atrial natriuretic factor (ANF), which is secreted by the heart and which has potent vasodilatory and diuretic/natriuretic activity. Thus, the compounds of the invention, by inhibiting the neutral endopeptidase E.C.3.4.24.11, can potentiate the biological effects of ANF. Thus, in particular the compounds are diuretic agents having utility in the treatment of a number of disorders, including hypertension, heart failure, renal insufficiency, premenstrual syndrome, cyclical oedema, Menieres disease and hypercalciuria. In addition, because of their ability to potentiate the effects of ANF the compounds have utility in the treatment of glaucoma. As a further result of their ability to inhibit the neutral endopeptidase E.C.3.4.24.11 the compounds of the invention may have activity in other therapeutic areas including for example the treatment of asthma, inflammation, pain, epilepsy, affective disorders, dementia and geriatric confusion, obesity and gastrointestinal disorders (especially diarrhoea and irritable bowel syndrome), the modulation of gastric acid secretion and the treatment of hyperreninaemia. and pharmaceutically acceptable salts thereof and bioprecursors therefor. Web site: http://www.delphion.com/details?pn=US05030654__
•
Injectable implant Inventor(s): Dittgen; Michael (Apolda, DE), Fricke; Sabine (Jena, DE), Gerecke; Hagen (Jena, DE), Moller; Ines-Patricia (Jena, DE), Volkel; Christoph (Jena, DE) Assignee(s): Jenapharm Gmbh & Co. KG (jena, De) Patent Number: 6,303,137 Date filed: August 16, 1999
84
Diuretics
Abstract: This invention relates to an in-situ implant that can be produced by placing a sterile, injectable, and water-insoluble complex from a biodegradable polymer and a biocompatible polyether with functional end-groups in the organism, and coagulating them under the influence of the body fluid. This coagulate may optionally contain at least one bioactive substance selected from the group of hormones, immunomodulators, immunosuppressants, antibiotics, cytostatics, diuretics, gastro-intestinal agents, analgesics, local anaesthetics and/or neuropharmacological agents. Excerpt(s): Not applicable. This invention relates to an in-situ implant that can be produced by placing a sterile, injectable, and water-insoluble complex from a biodegradable polymer and a biocompatable polyether with functional end-groups in the organism, and coagulating them under the influence of the body fluid. Web site: http://www.delphion.com/details?pn=US06303137__ •
Linear analogs of atrial natriuretic peptides Inventor(s): Johnson; Lorin K. (Pleasanton, CA), Lewicki; John A. (Los Gatos, CA), Scarborough; Robert M. (Hayward, CA) Assignee(s): California Biotechnology Inc. (mountain View, Ca) Patent Number: 5,047,397 Date filed: December 16, 1988 Abstract: Compounds and compositions comprising synthetic analogs of Atrial Natriuretic Peptides are provided, together with methods for their production and use as natriuretics, diuretics and/or vasodilators, or as intermediates for or modulators of such useful compounds or of native Atrial Natriuretic Peptides. Excerpt(s): The present invention relates generally to synthetic analogs of atrial peptides and more particularly to synthetic linear peptide compounds which find use as diuretics, natriuretics and/or vasodilators, or as intermediates for or modulators of such useful compounds, together with methods for their production and use. Most multicellular organisms are organized into tissues and organs which perform specialized functions. Thus, a system has evolved to transport and circulate materials between them. In higher animals, including mammals, this circulatory system is closed, in order to improve the efficiency of transport. The flow of blood fluid through this closed cardiovascular system requires that the fluid be maintained under pressure and the regulation of the systemic arterial blood pressure requires a complex interaction of numerous factors including, e.g., fluid volume and vascular elasticity and caliber. The maintenance of normal extracellular fluid volume depends primarily on the excretion of sodium (natriuresis) and water (diuresis) by the kidneys. This is determined by (1) the rate at which plasma is filtered at the glomerulus (glomerular filtration rate, or GFR) and (2) the degree to which sodium is actively reabsorbed along the renal tubule (with water following passively). The latter process is in part regulated by the adrenal steroid hormone aldosterone. It has been long believed that, in addition to GFR and aldosterone, there must be a "third factor" which also regulates sodium reabsorption. It is now apparent that many of the phenomena which required the postulation of a "third factor" can be explained by the effects of physical forces (e.g., blood pressure, red blood cell concentration and plasma viscosity) on sodium reabsorption. Nonetheless, the search continues for a "natriuretic hormone" which might modulate tubular reabsorption. Web site: http://www.delphion.com/details?pn=US05047397__
Patents 85
•
Method and formulations for the therapy of cystic fibrosis, Bartter's syndrome and secretory diarrheas, and for diuretic treatment Inventor(s): Agus; Zalman S. (Cherry Hill, NJ), Kelepouris; Ellie (Merion, PA), Morad; Martin (Philadelphia, PA) Assignee(s): The Trustees of the University of Pennsylvania (philadelphia, Pa) Patent Number: 5,100,647 Date filed: October 2, 1990 Abstract: Methods for the therapy of cystic fibrosis, Bartter's syndrome, and secretory diarrheas, and for diuretic treatment, by administering to a patient dodecahydro-7,14methano-2H,6H-di-pyrido[1,2-a:1',2'-e][1,5]diazocine or a pharmaceutically acceptable derivative thereof are disclosed. The formulations include an aerosol formulation comprising the active ingredient in association with an aerosol propellant. Excerpt(s): The present invention relates to methods and formulations for the therapy of cystic fibrosis, Bartter's syndrome and secretory diarrheas such as cholera, and for diuretic treatment. Cystic fibrosis: This is a congenital disease for which an accurate diagnosis has long been available. Historically, a midwife would lick the forehead of a newborn. If the sweat tasted abnormally salty, the infant was destined to die of pulmonary congestion and its side effects. Today, cystic fibrosis remains the most common lethal congenital disease among caucasians where it has a prevalence of about of about 1 in 2,000 live births. Cystic fibrosis is a disease of secretory epithelia, tissues that mediate the transport of water, salt, and other solutes between the blood and the outside world. Epithelial cells exhibit anatomical and functional polarity. The basolateral membrane, which faces the blood, and the apical membrane, which faces the lumen (the outside world) mediate different transport events. Together they give rise to net chloride transport across the epithelium from blood to lumen. Web site: http://www.delphion.com/details?pn=US05100647__
•
Method for determining the diuretic potency of candidate drugs as inhibitors of the antidiuretic hormone-elicited water channel Inventor(s): Harris; H. William (Dover, MA), Zeidel; Mark L. (Wellesley, MA) Assignee(s): Childrens Medical Center Corporation (boston, Ma) Patent Number: 5,106,610 Date filed: December 29, 1989 Abstract: A method for determining the diuretic potency of candidate drugs as inhibitors of ADH-elicited water channels is disclosed. In a preferred embodiment, such diuretic potency of candidate drugs is determined by suspending vesicles containing ADH water channels in an aqueous suspending medium, incorporating the candidate into the suspension, rapidly changing the pH of the suspending medium and thereafter detecting the proton permeability of the water channels. The proton permeability in the presence of the candidate drug can then be compared to the proton permeability of water channels under similar conditions without the presence of the candidate drug to determine the diuretic potency of the candidate drug to inhibit ADH-elicited water channels. Excerpt(s): Aqueous fluids account for approximately half oa normal adult's body weight. These fluids contain osmotically active solutes. The proper concentrations of
86
Diuretics
solutes within bodily fluids are maintained within narrow limits despite large variations of both solute and water intake by changes in the volume of water excreted per day. Thus, proper renal processing of aqueous fluids, including modulation of water excretion, is critically important to the maintenance of good health. Renal processing of the body's solutes and water content first involves filtering of blood at lomeruli to separate retained blood cells and proteins from filtered solutes and water. The majority of the filtered solutes and water are returned to the body's circulation via selective absorption by renal tubules. In the proximal portion of renal tubules, water reabsorption occurs as a result of active reabsorption f solutes. In contrast, in distal portions of the tubules, solute and water reabsorption occur by separate processes. When an excess of body water is present, there is reabsorption of body solutes and excess water flows through the distal nephron to the bladder as dilute urine. In periods of dehydration, water is osmotically reabsorbed such that a concentrated hypertnic urine is formed. Osmotic reabsorption of water in the distal nephron segment, called the collecting duct, is modulated by antidiuretic hormone (ADH). Changes in collecting duct water permeability are accomplished through control of the water permeability of the apical membranes of epithelial cells that line this segment. ADH causes the insertion of water channels into epithelial cell apical membranes. These water channels were originally contained in vesicles within the cytoplasm of these epithelial cells. ADH causes water channel insertion by fusion of the water channel-containing vesicles with the apical membrane. Removal of the ADH stimuli causes removal of water channels from the apical membrane by retrieval of the water channel-containing membrane into the epithelial cell cytoplasm. A variety of diseases are associated with retention of excess body water. These include, for example, liver failure, heart disease and syndrome of inappropriate ADH secretion (SIADH). These diseases are difficult to manage therapeutically because of the kidney's dissociation of solute and water reabsorption, as discussed above. Web site: http://www.delphion.com/details?pn=US05106610__ •
Method of ameliorating cellulite by disrupting the barrier function of the stratum corneum Inventor(s): Smith; Walter P. (New Canaan, CT) Assignee(s): Mary Kay Inc. (dallas, Tx) Patent Number: 5,587,396 Date filed: August 26, 1994 Abstract: New topically applied treatments for cellulite are shown by comparative data to effect structural improvements in cellulite-afflicted thigh area tissues including skinthickening, thigh-firming and thigh-reduction. The disclosed treatments disrupt the skin's water barrier and elevate trans-epidermal water loss (TEWL) for extended periods of weeks or months and include methods of mechanical or solvent action, for example, tape stripping, or acetone washes. Preferred treatments use creams with active ingredients such as lactic acid to elevate TEWL, a retinoid, preferably vitamin A palmitate to disrupt barrier rebuilding and prolong elevation of TEWL levels, and a cerebroside to inhibit lipid synthesis and intensify the TEWL elevation. Diuretics, for immediate esthetic improvements, anti-irritants and anti-oxidants for irritation control are optional ingredients. Excerpt(s): The present invention relates to topically applied cellulite treatments, being compositions and methods which produce structural improvements in cellulite
Patents 87
conditions when used on a long-term basis, for example, when applied daily for several months. The term "cellulite" refers to abnormal accumulations of fatty cells in masses beneath the skin which produce unsightly topical and visual discontinuities of the skin surface. Cellulite, a term coined by Nicole Ronsard in the 1970's (see Webster's New Universal Unabridged Dictionary, 2nd ed. Dorset & Baber 1983) describes a widespread condition in which abnormal subcutaneous deposits of irregular fatty masses produce unsightly disturbances in the skin's normally smooth curvatures. Physiologically, cellulite is caused by a degeneration of the micro circulation in areas of the body prone to fatty deposits. Severe cellulite is characterized by degeneration of subcutaneous blood vessels, poor blood flow, a thinning of the epidermal and dermal layers of the skin, the presence of hard lumps of fatty material surrounded by protein in the subcutaneous regions, and an accumulation and pooling of body fluids. The result in the skin taking on an "orange peel" appearance. Web site: http://www.delphion.com/details?pn=US05587396__ •
Method of diuretic treatment with 3,7-diazabicyclo[3,3,1]nonane compounds Inventor(s): Burow; Kurt (Hanover, DE), Buschmann; Gerd (Hanover, DE), Farjam; Arman (Wienhausen, DE), Kuehl; Ulrich (Gehrden, DE), Schoen; Uwe (Burgdorf, DE), Varchmin; Gerda (Hanover, DE), Ziegler; Deiter (Ronnenberg, DE) Assignee(s): Kali-chemie Pharma Gmbh (hanover, De) Patent Number: 5,164,401 Date filed: June 17, 1991 Abstract: A method of treating a mammal in need of diruetic treatment by administering an effective diuretic amount of a diuretically active 3,7,9,9-tetrasubstituted 3,7diazabicyclo[3,3,1]nonane compound, diuretic pharmaceutical compositions containing an effective diuretic amount of a diuretically active 3,7,9,9-tetrasubstituted 3,7diazabicyclo[3,3,1]nonane compound; and previously unknown diuretically active 3,7,9,9-tetrasubstituted 3,7-diazabicyclo[3,3,1]nonane compounds containing an optionally substituted phenylalkyl group in the 3-position. Excerpt(s): The present invention relates to the use of 3,7,9, 9-tetrasubstituted 3,7diazabicyclo[3,3,1]nonane compounds as diuretically active pharmacologically active substances, to diuretically active medicaments which contain 3,7,9,9-tetrasubstituted 3,7diazabicyclo-[3, 3,1]nonane compounds as active substances, and also to novel 3,7,9,9tetrasubstituted 3,7-diazabicyclo-[3,3, 1]nonane compounds with valuable pharmacological properties, in particular diuretic effects. 3,7-diazabicyclo[3,3,1]nonane compounds which are 3,7,9,9-tetrasubstituted by aliphatic groups and have properties affecting the heart, in particular anti-arrhythmic properties, are known from EP-A-O 103 833. EP-A-O 306 871 describes 3,7,9,9-tetrasubstituted 3,7-diazabicyclo[3, 3,1]nonane compounds which have in the 3-position an optionally substituted benzhydryl or cinnamyl group and have properties affecting the heart, in particular bradycardic and calcium-antagonistic properties, and have a beneficial effect on the cardiac rhythm. In EP-A-O 301 245, 3,7,9,9-tetrasubstituted 3,7-diazabicyclo[3,3,1]nonane compounds are described which have a benzyl group in the 3-position and serve as intermediate products for the production of 3,7,9, 9-tetrasubstituted 3,7-diazabicyclo[3,3,1]nonane compounds having a substituted sulfonyl group in the 3-position which have pharmacological effects affecting stomach motility. It is the object of the invention to provide a new method of treating humans and other mammals in need of diuretic treatment.
88
Diuretics
Web site: http://www.delphion.com/details?pn=US05164401__ •
Method of modifying angiotensin receptor activity for mediation of pain Inventor(s): dePadova; Anthony S. (49 Dexter Dr. North, Basking Ridge, NJ 07920) Assignee(s): None Reported Patent Number: 5,753,651 Date filed: October 25, 1996 Abstract: The present invention relates to a method of modifying Angiotensin II subtype 1 (AT.sub.1) receptor activity for the treatment of premenstrual syndrome (PMS) and the symptoms associated therewith, and further relates to a method for the treatment of acute or chronic pain mediated by the sympathetic nervous system. The treatment includes the administration of an effective amount of an AT.sub.1 antagonist. AT.sub.1 antagonists are drugs that are capable of blocking AT.sub.1 receptors present within the body throughout the central nervous system including the hypothalamus. By blocking the AT.sub.1 receptor activity, hypothalamic nerve activity, and therefore, sympathetic nerve activity are modulated. Thus, an effective method for treating sympathetically mediated pain is provided, as well as an effective method for treating PMS. The AT.sub.1 antagonist can be used alone or in combination with other drug therapies, for instance, non-steroidal anti-inflammatory drugs, antidepressants, opiod drugs, angiotensin converting enzyme inhibitors, and diuretics. Excerpt(s): The present invention relates to a method of modifying Angiotensin II subtype 1 (AT.sub.1) receptor activity for the treatment of premenstrual syndrome (PMS) and for the mediation and alleviation of pain. More specifically, the present invention relates to the use of AT.sub.1 antagonists to modulate sympathetic nerve activity as treatment for pain and as treatment for PMS. The nervous system of the human body carries information in the form of nerve impulses to and from all parts of the body in order to regulate body activity. The nervous system consists of the central nervous system (CNS), including the brain and the spinal cord, which is responsible for integrating all activities of the nervous system; and the peripheral nervous system, including the cranial nerves and the spinal nerves, which link the receptors and the effector organs with the brain and spinal cord. The autonomic nervous system controls many bodily functions that are not consciously directed. The autonomic nervous system is subdivided into the sympathetic and the parasympathetic nervous systems, which individually control and coordinate various functions of body organs. It is well known that the hypothalamus is an area of the brain which integrates hormonal and autonomic activity within the body, and coordinates physiological, behavioral and mood responses. The hypothalamus is the major central controller of the autonomic nervous system. Nearly every region of the brain sends signals to the hypothalamus. Pathways of nerve fibers descend from the brain and connect through synapses with areas on the brain stem, and then descend to the spinal cord where they synapse with neurons in the lateral columns of white matter which represent collections of nerve cells. There is an intimate interconnection between the nerve pathways involved in pain transmission and the sympathetic nervous system. (Basic Neurochemistry, Raven Press, 1994). Web site: http://www.delphion.com/details?pn=US05753651__
Patents 89
•
Nitrosated and nitrosylated cyclooxygenase-2 inhibitors, compositions and methods of use Inventor(s): Bandarage; Upul K. (Newton, MA), Fang; Xinqin (Lexington, MA), Garvey; David S. (Dover, MA), Letts; L. Gordon (Dover, MA), Schroeder; Joseph D. (Dedham, MA), Tam; Sang William (Dover, MA) Assignee(s): Nitromed, Inc. (bedford, Ma) Patent Number: 6,649,629 Date filed: December 22, 2000 Excerpt(s): The present invention describes novel nitrosated and/or nitrosylated cyclooxygenase 2 (COX-2) inhibitors and novel compositions comprising at least one nitrosated and/or nitrosylated cyclooxygenase 2 (COX-2) inhibitor, and, optionally, at least one compound that donates, transfers or releases nitric oxide, stimulates endogenous synthesis of nitric oxide, elevates endogenous levels of endotheliumderived relaxing factor or is a substrate for nitric oxide synthase, and/or at least one therapeutic agent. The present invention also provides novel compositions comprising at least one COX-2 inhibitor. The present invention also provides methods for treating inflammation, pain and fever; for treating and/or improving the gastrointestinal properties of COX-2 inhibitors; for facilitating wound healing; for treating and/or preventing renal toxicity; and for treating and/or preventing other disorders resulting from elevated levels of cyclooxygenase-2. Nonsteroidal anti-inflammatory compounds (NSAIDs) are widely used for the treatment of pain, inflammation, and acute and chronic inflammatory disorders such as osteoarthritis and rheumatoid arthritis. These compounds inhibit the activity of the enzyme cyclooxygenase (COX), also known as prostaglandin G/H synthase, which is the enzyme that converts arachidonic acid into prostanoids. The NSAIDs also inhibit the production of other prostaglandins, especially prostaglandin G.sub.2, prostaglandin H.sub.2 and prostaglandin E.sub.2, thereby reducing the prostaglandin-induced pain and swelling associated with the inflammation process. The chronic use of NSAIDs has been associated with adverse effects, such as gastrointestinal ulceration and renal toxicity. The undesirable side effects are also due to the inhibition of prostaglandin in the affected organ. Recently two isoforms of cyclooxygenase, encoded by two distinct genes (Kujubu et al, J. Biol. Chem., 266, 1286612872 (1991)), have been identified--a constitutive form, cyclooxygenase-1 (COX-1), and an inductive form, cyclooxygenase-2 (COX-2). It is thought that the antiinflammatory effects of NSAIDs are mediated by the inhibition of COX-2, whereas the side effects seem to be caused by the inhibition of COX-1. The NSAIDs currently on the market either inhibit both isoforms of COX with little selectivity for either isoform or are COX-1 selective. Recently compounds that are selective COX-2 inhibitors have been developed and marketed. These selective COX-2 inhibitors have the desired therapeutic profile of an antiinflammatory drug without the adverse effects commonly associated with the inhibition of COX-1. However, these compounds can result in dyspepsia and can cause gastropathy (Mohammed et al, N. Engl. J. Med., 340(25) 2005 (1999)). Web site: http://www.delphion.com/details?pn=US06649629__
90
•
Diuretics
Potentiation of the anti-reactive-antiasthmatic effect of inhaled loop diuretics by inhaled non-steroidal anti-inflammatory drugs Inventor(s): Bianco; Sebastiano (Milan, IT) Assignee(s): Hoechst Aktiengesellschaft (frankfurt AM Main, De) Patent Number: 5,366,967 Date filed: May 21, 1993 Abstract: The antireactive-antiasthmatic effect of inhaled loop diuretics is potentiated by the use of a combination of a loop diuretic and a non-steroidal anti-inflammatory drug as an inhalant for combating asthma. The use of a cyclooxygenase inhibitor as the nonsteroidal anti-inflammatory drug is preferred, particularly preferred is the use of furosemide as the loop diuretic. Especially advantageous is the use of piretanide as the loop diuretic. Particularly preferred is the use of acetylsalicylic acid as the non-steroidal anti-inflammatory drug.The most remarkable finding of this invention is the excellent and steady protective effect afforded by the combination of the two drugs in the patients with late asthmatic reactions between the seventh and eighth hour, when the effect of treatment with either drug alone appeared to be progressively decreasing. Excerpt(s): The invention relates to the potentiation of the antireactive-antiasthmatic effect of inhaled loop diuretics by inhaled non-steroidal anti-inflammatory drugs. Despite the fact that more refined drugs are available and that asthma care is better overall, nevertheless the mortality and morbidity of asthma appear to be increasing. In the 1970's great attention was paid to bronchospasm--contraction of bronchial smooth muscle--and its undoubted role in airflow limitation. Selective beta2-agonists came to the forefront of therapy, and the therapeutic benefits were derived. In the 1980's when a knowledge of basic mechanisms in asthma had improved significantly, the role of airways inflammation was introduced and emphasized. Until then, even in symptomatic asthmatics, widespread background inflammatory changes were present which were poorly controlled, if at all, by beta2-agonist drugs. This knowledge served to put the spotlight on anti-inflammatory drugs such as corticosteroids and more recently on some non-steroidal anti-inflammatory drugs (NSAIDs) like cromoglycate and nedocromil sodium. Corticosteroids, however, are not specific and are known to be responsible for hypopituitary-adrenal (HPA) axis suppression at higher doses. Furthermore, their effect on exercise-induced asthma is indirect and unhelpful at times. Thus, non-steroidal antiinflammatory drugs for treatment of asthma have obtained increasing importance. Web site: http://www.delphion.com/details?pn=US05366967__
•
Therapeutic use of D-methionine to reduce the toxicity of ototoxic drugs, noise, and radiation Inventor(s): Campbell; Kathleen C. M. (Glenarm, IL) Assignee(s): Southern Illinois University School of Medicine (springfield, Il) Patent Number: 6,265,386 Date filed: April 8, 1998 Abstract: Methods of preventing or reducing hearing or balance loss, damage to ear cells, weight loss, gastrointestinal toxicity, neurotoxicity, alopecia, and prolonging survival in patients undergoing treatment with therapeutically effective amounts of platinum-containing chemotherapeutic agents such as cisplatin are provided. Methods
Patents 91
are also provided for preventing or reducing such symptoms in patients undergoing treatment with loop diuretics, aminoglycoside antibiotics, iron chelating agents, quinine, and quinidine, or those who have been exposed to toxic levels of noise or radiation. These methods comprise administering an effective amount of a methionine protective agent, such as D-methionine, prior to, simultaneously with, or subsequently to administration of the platinum-containing chemotherapeutic agent, loop diuretic agent, etc., or exposure to noise or radiation. Combinations of these time periods can also be employed. Excerpt(s): The present invention relates to the use of protective agents in cancer chemotherapy in human and animal subjects. Protective agents are compounds that prevent, reduce, or otherwise ameliorate the toxic side effects of anti-cancer chemotherapeutic compounds in normal body cells while substantially preserving the anti-tumor properties of these compounds in vivo when administered prior to, concomitantly with, or subsequently to administration of such chemotherapeutic compounds. More specifically, the present invention relates to the use of D-methionine and structurally related compounds as protective agents having otoprotective, weight loss-protective, gastrointestinal-protective, neuro-protective, alopecia-protective, and survival-enhancing effects in conjunction with chemotherapy employing platinumcontaining antineoplastic agents, such as cisplatin. The present invention also relates to the use of D-methionine and structurally related compounds as protective agents having otoprotective effects against noise-induced, loop diuretic-induced, aminoglycoside antibiotic-induced, iron chelator-induced, quinine- and quinidine-induced, and radiation-induced hearing loss, as well as protective effects in ameliorating other radiation-induced side effects such as neural damage, alopecia, gastrointestinal disorders, and reduced patient survival. Cisplatin (cis-diamminedichloroplatinum(II); CDDP) is a widely used antineoplastic agent. Cisplatin administration has increased both in the variety of cancer types for which it is employed and in the amount used in a given individual to achieve maximal therapeutic effect (Blumenreich et al., 1985; Forastiere et al., 1987; Gandara et al., 1989). The toxic side effects of cisplatin have long been recognized and are widely reported (Lippman et al., 1973; also see the review by Hacker, 1991). These toxicities include a variety of peripheral neuropathies, myelosuppression, gastrointestinal toxicity, nephrotoxicity, and ototoxicity (Ozols and Young, 1985; Stewart et al., 1987; Stoter et al., 1989). Initially, the primary dose-limiting factor was nephrotoxicity, but now the routine administration of mannitol, hypertonic saline, and high fluid administration have ameliorated, but not eliminated, that side effect. However, ototoxicity remains uncontrolled (Bajorin et al., 1987; Fillastre and RaguenezViotte, 1989). Although nephrotoxicity can still be dose-limiting, currently the primary dose-limiting factor is ototoxicity (Blumenreich et al., 1985; Forastiere et al., 1987; Berry et al., 1990). Web site: http://www.delphion.com/details?pn=US06265386__ •
Use of inhaled loop diuretics for treating allergen-induced nasal reactions Inventor(s): Bianco; Sebastiano (Milan, IT) Assignee(s): Hoechst Aktiengesellschaft (frankfurt AM Main, De) Patent Number: 5,392,767 Date filed: November 7, 1991
92
Diuretics
Abstract: Loop diuretics, particularly their well known representative furosemide, are effective drugs for the treatment of allergen-induced nasal reactions, if a solution of the loop diuretic is nebulized into the nostrils. Excerpt(s): This invention relates to the use of loop diuretics for treating allergeninduced nasal reactions and to a method which comprises nebulizing a solution of loop diuretic into the nostrils for treating allergen induced nasal reactions. Furosemide also turned out to be an agent for preventing or treating asthma (see The Lancet, Jul. 30, 1988, p. 252). But there was no suggestion in any one of these citations to use loop diuretics in combating allergic reactions of the nasal mucosa. Loop diuretics are for instance bumetanid, ethacrynic acid, etolozine or piretanide, torasemide, indacrinon, azosemide, besides furosemide. Web site: http://www.delphion.com/details?pn=US05392767__ •
Vasonatrin peptide and analogs thereof Inventor(s): Burnett; John C. (Rochester, MN), Wei; Chi-Ming (Rochester, MN) Assignee(s): Mayo Foundation for Medical Education and Research (rochester, Mn) Patent Number: 5,583,108 Date filed: August 29, 1994 Abstract: Synthetic analogs of C-type natriuretic peptide are provided, together with methods for their production and use as natriuretics, diuretics, and/or vasodilators, or as intermediates for or modulators of such useful compounds or of native natriuretic peptides. Excerpt(s): Among species, the amino acid sequence of both ANP and CNP are highly conserved, whereas the structure of BNP varies greatly. For example, the mature 28amino-acid human and porcine ANPs are identical, and there is only one substitution in the rat peptide. This existence of this structural variation, coupled with the presence of at least three types of receptors specific for the natriuretic peptides, suggests that the physiological control of body fluid homeostasis is complex. ANP and CNP both decrease cardiac preload. However, unlike ANP, CNP is not natriuretic. See, A. J. Stingo et al., Am. J. Physiol., 262, H308 (1992). The diverse actions of ANP, BNP and CNP on both the cardiovascular system and the kidney as well as their roles in pathophysiological states such as heart failure, hypertension, and renal disease have made the native peptides and their analog molecules of great interest to both clinical and basic scientists. See, for example, J. A. Lewicki et al. (U.S. Pat. Nos. 5,114,923, 4,804,650 and U.S. Pat. No. 4,757,048), L. K. Johnson et al. (U.S. Pat. No. 5,047,397) and L. K. Johnson et al. (U.S. Pat. No. 4,935,492). Therefore, a continuing need exists to identify and characterize bioactive peptides belonging, or related to, this class of materials. Such peptides may be useful both to elucidate the mechanism of action of these compounds, as well as to provide new pharmaceutical agents with useful profiles of bioactivity. wherein A.sub.1 is Lys, Arg, Orn, Ala, Thr, Asn or Gln; A.sub.2 is Ile, Met, Val or Leu; A.sub.3 is Glu or Asp; A.sub.4 is Lys, Arg, Orn, Ala, Thr, Asn or Gln; A.sub.5 is Val, Leu or Ileu; X.sub.1 is a peptide of from 1-125 amino acid residues, preferably 1-5 amino acid residues comprising Gly at the carboxyl terminus, and preferably Gly at the N-terminus, with the remainder being individually selected from the group consisting of Leu, Ser and Lys. Most preferably, X.sub.1 is (H)-Gly-Leu-Ser-Lys-Gly (SEQ ID NO; 5), or an Nterminal deleted form such as (H)Leu-Ser-Lys-Gly (SEQ ID NO: 5), (H)Ser-Lys-Gly, (H)Lys-Gly or (H)Gly; A.sub.y and A.sub.z are amino acid residues which together form
Patents 93
a bridging bond, wherein said bond is selected from the group consisting of disulfide, methylene, sulfide/methylene, amide and ester; preferably, disulfide; X.sub.2 is a peptide of 1-10 amino acid residues, preferably of about 1-3 residues, individually selected from the group consisting of Phe, Trp, Val, Leu, Ile, Gly, Ser and Cys; X.sub.3 is a peptide of 1-10 amino acid residues, preferably about 1-7 residues and X.sub.y is a peptide of about 1-5 residues selected from the group consisting of R-Asn-, R-Ser-Asn, R-Phe-Ser-Asn, R-Arg-Phe-Ser-Asn-(SEQ ID NO: 7) and R-Tyr-Arg-Phe-Ser-Asn-(SEQ ID NO: 8) wherein R is OH, NH.sub.2, NHR.sup.3 or NR.sup.3 R.sup.4, wherein R.sup.3 and R.sup.4 are independently (C.sub.1 -C.sub.4)alkyl, (C.sub.3 -C.sub.5)cycloalkyl, phenyl or benzyl. Preferably, X.sub.3 is a heptapeptide comprising peptidyl residues individually selected from the group consisting of Gly, Ser, Met and Leu. Preferably, when A.sub.2 is Ile, A.sub.1 is not Arg, and when A.sub.2 is Arg, A.sub.2 is not Ile. Preferably, the total ring size is equivalent to that obtained by disulfide bridge formation between cysteine residues separated by 7-15 amino acid (peptidyl) residues. Optionally, one or more of the amide linkages between adjacent amino acid residues can be replaced by a linkage such as --CH.sub.2 --NH--, --CH.sub.2 --S--, --CH.sub.2 CH.sub.2 --, -CH=CH--, --COCH.sub.2 --, --CH(OH)CH.sub.2 -- or --CH.sub.2 SO--. X.sub.1 can also be an amino acid protecting group such as fluorenylmethyloxycarbonyl, benzyloxycarbonyl, (2-(2',6'-methoxynaphthyl)propionyl, diphenylpropionyl, cyclohexylacetyl, 3-indolepropionyl, 2-naphthoxy and the like. Other such groups are disclosed in U.S. Pat. No. 4,935,492. Web site: http://www.delphion.com/details?pn=US05583108__ •
Xanthine derivatives as diuretic agents Inventor(s): Adamus; Stefan (Ingelheim, DE), Gaida; Wolfram (Ingelheim, DE), K ufnerMuhl; Ulrike (Ingelheim, DE), Meade; Christopher (Bingen-B udesheim, DE) Assignee(s): Boehringer Ingelheim KG (ingelheim AM Rhein, De) Patent Number: 5,599,817 Date filed: July 6, 1995 Abstract: A method for stimulating diuresis comprising administering a composition comprising 8-(3-oxocyclopentyl)-1,3-di-n-propyl-7H-purine-2,6-dione and, optionally, a loop diuretic, is disclosed. Excerpt(s): This application is a '371 of PCT/EP93/03158 filed Oct. 11, 1993. The present invention relates to the use of 8-(3-oxocyclopentyl)-1,3-dipropyl-7H-purine-2,6-dione and xanthines of similar structure as diuretics. Diuretics play an important part in the treatment of oedema, hypertension and other illnesses. The diuretic effect of xanthines is known in principle, but the compounds investigated hitherto have a relatively weak activity (see Beutler J. J., Koomans H. A., Bijlsma J. A. Dorhout-Mees E. J., J. Pharmacol. exp. Ther. (1990) 255, 1314). Web site: http://www.delphion.com/details?pn=US05599817__
94
Diuretics
Patent Applications on Diuretics As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to diuretics: •
CHIMERIC NATRIURETIC PEPTIDES Inventor(s): BURNETT, JR., JOHN C.; (ROCHESTER, MN), LISY, ONDREJ; (ROCHESTER, MN) Correspondence: Schwegman, Lundberg, Woessner & Kluth, P.A.; P.O. Box 2938; Minneapolis; MN; 55402; US Patent Application Number: 20020082219 Date filed: December 17, 1999 Abstract: Peptides of Dendroaspis, including chimeric peptides thereof, are provided, as well as methods of using the peptides as natriuretics, diuretics, and/or vasodilators. Excerpt(s): Atrial natriuretic peptide (ANP) is the first described peptide in a family of hormones which regulate body fluid homeostasis (see Brenner et al., 1990). The description of the potent diuretic and natriuretic properties of atrial extracts by de Bold et al. (1981) was the first evidence that the heart could be an endocrine organ. The subsequent isolation and characterization of this activity by groups including Flynn et al. (1981) characterized ANP as the first secreted cardiac hormone. ANP is secreted by atrial myocytes in response to increased intravascular volume. Once it is in the circulation, its effects are primarily on the kidney, vascular tissue, and adrenal gland, in which its actions lead to the excretion of sodium and water by the kidneys and a decrease in intravascular volume and blood pressure (Atlas et al., 1987). Matsuo and his coworkers isolated two other natriuretic peptides. Brain natriuretic peptide (BNP) and C-type natriuretic peptide (CNP) were both isolated from porcine brain extracts on the basis of their potent relaxant effects on chick rectum (Sudeh et al., 1988; Sudeh et al., 1990). BNP is of myocardial cell origin, and like ANP circulates in human plasma (de Bold et al., 1981; Burnett et al., 1984). BNP is natriuretic, renin inhibiting, vasodilating, and lusitropic (Mukoyama et al., 1991; Yamamoto et al. 1996; Grantham et al., 1996). CNP is of endothelial cell origin and functions as a vasodilating and growth-inhibiting peptide (Suga et al., 1992; Stingo et al., 1992; Koller et al., 1991). ANP and BNP are increased in the plasma and heart during congestive heart failure (CHF) in humans, and they exert important cardiorenal protective actions in addition to serving as serum markers for ventricular dysfunction (Stevens et al., 1995; Yamamoto et al., 1997; McDonagh et al., 1998). ANP, BNP and CNP are synthesized from large precursor proteins, and the mature, active peptides have a 17 amino acid loop formed by an intramolecular disulfide linkage. In the human peptides, eleven of these amino acids are identical in ANP, BNP, and CNP, whereas the - and C-terminal tails vary in both length and composition (see Kambayashi et al., 1990; and Tawaragi et al., 1991). CNP has no Cterminal tail, and studies of the structure of the gene for CNP demonstrated that translation is terminated by a stop codon immediately after the final cysteine codon in the mRNA. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
10
This has been a common practice outside the United States prior to December 2000.
Patents 95
•
Combination therapy of angiotensin converting enzyme inhibitor, side-effect reduced amount of aldosterone antagonist and diuretic for treatment of cardiovascular disease Inventor(s): Perez, Alfonso T.; (Lake Forest, IL) Correspondence: Joseph R. Schuh; Pharmacia Corporation; Corporate Patent Department; P.O. Box 5110; Chicago; IL; 60680; US Patent Application Number: 20030144213 Date filed: October 8, 2002 Abstract: Combinations of an ACE inhibitor, an aldosterone receptor antagonist and a diuretic are described for use in treatment of circulatory disorders. Of particular interest are therapies using captopril or enalapril co-administered with a low-dose of spironolactone and furosemide. This co-therapy would be particularly useful to treat congestive heart failure while avoiding or reducing aldosterone-antagonist-induced side effects such as hyperkalemia. Excerpt(s): Combinations of an angiotensin converting enzyme inhibitor, an aldosterone receptor antagonist and a diuretic are described for use in treatment of circulatory disorders, including cardiovascular diseases such as heart failure, hypertension and congestive heart failure. Of particular interest are therapies using spirolactone-type aldosterone receptor antagonist compound in combination with an angiotensin converting enzyme inhibitor with a diuretic, using a side-effect-reduced amount of the aldosterone receptor antagonist. Myocardial (or cardiac) failure, whether a consequence or previous myocardial infarction(s), heart disease associated with hypertension, or primary cardiomyopathy, is a major health problem of worldwide proportions. The incidence of symptomatic heart failure has risen steadily over the past several decades. In clinical terms, decompensated cardiac failure consists of a constellation of signs and symptoms that arise from congested organs and hypoperfused tissues to form the congestive heart failure (CHF) syndrome. Congestion is caused largely by increased venous pressure and by inadequate sodium (Na.sup.+) excretion, relative to dietary Na.sup.+ intake, and is importantly related to circulating levels of aldosterone (ALDO). An abnormal retention of Na.sup.+ occurs via tubular epithelial cells throughout the nephron, including the later portion of the distal tubule and cortical collecting ducts, where ALDO receptor sites are present. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Composition and formulations and their use as nociceptic, anti-axniolytic and anabolic agents Inventor(s): Nyce, Jonathan W.; (Princeton, NJ) Correspondence: Albert P. Halluin; Howrey Simon Arnold & White, Llp; Box 34; Menio Park; CA; 94025; US Patent Application Number: 20030202935 Date filed: May 9, 2000 Abstract: Composition and formulations comprising a first agent such as folinic acid, pharmaceutically acceptable salts thereof or mixtures thereof, and a second agent(s) such as analgesics, muscle relaxants, mood disorder agents, anti-inflammatories, antimigraine agents, anti-emetics, diuretics, high protein composites, and the like. The products are suitable as nociceptics and for the treatment of wasting disorders, bulimia,
96
Diuretics
anorexia nervosa, anxiety, irritability and other symptoms associated with Pre Menstrual Syndrome, as well as for administration either in conjunction with steroids or to compensate adenosine depletion and/or bizarre behavior or aggression common in steroid users. Excerpt(s): This invention relates to a composition and formulations comprising folinic acid, pharmaceutically acceptable salts thereof or mixtures thereof, and other agents such as analgesics, anti-inflammatories, muscle relaxants, anti-migraine agents, antiemetics, diuretics, and the like. The products are suitable as nociceptics, for treatment of wasting disorders, anxiety, irritability associated with Pre Menstrual Syndrome and for administration either in conjunction with steroids or to compensate adenosine depletion common in steroid users. Folinic acid is an intermediate product of the metabolism of folic acid, and is believed to be the active form into which folic acid is converted in the body. It is also known that ascorbic acid or Vitamin C is required as a necessary factor in the conversion of folic acid to folinic acid. Folinic acid has been used therapeutically as an antidote to folic acid antagonists such as methotrexate which block the conversion of folic acid into folinic acid. Additionally, folinic acid has been used as an anti-anemic, because of its ability to combat folate deficiency. Folinic acid has heretofore never been used in patients afflicted with adenosine depletion nor in a method to therapeutically elevate adenosine levels in the brain or other organ. Adenosine is a purine involved in intermediary metabolism. Adenosine also participates in the regulation of physiological activity in a variety of mammalian tissues as well as in many local regulatory mechanisms, such as those occurring in synapses in the central nervous system (CNS) and at neuroeffector junctions in the peripheral nervous system. In the CNS, adenosine inhibits the release of a variety of neurotransmitters, such as acetylcholine, noradrenaline, dopamine, serotonin, glutamate and GABA, depresses neurotransmission, induces spinal analgesia possibly by reducing neuronal firing and possesses anxiolytic properties. In the heart, adenosine suppresses pacemaker activity, slows AV conduction, possesses antiarrhythmic and arrhythmogenic effects, modulates autonomic control and triggers the synthesis and release of prostaglandins. In addition, adenosine has potent vasodilatory effects and modulates vascular tone. At present, adenosine is used clinically for the treatment of SupraVentricular Tachycardia (SVT) and other cardiac anomalies, as well as for testing cardiovascular function. Adenosine analogues are also being investigated for use as anticonvulsant, anxiolytic and neuroprotective agents. Adenosine is also protective of tissues subjected to ischemia (oxygen deprivation) and aids reperfusion of these tissues, e. g. brain following stroke or other acute or chronic brain ischemia-producing conditions and diseases, heart following heart attack or other acute or chronic heart ischemia-producing conditions or diseases, and other organs at risk for ischemia associated with diseases and condition processes, acute and chronic physiological events and in transplantable organs during the harvest and transportation stages prior to tranplantation as well as in already transplanted organs, among others. Adenosine analogues also are being investigated for use as anti-convulsant, anxiolytic and neuroprotective agents. Adenosine, in addition, is a natural anti-inflammatory agent which, for example, is known to mediate the antiinflammatory effect of methotrexate. Adenosine also promotes and accelerates wound healing and regulates neutrophil function via activation of a serine/threonine phosphatase. Although adenosine has various therapeutic applications as described above, it has an extremely short half life (about a second). Adenosine's short half life and its propensity to cause angina-like pain make it a poor choice for therapeutic applications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Patents 97
•
Diuretic or sulphonylurea for use in antiviral treatment Inventor(s): Hartley, Christopher Edward; (Halesowen, GB), Pardoe, Ian Stuart; (Moseley Birmingham, GB) Correspondence: Caesar, Rivise, Bernstein,; Cohen & Pokotilow, LTD.; 12th Floor, Seven Penn Center; 1635 Market Street; Philadelphia; PA; 19103-2212; US Patent Application Number: 20040034016 Date filed: March 20, 2003 Abstract: A diuretic, e.g., loop diuretic or thiazide, or a sulphylurea is useful in the treatment of DNA viral infections. Excerpt(s): The invention relates to anti-viral treatments and in particular to prophylactic and therapeutic treatments of DNA viral infections such as Herpes virus infections. Herpes viruses are DNA viruses, having a central core of DNA within a proteinaceous structure. DNA carries the genetic code to reproduce the virus. Viruses must infect a living cell to reproduce. There are numerous viral proteins that are well characterised including important enzymes which act as ideal targets for antiviral chemotherapy. These include DNA polymerase and thymidine kinase which are needed for DNA replication. The replication of viral DNA is essential for virus infectivity. It is known that infecting viruses can alter the natural ionic balances of a living cell in the course of their replication. We have discovered that certain classes of known drugs can be used for an antiviral effect against DNA viruses. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Diuretics containing y-tocotrienol Inventor(s): Igarashi, Osamu; (Tokyo, JP), Kiyose, Chikako; (Saitama, JP), Yoshimura, Hiroyuki; (Ibaraki, JP), Yoshitake, Shigehiro; (Nara, JP) Correspondence: Flynn Thiel Boutell & Tanis; 2026 Rambling Road; Kalamazoo; MI; 49008-1699; US Patent Application Number: 20030139467 Date filed: September 24, 2002 Abstract: The present invention provides a diuretic, sodium ion-excreting agent, medicament for preventing or treating hypertension, medicament for preventing or treating ischemic cardiac diseases, medicament for preventing or treating congestive cardiac insufficiency or medicament for preventing or treating renal diseases, which comprises.gamma.-tocotrienol. Excerpt(s): The present invention relates to a therapeutic agent, in particular to a diuretic, sodium ion-excreting agent etc., which comprises.gamma.-tocotrienol.gamma.Tocotrienol is known to have a cholesterol-reducing action, a carotid artery stricturepreventing action, a breast cancer-preventing action, and an immune functionimproving action (JP-A 11-49767). On the other hand,.gamma.-CEHC (2,7,8-trimethyl(S)-2-(.beta.-carboxyethyl)-6-h- ydroxychroman, also called LLU-.alpha.), which is a metabolite of.gamma.-tocopherol, is known to have a sodium diuresis action (JP-A 10506383). As the actions of.gamma.-tocotrienol administered, the above-described cholesterol-reducing action, immune function-improving action etc. are known, and the present inventors studied a metabolite of.gamma.-tocotrienol, and found that.gamma.tocotrienol has new actions described below, to complete the present invention.
98
Diuretics
Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Formulation of an erodible, gastric retentive oral diuretic Inventor(s): Berner, Bret; (El Granada, CA), Louie-Helm, Jenny; (Union City, CA), Urquhart, John; (Palo Alto, CA) Correspondence: Reed & Eberle Llp; 800 Menlo Avenue, Suite 210; Menlo Park; CA; 94025; US Patent Application Number: 20030152622 Date filed: November 12, 2002 Abstract: An erodible, gastric-retentive oral diuretic is provided that is formulated using the in vitro drug release profile obtained with USP Disintegration test equipment rather the USP Dissolution Apparatus. The invention is premised on the discovery that the USP Disintegration Test and modified versions thereof are far more predictive of the in vivo release profile for a controlled release dosage form than is the standard USP Dissolution Test, particularly controlled release dosage forms of the swellable, erodible type. The dosage forms generally comprise particles of a biocompatible, hydrophilic polymer having the active agent incorporated therein, wherein the particles are optionally but preferably compacted into a tablet or loaded into a capsule. The dosage forms can be used to deliver water-insoluble or sparingly soluble drugs as well as watersoluble drugs, providing that the latter are coated with a protective coating or contained in a protective vesicle. Using the controlled release dosage form, adverse side effects associated with peak diuresis are diminished or eliminated, while the overall diuretic effect of the drug is maintained. Excerpt(s): This is a continuation-in-part of U.S. Ser. No. ______, filed on Oct. 25, 2002, which is a continuation-in-part of U.S. Ser. No. 10/014,750, filed Oct. 25, 2001,. The disclosures of both applications in their entireties are incorporated by reference herein. The present invention relates generally to the field of drug delivery. More particularly, the invention relates to controlled release oral dosage forms of diuretics formulated using in vitro data obtained using a disintegration test such as the established USP Disintegration Test, rather than the results obtained using a standard USP Dissolution Test, as is conventionally done. Diuretics, such as furosemide and the like, are used to treat hypertension, as well as edema associated with conditions such as congestive heart failure, cirrhosis of the liver, or renal failure. Furosemide acts by decreasing reabsorption of sodium in the distal and proximal tubes of the kidney as well as the loop of Henle. With respect to furosemide as one example of a diuretic, within two hours of oral administration of the drug, diuresis will peak and will continue for up to six to eight hours. The potent diuretic effect of drugs such as furosemide and the like can lead to side effects such as weakness, fatigue, light-headedness or dizziness, muscle cramps, thirst, and urinary frequency. Physician's Desk Reference 2284-2285 (Medical Economics Co., Montvale, N.J. 56th ed. 2002); A Gennaro, Remington: The Science and Practice of Pharmacy 1352-1353 (Lippincott, Williams and Wilkins, Baltimore, Md. 20th ed. 2000). Accordingly, there is a need in the art to deliver diuretics such as furosemide in such a way that the antihypertensive effects of the drug are maintained while the adverse side effects associated with peak diuresis are diminished or eliminated. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Patents 99
•
Gastrin and cholecystokinin receptor ligands(II) Inventor(s): Buck, Ildiko Maria; (London, GB), Kalindjian, Sarkis Barret; (London, GB), Low, Caroline Minli Rachel; (London, GB), Pether, Michael John; (London, GB), Steel, Katherine Isobel Mary; (London, GB), Tozer, Matthew John; (London, GB), Wright, Paul Trevor; (London, GB) Correspondence: Heller Ehrman White & Mcauliffe Llp; 1666 K Street,nw; Suite 300; Washington; DC; 20006; US Patent Application Number: 20030199565 Date filed: April 7, 2003 Abstract: Substituted imidazoles (1) are useful as angiotensin II blockers. These compounds have activity in treating hypertension and congestive heart failure. Pharmaceutical compositions containing the novel imidazoles and pharmaceutical methods using them, alone and in conjunction with other drugs, especially diuretics and non-steroidal antiinflammatory drugs (NSAID's) are also described. Excerpt(s): This invention relates to gastrin and cholecystokinin (CCK) receptor ligands. (The receptor previously known as the CCK.sub.B/gastrin receptor is now termed the CCK.sub.2 receptor), The invention also relates to methods for preparing such ligands and to compounds which are useful intermediates in such methods. The invention further relates to pharmaceutical compositions comprising such ligands and methods for preparing such pharmaceutical compositions. Gastrin and the cholecystokinins are structurally related neuropeptides which exist in gastrointestinal tissue and the central nervous system (Mutt V., Gastrointestinal Hormones, Glass G. B. J., ed., Raven Press, New York, p. 169; Nisson G., ibid., p. 127). Gastrin is one of the three primary stimulants of gastric acid secretion. Several forms of gastrin are found including 34-, 17- and 14amino acid species with the minimum active fragment being the C-terminal tetrapeptide TrpMetAspPhe-NH.sub.2) which is reported in the literature to have full pharmacological activity (Tracey H. J. and Gregory R. A., Nature (London), 1964, 204, 935). Much effort has been devoted to the synthesis of analogues of this tetrapeptide (and the N-protected derivative Boc-TrpMetAspPhe-NH.sub.2) in an attempt to elucidate the relationship between structure and activity. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Method and composition for restoring diuretic and renal function Inventor(s): Beckman, Evan; (Sudbury, MA), Smits, Glenn; (Oxford, MA) Correspondence: Louis Myers; Fish & Richardson P.C.; 225 Franklin Street; Boston; MA; 02110-2804; US Patent Application Number: 20020115687 Date filed: May 21, 2001 Abstract: Methods and compositions for restoring diuretic and renal function. Excerpt(s): The present invention relates to methods of treating patients who are refractory to non-adenosine modifying diuretics by administering a combination of a non-adenosine modifying pharmaceutical composition and an adenosine A1 antagonist. The claimed methods are useful in any condition which interferes with the pre-renal signaling in such patient. Adenosine is an extracellular messenger generated by all cells in the body. Adenosine itself, substances that mimic the actions of adenosine, and
100
Diuretics
substances that antagonize its actions have important clinical applications. Adenosine receptors are divided into subtypes designated for example as A1, A2, etc. In most organ systems (e.g. the heart), adenosine is present exclusively during periods of metabolic stress, to mediate adaptive responses to the insult which precipitated its production and release. The kidney also releases excess adenosine in response to ischemic and toxic stimuli. In addition, however, the kidney produces adenosine constitutively to regulate glomerular filtration and electrolyte reabsorption mediated by the adenosine A1receptor system. Adenosine receptors, when activated, can elicit either vasoconstriction (A1) or vasodilation (A2). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method of treatment for decreasing mortality resulting from congestive heat failure Inventor(s): Lukas-Laskey, Mary Ann; (Philadelphia, PA), Ruffolo, Robert JR.; (Spring City, PA), Shusterman, Neil Howard; (Wynnewood, PA), Sponer, Gisbert; (Laudenbach, DE), Strein, Klaus; (Hemsbach, DE) Correspondence: Smithkline Beecham Corporation; Corporate Intellectual Property Uw2220; P.O. Box 1539; King OF Prussia; PA; 19406-0939; US Patent Application Number: 20010044455 Date filed: May 23, 2001 Abstract: A method of treatment using a compound of Formula I: 1wherein:R.sub.1 is hydrogen, lower alkanoyl of up to 6 carbon atoms or aroyl selected from benzoyl and naphthoyl;R.sub.2 is hydrogen, lower alkyl of up to 6 carbon atoms or arylalkyl selected from benzyl, phenylethyl and phenylpropyl;R.sub.3 is hydrogen or lower alkyl of up to 6 carbon atoms;R.sub.4 is hydrogen or lower alkyl of up to 6 carbon atoms, or when X is oxygen, R.sub.4 together with R.sub.5 can represent --CH.sub.2--O--;X is a valency bond, --CH.sub.2, oxygen or sulfur;Ar is selected from phenyl, naphthyl, indanyl and tetrahydronaphthyl;R.sub.5 and R.sub.6 are individually selected from hydrogen, fluorine, chlorine, bromine, hydroxyl, lower alkyl of up to 6 carbon atoms, a -CONH.sub.2-- group, lower alkoxy of up to 6 carbon atoms, benzyloxy, lower alkylthio of up to 6 carbon atoms, lower alkysulphinyl of up to 6 carbon atoms and lower alkylsulphonyl of up to 6 carbon atoms; orR.sub.5 and R.sub.6 together represent methylenedioxy; or a pharmaceutically acceptable salt thereof, alone or in conjunction with one or more other therapeutic agents, said agents being selected from the group consisting of ACE inhibitors, diuretics, and digoxin for decreasing mortality resulting from congestive heart failure (CHF) in mammals, particularly humans. Excerpt(s): The present invention relates to a new method of treatment using compounds which are dual non-selective.beta.-adrenoceptor and.beta.sub.1adrenoceptor antagonists, in particular the carbazolyl-(4)-oxypropanolamine compounds of Formula I, preferably carvedilol, for decreasing the mortality of patients suffering from congestive heart failure (CHF). The invention also relates to a method of treatment using compounds which are dual non-selective.beta.-adrenoceptor and.alpha.sub.1-adrenoceptor antagonists, in particular the carbazolyl-(4)oxypropanolamine compounds of Formula I, preferably carvedilol, in conjunction with one or more other therapeutic agents, said agents being selected from the group consisting of angiotensin converting enzyme (ACE) inhibitors, diuretics, and digoxin, for decreasing the mortality of patients suffering from CHF. Congestive heart failure occurs as a result of impaired pumping capability of the heart and is associated with abnormal retention of water and sodium. Traditionally, treatment of chronic mild failure
Patents 101
has included limitation of physical activity, restriction of salt intake, and the use of a diuretic. If these measures are not sufficient, digoxin, which is an agent that increases the force of mycardial contraction, is typically added to the treatment regiment. Subsequently, angiotensin converting enzyme inhibitors, which are compounds that prevent the conversion of angiotensin I into the pressor-active angiotensin II, are prescribed for chronic treatment of congestive heart failure, in conjunction with a diuretic, digoxin, or both. Congestive heart failure is a condition that is associated with activation of both the renin-angiotensin system (RAS) and the sympathetic nervous system (SNS). Modulation of the RAS by angiotensin converting enzyme inhibitors has been shown to improve the symptoms associated with CHF. Sharpe, D. N., Murphy, J., Coxon, R. & Hannan S. F. (1984) Circulation, 70, 271-278. However, ACE inhibitors appear to have little effect on the enhanced SNS in CHF. Cohn, J. N., Johnson, G. & Ziesche, S., (1991) N. Engl. J. Med., 325, 293-302 and Francis, G. S., Rector, T. S. & Cohn, J. N. (1988) Am. Heart J., 116, 1464-1468. Therefore, there is a need for an agent that would be effective in blocking the activation of the SNS in CHF patients. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Nociceptin-based analgesics Inventor(s): Judd, Amrit K.; (North Logan, UT) Correspondence: Madson & Metcalf; Gateway Tower West; Suite 900; 15 West South Temple; Salt Lake City; UT; 84101 Patent Application Number: 20030166571 Date filed: October 9, 2002 Abstract: The invention relates to a family of hexapeptide compounds exhibiting activity with regard to the ORL-1 receptor. The compounds share a general formula of Arg-TyrTyr-Arg-Trp-Arg, and may be constructed having modifications or substitutions at any position, and may include modifications of the amino- and carboxy-termini of the hexapeptide. These compounds include agents exhibiting agonist activity and antagonist activity when exposed to the human ORL-1 receptor. As such, the hexapeptides may be useful as analgesics, anxiolytics, diuretics, and anti-cancer agents. Excerpt(s): This application is related to and claims the benefit of U.S. Provisional Patent Application No. 60/327,888, filed Oct. 9, 2001, of Amrit K. Judd entitled "Development of Nociceptin-Based Analgesics," which is incorporated herein by reference. The present invention relates to analgesic compounds targeted to the ORL1 receptor. More specifically, the present invention relates to agonist and antagonist compounds targeted to the ORL1 receptor and methods for their use. It has been estimated that as much as 30% of the population of the industrialized countries of the world suffers from some degree of chronic pain. Many individuals suffering from chronic pain are forced to incur significant direct medical and pharmaceutical expenses. Such individuals often also suffer losses in income and productivity. In the United States, it is estimated that the combined value of these losses and costs is in excess of $50 billion annually. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
102
•
Diuretics
Osmotic device containing diltiazem and an ACE inhibitor or diuretic Inventor(s): Faour, Joaquina; (Buenos Aires, AR), Vergez, Juan A.; (Buenos Aires, AR) Correspondence: Innovar, Llc; P O Box 250647; Plano; TX; 75025; US Patent Application Number: 20020006430 Date filed: January 5, 2001 Abstract: The present invention provides an osmotic device containing controlled release diltiazem in the core in combination with a rapid release ACE inhibitor, or diuretic, in an external coat. The delivery device of the invention can also be a chronotherapeutic osmotic device that provides a delayed and controlled release of diltiazem and a delay and rapid release of an ACE inhibitor or diuretic. A wide range of ACE inhibitors or diuretics can be used in this device. Particular embodiments of the invention provide osmotic devices having predetermined release profiles. One specific embodiment of the osmotic device includes an external coat that has been spray coated rather than compression coated onto the device. The device with spray coated external core is smaller and easier to swallow than the similar device having a compression coated external coat. The device is useful for the treatment of blood pressure or hypertension related disorders. Excerpt(s): The present application claims the priority of U.S. provisional application for patent Ser. No. 60/176,174 filed Jan. 13, 2000. This invention pertains to an osmotic device containing diltiazem and an angiotensin converting enzyme (ACE) inhibitor. More particularly, it pertains to an osmotic device tablet which provides a controlled release of diltiazem and a rapid or immediate release of an ACE inhibitor diuretic compound. ACE inhibitors, diuretics and calcium channel blockers are three types of antihypertensive agents used either as monotherapy or in combination to regulate blood pressure in the treatment of hypertension. The efficacy of ACE inhibitors is related to the initial level of plasma angiotensin II (Ang II) or plasma renin activity. However, patients with low plasma renin activity also experience a fall in blood pressure during ACE inhibitor therapy. In contrast to diuretics, diltiazem does not have adverse metabolic effects on electrolytes, carbohydrate metabolism and lipid metabolism. Diltiazem is particularly indicated in patients with hypertension and concurrent angina pectoris, diabetes, hyperlipidemias and chronic renal disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Pharmaceutical composition Inventor(s): Mizuno, Makoto; (Tokyo, JP), Sada, Toshio; (Tokyo, JP) Correspondence: Frishauf, Holtz, Goodman & Chick, PC; 767 Third Avenue; 25th Floor; New York; NY; 10017-2023; US Patent Application Number: 20040002529 Date filed: May 20, 2003 Abstract: A pharmaceutical composition comprises an angiotensin II receptor antagonist selected from among compounds having the following formula (I), a pharmacologically acceptable salt thereof, a pharmacologically acceptable ester thereof and a pharmacologically acceptable salt of such ester, and one or more diuretics: 1The pharmaceutical composition of the present invention has an excellent hypotensive effect
Patents 103
and low toxicity, and therefore is useful as a medicament for preventing or treating hypertension or heart disease. Excerpt(s): This application is a Continuation application of International application No. PCT/JP01/10095, filed Nov. 19, 2001, the entire contents of which are hereby incorporated by reference herein. The present invention relates to a pharmaceutical composition containing a specific angiotensin II receptor antagonist and one or more diuretics as the active ingredients (particularly a pharmaceutical composition for preventing or treating hypertension), the use of a specific angiotensin II receptor antagonist and one or more diuretics for manufacturing the pharmaceutical composition (particularly a pharmaceutical composition for preventing or treating hypertension), and a method for preventing or treating (particularly treating) diseases (particularly hypertension) by the administration of a pharmaceutical composition to warm-blooded animals (particularly humans) comprising effective doses of a specific angiotensin II receptor antagonist and one or more diuretics. It is known that coadministration of an angiotensin II receptor antagonist and a diuretic is an effective therapy for the prevention or treatment of hypertension (particularly treatment). These pharmaceutical compositions are described, for example, in WO89/6233, Japanese Patent Application Kokai No. Hei 3-27362 and the like. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Substituted aryl compounds as novel cyclooxygenase-2 selective inhibitors, compositions and methods of use related applications Inventor(s): Earl, Richard A.; (Westford, MA), Ezawa, Maiko; (Drummer Raod, MA), Fang, Xinqin; (Lexington, MA), Garvey, David S.; (Dover, MA), Gaston, Ricky D.; (Malden, MA), Khanapure, Subhash P.; (Clinton, MA) Correspondence: Edward D Grieff; Hale & Dorr Llp; 1455 Pennsylvania Ave, NW; Washington; DC; 20004; US Patent Application Number: 20020119977 Date filed: December 21, 2001 Abstract: The invention describes novel substituted aryl compounds that are cyclooxygenase 2 (COX-2) selective inhibitors and novel compositions comprising at least one cyclooxygenase 2 (COX-2) selective inhibitor, and, optionally, at least one compound that donates, transfers or releases nitric oxide, stimulates endogenous synthesis of nitric oxide, elevates endogenous levels of endothelium-derived relaxing factor or is a substrate for nitric oxide synthase, and/or, optionally, at least one therapeutic agent, such as, steroids, nonsterodal antiinflammatory compounds (NSAID), 5-lipoxygenase (5-LO) inhibitors, leukotriene B.sub.4 (LTB.sub.4) receptor antagonists, leukotriene A.sub.4 (LTA.sub.4) hydrolase inhibitors, 5-HT agonists, 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) inhibitors, H.sub.2 antagonists, antineoplastic agents, antiplatelet agents, thrombin inhibitors, thromboxane inhibitors, decongestants, diuretics, sedating or non-sedating anti-histamines, inducible nitric oxide synthase inhibitors, opioids, analgesics, Helicobaxcter pylori inhibitors, proton pump inhibitors, isoprostane inhibitors, and mixtures thereof. The invention also provides novel kits comprising at least one COX-2 selective inhibitor, and, optionally, at least one nitric oxide donor, and/or, optionally, at least one therapeutic agent. The novel cyclooxygenase 2 selective inhibitors of the invention can be optionally nitrosated and/or nitrosylated. The invention also provides methods for treating inflammation, pain and fever; for treating and/or improving the gastrointestinal properties of COX-2
104
Diuretics
selective inhibitors; for facilitating wound healing; for treating and/or preventing renal toxicity or other toxicities; for treating and/or preventing other disorders resulting from elevated levels of cyclooxygenase-2; and for improving the cardiovascular profile of COX-2 selective inhibitors. Excerpt(s): This application claims priority to U.S. Provisional Application No. 60/256,932 filed Dec. 21, 2000. Nonsteroidal anti-inflammatory compounds (NSAIDs) are widely used for the treatment of pain, inflammation, and acute and chronic inflammatory disorders such as osteoarthritis and rheumatoid arthritis. These compounds inhibit the activity of the enzyme cyclooxygenase (COX), also known as prostaglandin G/H synthase, which is the enzyme that converts arachidonic acid into prostanoids. The NSAIDs also inhibit the production of other prostaglandins, especially prostaglandin G.sub.2, prostaglandin H.sub.2 and prostaglandin E.sub.2, thereby reducing the prostaglandin-induced pain and swelling associated with the inflammation process. The chronic use of NSAIDs has been associated with adverse effects, such as gastrointestinal ulceration and renal toxicity. The undesirable side effects are also due to the inhibition of prostaglandin in the affected organ. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Treatment of congestive heart failure Inventor(s): Bakker-Arkema, Rebecca Guggemos; (Ann Arbor, MI), Pressler, Milton Lethan; (Saline, MI) Correspondence: Charles W Ashbrook; Warner Lambert Company; 2800 Plymouth Road; Ann Arbor; MI; 48105; US Patent Application Number: 20030008860 Date filed: May 9, 2002 Abstract: Combinations of diuretics and vasopressin antagonists are useful to slow and reverse the symptoms and process of congestive heart failure, to increase the excretion of water in the urine, and to decrease the excretion of sodium and potassium ions in urine. Preferred vasopressin antagonists have the formula (I) wherein R and R.sup.5 are hydrogen or lower alkyl; R.sup.1, R.sup.2, and R.sup.3 are hydrogen, halo, alkyl, alkoxy, and amino; and R.sup.4 is hydrogen or phenyl, and a pharmaceutically acceptable salt thereof Excerpt(s): This invention relates to combinations of vasopressin antagonists and diuretic agents for use in treating edematous conditions such as congestive heart failure. Congestive heart failure (CHF) is a pathophysiological state in which the heart is unable to pump sufficient blood to meet the metabolic needs of the body. The underlying basis of this disorder is a deficiency of mvocardial contractility, resulting in a decreased mechanical ability to pump blood and in turn, a decreased cardiac output. Congestive heart failure may result from a number of factors affecting the myocardium, altering systolic and/or diastolic function. As the condition progresses, activation of both the sympathetic nervous system and the renin-angiotensin-aldosterone system lead to an increase in the total peripheral resistance. In addition, elevated levels of arginine vasopressin (AVP) have been reported in some patients with heart failure, although its pathophysiologic role is unknown. It has been postulated that the increase in AVP may provide increased systemic vascular resistance and impaired water excretion as a compensatory mechanism to the low cardiac output associated with CHF. Arginine vasopressin, also known as antidiuretic hormone (ADH), is synthesized in the
Patents 105
magnocellular neurosecretory cells of the paraventricular and supraoptic nuclei of the hypothalamus and stored in the posterior pituitary. There are 2 classes of AVP receptors. V.sub.1 and V.sub.2. There are 2 subclasses of V.sub.1 receptors, V.sub.1A and V.sub.1B. V.sub.1A receptors are found in the vasculature, and mediate the pressor response of AVP by increasing the contraction of blood vessels. V.sub.1A receptors are also found on platelets, where they mediate platelet aggregation. V.sub.1B receptors are located in the anterior pituitary, and mediate adrenocorticotropic hormone (ACTH ) release. V.sub.2 receptors are located in the collecting ducts of the kidney: they are coupled to aquaporine channels and modulate free water clearance. Arginine vasopressin is released into the circulation in response to an increase in plasma osmolality (mediated by osmoreceptors) or a decrease in plasma volume or blood pressure (mediated by baroceptors). However, there are other stimuli for AVP release, including norepinephrine, angiotensin II, emotion, nausea and vomiting, and fever. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Use of DPPIV inhibitors as diuretic and anti-hypertensive agents Inventor(s): Aronson, Peter S.; (Guilford, CT), Girardi, Adriana; (S?atilde;o Paulo, BR), Knauf, Felix; (Berlin, DE) Correspondence: Mary M. Krinsky, PH. D., J.D.; Patent Attorney; 79 Trumbull Street; New Haven; CT; 06511; US Patent Application Number: 20020037829 Date filed: August 23, 2001 Abstract: Dipeptidyl peptidase IV inhibitors are used as diuretics and anti-hypertensive agents. Excerpt(s): This application claims priority benefit of provisional application U.S. Ser. No. 60/227,400, filed Aug. 23, 2000. This invention relates to a new class of diuretics and antihypertensive agents and methods for their use. Epidemiologic studies have clearly demonstrated that elevated blood pressure is correlated with an increased incidence of cardiovascular disease, including stroke, renal failure, congestive heart failure, and myocardial infarction. The prevalence of hypertension increases with age in all groups: blacks, whites, men, and women. Hypertension is an extremely common health problem in the geriatric population, afflicting approximately 65% of persons in the 65- to 74-yearold group (Bennett, J.C., and Plum, F., eds., Cecil's Textbook of Medicine, 20th ed., W. B. Saunders Co., Philadelphia, 1996, p. 258; this reference and others cited herein are expressly incorporated in their entireties by reference). Blacks have a higher prevalence of hypertension than whites, and men have a higher overall prevalence than women (ibid.). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
106
•
Diuretics
Vasopressin antagonist and diuretic combination Inventor(s): Ellis-Grosse, Evelyn; (Downingtown, PA), Orczyk, Gayle P.; (Berwyn, PA) Correspondence: Wyeth; Patent Law Group; Five Giralda Farms; Madison; NJ; 07940; US Patent Application Number: 20030069227 Date filed: June 4, 2002 Abstract: This invention provides methods of increasing urine flow in humans while minimizing the loss of electrolytes or ions, the methods comprising administering to a human in need thereof a combination of N-[4-(5H-pyrrolo[2,1-c][1,4]benzodiazepin10(11H)ylcarbonyl)-3-chlorophenyl]-5-fluoro-2-methylbenzamide (or a pharmaceutically acceptable salt thereof), also known as VPA-985, and one or more diuretic agents, as well as pharmaceutical compositions and kits or packages for such combinations. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/198,237, which was converted from U.S. patent application Ser. No. 09/406,658, filed Sep. 27, 1999, pursuant to a petition filed under 37 C.F.R. 1.53(c)(2)(i). This invention relates to new methods of increasing urine flow in humans while controlling the loss of electrolytes, the method comprising administering N-[4-(5H-pyrrolo[2,1c][1,4]benzodiazepin-10(11H)ylcarbonyl- )-3-chlorophenyl]-5-fluoro-2-methylbenzamide (or a pharmaceutically acceptable salt thereof) and a diuretic, such as furosemide. Particularly, this invention provides useful means for removing excess water, such as in the case of congestive heart failure, while maintaining a desirable blood osmolality in the recipient. The art describes many methods of producing liquid or semi-solid encapsulated pharmaceutical formulations. In Bull. Tech./Gattefosse Rep. (1996), 89, 2738, authors Shah et al. describe hard gelatin capsule technology, particularly for use in enhancing the bioavailability of poorly soluble or poorly absorbed drugs. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with diuretics, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “diuretics” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on diuretics. You can also use this procedure to view pending patent applications concerning diuretics. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
107
CHAPTER 7. BOOKS ON DIURETICS Overview This chapter provides bibliographic book references relating to diuretics. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on diuretics include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “diuretics” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on diuretics: •
Transplantation Drug Manual. 3rd ed Source: Georgetown, TX: Landes Bioscience. 1999. 133 p. Contact: Available from Landes Bioscience. 810 South Church Street, Georgetown, TX 78626. (512) 863-7762. Fax (512) 863-0081. Website: www.landesbioscience.com. PRICE: $45.00. ISBN: 1570595933. Summary: This book compiles practical information on the wide array of pharmaceutical agents currently available to treat patients who have undergone transplantation. Drugs discussed include both those used for immunosuppression and those used to minimize posttransplant complications. An introductory chapter offers a working guide to immunosuppression, providing an overview of current agents and a brief discussion of investigational agents. The remaining eight chapters cover antimicrobials (antibiotics, antivirals, antifungals), cardiovascular agents, antiosteoporosis agents, antiplatelets (including aspirin), diabetes agents, ulcer
108
Diuretics
prophylaxis and treatment, diuretics, and other concomitant agents. The information is presented primarily in chart format, with the following provided for each drug: the brand name, company, class, mechanism of action, indications, contraindications, warnings, special precautions, adverse reactions, drug interactions, formulation, and dosage. The book is spiral bound and concludes with a subject index. •
Regulation of Sodium and Chloride Balance Source: New York, NY: Raven Press. 1990. 540 p. Contact: Available from Raven Press. 1185 Avenue of the Americas, Dept. 5B, New York, NY 10036. (800) 777-2836 or (212) 930-9500. Fax (212) 869-3495. PRICE: $72.50 plus shipping. ISBN: 0881674818. Summary: This book discusses the regulation of sodium and chloride balance in eighteen chapters divided into two sections: normal sodium and chloride balance and abnormal sodium and chloride balance. Topics covered include the distribution of sodium chloride across cell membranes, the regulation of sodium chloride distribution within the extracellular space, mechanisms of segmental sodium and chloride reabsorption, glomerulotubular balance and the regulation of sodium excretion by intrarenal hemodynamics, the integrated regulation of electolyte balance and blood pressure by the renin system, the renin system and its pathophysiology in disease, the diagnosis of sodium and chloride disturbances, sodium blance and fluid volume in normal and edematous states, the edema of congestive heart failure, the pathogenesis of edema in the nephrotic syndrome, the edema of cirrhosis and its treatment, idopathic edema of women and its treatment, salt wastage and salt depletion, the diagnosis and treatment of hyponatremia, sodium handling in hypertensive states, the primary and seconary effects of diuretics, and the applied pharmcokinetics and drug resistance of diretics. A subject index concludes the volume.
•
Mayo Clinic on High Blood Pressure Source: New York, NY: Kensington Publishing. 1999. 180 p. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. PRICE: $14.95 plus shipping and handling. ISBN: 1893005011. Summary: This book focuses on what people who have high blood pressure can do to better manage their blood pressure and keep it at a safe level. The book begins with a chapter that explains the basics of blood pressure, how high blood pressure develops, and why it can be harmful. This is followed by a chapter that identifies unmodifiable and modifiable risk factors for high blood pressure. Unmodifiable risk factors include race, age, family history, and gender. Modifiable risk factors include obesity, inactivity, tobacco use, sodium sensitivity, low potassium, excessive alcohol consumption, stress, chronic illness, high cholesterol, diabetes, sleep apnea, and heart failure. Other topics addressed in this chapter include secondary high blood pressure and ways of preventing high blood pressure. The third chapter focuses on the diagnosis and treatment of high blood pressure. Topics include measuring blood pressure, receiving a diagnosis, getting a medical evaluation, and deciding on treatment with either medication or lifestyle changes. Subsequent chapters discuss determining a healthy weight, losing weight, becoming more physically active, and eating well using the Dietary Approaches to Stop Hypertension (DASH) plan. The following chapters detail the effects of sodium, tobacco, alcohol, caffeine, and stress on blood pressure. Another chapter focuses on the mode of action and side effects of various medications used in
Books
109
controlling high blood pressure, including diuretics, beta blockers, angiotensinconverting enzyme inhibitors, angiotensin II receptor blockers, calcium antagonists, alpha blockers, central acting agents, and direct vasodilators. Remaining chapters examine factors unique to women, management of high blood pressure among specific populations and groups, treatment of difficult-to-control high blood pressure, management of a hypertensive emergency, and home monitoring of blood pressure. The book also includes a week of menus based on the recommendations of the DASH eating plan. 17 figures. 2 tables. •
Carpal Tunnel Syndrome and Other Disorders of the Median Nerve Source: Wolburn, MA: Butterworth-Heinemann. 1993. 377 p. Contact: Available from Butterworth-Heinemann. 225 Wildwood Avenue, Wolburn, MA 01801. (800) 366-2665. PRICE: $100.00 plus shipping and handling. ISBN 0750692294. Summary: This book for health professionals presents an overview of carpal tunnel syndrome and other disorders of the median nerve. The first two chapters describe the anatomy of the median nerve and review the evolution of understanding of carpal tunnel syndrome. These are followed by chapters on the common symptoms and physical findings in carpal tunnel syndrome, the diagnosis of those conditions that are most likely to be confused with carpal tunnel syndrome or the conditions that carpal tunnel syndrome might mimic, and the relationship of carpal tunnel syndrome to other medical conditions. Other topics addressed in subsequent chapters include the use of electrodiagnostic methods for evaluation of carpal tunnel syndrome, the interpretation of electrodiagnostic findings in carpal tunnel syndrome, the use of quantitative sensory testing and thermography for evaluating sensory phenomena of positive character and dysfunction of small caliber fiber systems, and the role of imaging in the evaluation of carpal tunnel. In addition, chapters discuss the pathologic, physiologic, and clinical correlations of acute and chronic mechanical nerve injury; the controversy over the role of activities or occupations in causing carpal tunnel syndrome; and the treatment of carpal tunnel syndrome with splinting, steroid injections, vitamin B6 therapy, diuretics, anti-inflammatories, and surgery. Final chapters focus on median nerve causalgia, median neuropathy proximal and distal to the carpal tunnel, and tumors of the median nerve. It also includes numerous figures, tables, and references.
•
Clinical Nephrology Source: River Edge, NJ: World Scientific Publishing Co., Inc. 1998. 340 p. Contact: Available from World Scientific Publishing Co., Inc. 1060 Main Street, River Edge, NJ 07661. (800) 227-7562 or (201) 487-9655. Fax (888) 977-2665 or (201) 487-9656. Email:
[email protected]. Website: www.wspc.com. PRICE: $15.00 plus shipping and handling. ISBN: 9810234848. Summary: This book provides a broad review of kidney diseases, with regard to symptoms, diagnosis, and treatment; the book is designed to help medical students prepare for their examinations and also to be useful to practicing physicians who need an overview of kidney disease. Twenty-seven chapters are included: the structure and function of the kidneys; symptoms and signs in renal (kidney) medicine; renal investigations (diagnostic tests); glomerulonephritis (inflammation of the kidney glomeruli, bundles of filtering units called nephrons); the nephrotic syndrome (a condition with symptoms of fluid accumulation, protein in the urine, and susceptibility to infections); the pathogenesis (development) and treatment of IgA nephritis (kidney
110
Diuretics
inflammation due to a specific immune system disorder); lupus nephritis (kidney inflammation due to lupus erythematosus, a systemic inflammatory disorder); urinary tract infection; sex and the kidney; hypertension (high blood pressure) and the kidney; diuretics (drugs used to promote the formation of urine); kidney stones (calculi, nephrolithiasis); diabetes mellitus and the kidney; fluid and electrolytes; acid base balance; clinical problems in fluids, electrolytes, and acid base balance; renal tubular acidosis; renal tubular disorders; systemic disease and the kidney; pregnancy and the kidney; cancer and the kidney; inherited kidney diseases; drugs and the kidney; acute renal failure (ARF); chronic renal failure (CRF); dialysis; and renal transplantation. Each chapter includes illustrations, tables, answers to common questions, and a list of references for additional study; a subject index concludes the book. •
Meniere's Disease: What You Need to Know Source: Portland, OR: Vestibular Disorders Association. 1998. 336 p. Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail:
[email protected]. Website: www.vestibular.org. PRICE: $24.95 plus shipping and handling. ISBN: 0963261118. Summary: This book provides information for people who have or suspect they have Meniere's disease and want to know more about its diagnosis and treatment, as well as strategies for coping with its effects. Written in nontechnical language, the book offers 40 chapters covering the anatomy of the normal ear, the physiology of hearing, balance and other vestibular functions, vision involvement, the symptoms of Meniere's disease, remission, late-stage Meniere's disease, diagnostic tests, hearing tests, indirect vestibular function tests, general treatment considerations, diet therapy, drug therapy, diuretics, drugs meant to block symptoms temporarily, steroids, drugs meant to block symptoms permanently, treatment for cochlear problems, alternative treatments, surgery, prognosis, compensation, coping, safety, preservation of hearing and balance function, research, the temporal bone bank, the members of the otologic health care team, insurance, where to get more information, and patient success stories. Each chapter concludes with references and the book concludes with a glossary of terms and a subject index.
•
Primer on Kidney Diseases. 2nd ed Source: San Diego, CA: Academic Press. 1998. 542 p. Contact: Available from Academic Press. Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 321-5068 or (407) 345-3800. Fax (800) 874-6418 or (407) 345-4060. E-mail:
[email protected]. Website: www.apnet.com. PRICE: $57.95 plus shipping and handling. ISBN: 0122990900. Summary: This comprehensive textbook on kidney diseases is designed for medical students, house staff, and practitioners. The text offers a summary of the management of renal disease and fluid and electrolyte disorders. The 79 chapters are categorized in 11 sections, covering renal function and its assessment, electrolyte disorders, glomerular disease, the kidney in systemic disease, acute renal failure, drugs and the kidney, hereditary renal diseases, tubulointerstitial diseases, the kidney in special circumstances, chronic renal disease, and hypertension. Specific chapter topics include the characteristics of kidney function in the very young and in the very old, tubulointerstitial diseases, analgesic abuse nephropathy and the effects of NSAIDs on the kidneys, hematuria (blood in the urine), proteinuria, renal imaging techniques, metabolic acidosis and alkalosis, edema and the clinical use of diuretics,
Books
111
immunopathogenesis, minimal change nephropathy, IgA nephropathy, Goodpasture's syndrome, renal function in congestive heart failure, renal function in liver disease, renal manifestations of systemic lupus erythematosus, diabetic nephropathy, dysproteinemias and amyloidosis, renal and urologic complications of cancer and its treatment, hemolytic uremic syndrome, the renal manifestations of HIV, interstitial nephritis, sickle cell nephropathy, Alport's syndrome, medullary cystic disease, tubulointerstitial disease, lead nephrotoxicity, lithium induced renal disease, medullary sponge kidney, obstructive uropathy, nephrolithiasis (kidney stones), urinary tract infections, the kidney in pregnancy, the uremic syndrome, hemodialysis and hemofiltration, peritoneal dialysis, nutrition and renal disease, renal osteodystrophy, renal transplantation, and the pathogenesis of hypertension. Each chapter is written by an established expert in the field. The book is illustrated with full color and black and white photographs, figures, and tables. Each chapter concludes with suggested readings. An extensive subject index concludes the text. •
Principles of Renal Physiology. 3rd ed Source: London: Chapman and Hall. 1994. 200 p. Contact: Available from Chapman and Hall. One Penn Plaza, 41st floor, New York NY 10119. (212) 244-6412. Fax (212) 268-9964. PRICE: $24.50. ISBN: 0412555204. Summary: This is a technical text for preclinical medical students that provides detailed information concerning various aspects of the physiology and function of the kidneys. The 15 text chapters examine the characteristics of body fluids; the essential anatomy of the kidney; the physiology of renal system components; renal blood flow and glomerular filtration rate; regulation of potassium, osmolality, volume, and pH; renal regulation of potassium, calcium, and phosphate levels; reabsorptive and secretory processes in nephron segments; disease conditions altering renal sodium and vater reabsorption; and the use of diuretics. Answers are appended to problems presented throughout the text.
•
Brenner and Rector's the Kidney. 6th ed Source: Philadelphia, PA: W.B. Saunders Company. 2000. 2 v., 2652 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $395.00 plus shipping and handling. ISBN: 0721679986 (two volume set); 0721679994 (volume 1); 0721680003 (volume 2). Summary: This medical text offers a comprehensive, detailed coverage of the kidney and its diseases. Two volumes include 61 chapters in five sections: elements of normal renal structure and function; disturbances in control of body fluid volume and composition; the pathogenesis of renal disease; the pathophysiology of renal disease; and management of the patient with renal failure. Specific topics include the anatomy and physiology of the kidney, glomerular filtration, renal acidification mechanisms, urine concentration and dilution, the pathophysiology of water metabolism, acid base disorders, disorders of potassium balance, disturbances of calcium metabolism, the radiologic assessment of the kidney, acute renal failure, primary glomerular disease, urinary tract infection, tubulointerstitial diseases, vascular complications involving the renal vessels, toxic nephropathies, microvascular diseases of the kidney, the kidney and hypertension in pregnancy, inherited disorders of the renal tubule, cystic diseases of the kidney, diabetic nephropathy, nephrolithiasis, urinary tract obstruction, renal neoplasia (including cancer), essential hypertension, the pathophysiology of uremia, the effect of
112
Diuretics
aging on renal function and disease, diuretics, antihypertensive drugs, nutritional therapy in renal disease, hemodialysis, peritoneal dialysis, and transplantation. Each chapter is written by an established expert and is illustrated with full color and black and white photographs, figures, and tables. Each chapter concludes with extensive references, and a subject index is included at the end of each volume (covering both volumes). •
Disorders of the Genitourinary Tract Source: in AARP Pharmacy Service Prescription Drug Handbook, 2nd ed. Washington, DC: American Association of Retired Persons. 1992. p. 914-974. Contact: Available from Virginia Pharmacy Service. P.O. Box 13671, Richmond, VA 23225-6115. (800) 456-2277. PRICE: $12.95 plus $1 shipping and handling. Summary: This text chapter details information concerning the causes, diagnosis, and drug treatment of urinary tract infections, urinary incontinence and kidney stones. Information is included for various specific drugs for treating urinary tract infections, covering dosage form and strength, drug profile, what to know before using the drug, food-drug interactions, restrictions during daily living, possible side effects, storage instructions, and ancillary information. Also included are various urinary anti-infectives (Azo Gantanol, Azo Gantrisin, NegGRAM, Trimethoprim, Bactrim, Septra, Methenamine salts, Cipro, Floxin, Noroxin, Macrodantin) and urinary analgesics (Pyridium drugs). Topics under urinary incontinence include causes and types (stress, overactive bladder, overflow incontinence), diagnosis, treatment, prognosis, and detailed information on specific urinary tract stimulants (Bethanechol drugs) and antispasmodics (Ditropan, Urispas). Uric acid reducers (Allopurinol) and thiazide diuretics (Hydrochlorothiazide) used in the treatment of kidney stones also are described.
•
Nephrology and Hypertension. 4th ed Source: Hagerstown, MD: Lippincott Williams and Wilkins. 1999. 368 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: www.lww.com. PRICE: $26.95 plus shipping and handling. ISBN: 078172077X. Summary: Written by those who remember the information that was useful to them in their training, this book provides students, residents, and practitioners with basic clinical information on commonly encountered conditions in nephrology (kidney disease). Chapter 1 provides a brief overview of the structural and functional features of the kidney. Chapters 2 through 4 outline a practical approach to the functional and radiologic evaluation of the kidney, including the clinical indications for a kidney biopsy. Chapter 5 discusses the clinical significance of hematuria (blood in the urine) and identifies those clinical settings in which thorough evaluation is a necessity. In Chapter 6, the etiology, pathophysiology, and method of evaluation of proteinuria (protein in the urine) and the nephrotic syndrome are presented. Chapter 7 reviews diabetic nephropathy; then Chapter 8 discusses several forms of renal disease that are glomerular in type, including minimal change disease, focal segmental glomerulosclerosis, membranous glomerulonephritis, post infectious proliferative glomerulonephritis, and IgA nephropathy. Chapter 9 describes the various types of glomerulonephritis observed in patients with systemic lupus erythematosus (SLE). In Chapter 10, the problem of vasculitis is addressed in its many forms, including Wegener's granulomatosis, polyarteritis nodosa, and Schonlein Henoch purpura.
Books
113
Chapter 11 provides descriptions of the renal (kidney) manifestations of the thrombotic microangiopathies, progressive systemic sclerosis, multiple myeloma, and amyloidosis. Chapter 12 discusses tubulointerstitial nephritis, and Chapter 13 reviews the more frequently encountered familial and cystic forms of renal disease. Chapter 14 covers HIV infection and the kidney, including management of HIV infected patients with acute or chronic renal failure. The next section contains four chapters on disorders of water, electrolytes, and acid base regulation. In Chapter 19 renal stone disease is reviewed; Chapter 20 covers urinary tract infection (UTI). The next five chapters cover the diagnosis and management of hypertension (high blood pressure) and the use of diuretics in clinical practice. The last section covers diagnosis and management of renal failure; six chapters cover dialysis, patient care management, the role of nutrition in managing kidney failure, and drug therapy for acute and chronic renal failure. Each chapter concludes with a list of suggested readings, and the handbook concludes with a subject index.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “diuretics” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “diuretics” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “diuretics” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Anti-Diuretic Hormone by Mary L. Forsling; ISBN: 0888311052; http://www.amazon.com/exec/obidos/ASIN/0888311052/icongroupinterna
•
Clinical Pharmacology and Therapeutic Uses of Diuretics (Progress in Pharmacology, Vol 6, No 3) by Ariel J. Reyers, et al; ISBN: 0895742675; http://www.amazon.com/exec/obidos/ASIN/0895742675/icongroupinterna
•
Contemporary Trends in Diuretic Therapy: Proceedings of a Symposium in Divonne, France, 17-18 October 1985 (Current Clinical Practice Series, No 35) by Aldactone Symposium 8, Hans R. Brunner; ISBN: 0444904484; http://www.amazon.com/exec/obidos/ASIN/0444904484/icongroupinterna
•
Diuretic agents : based on a symposium sponsored by the ACS Division of Medicinal Chemistry at the 174th meeting of the American Chemical Society, Chicago, Illinois, August 29, 1977; ISBN: 0841204640; http://www.amazon.com/exec/obidos/ASIN/0841204640/icongroupinterna
•
Diuretic Agents: Clinical Physiology and Pharmacology by Donald Seldin (Author), Gerhard Giebisch (Author); ISBN: 0126356904; http://www.amazon.com/exec/obidos/ASIN/0126356904/icongroupinterna
•
Diuretic Drug Cessation in General Practice: Withdrawing Diuretic Drugs Prescribed for Ankle Oedema by Jan-Willem De Jonge; ISBN: 9051702213; http://www.amazon.com/exec/obidos/ASIN/9051702213/icongroupinterna
•
Diuretics by O. S. Better, Greger; ISBN: 3540589651; http://www.amazon.com/exec/obidos/ASIN/3540589651/icongroupinterna
114
Diuretics
•
Diuretics; ISBN: 343711428X; http://www.amazon.com/exec/obidos/ASIN/343711428X/icongroupinterna
•
Diuretics II: Chemistry, Pharmacology and Clinical Applications: Proceedings of the Second International Conference on Diuretics, Held June 22-27, 1 by Jules B. Puschett, Arthur Greenberg (Editor); ISBN: 0444011978; http://www.amazon.com/exec/obidos/ASIN/0444011978/icongroupinterna
•
Diuretics III: Chemistry, Pharmacology, and Clinical Applications: Proceedings of the Third International Conference on Diuretics, Held April 2-7, 1 by Jules B. Puschett, Arthur Greenberg (Editor); ISBN: 0444015256; http://www.amazon.com/exec/obidos/ASIN/0444015256/icongroupinterna
•
Diuretics in heart failure : proceedings of a round-table meeting; ISBN: 0199220190; http://www.amazon.com/exec/obidos/ASIN/0199220190/icongroupinterna
•
Diuretics in Hypertension and in Heart Failure (Progress in Pharmacology and Clinical Pharmacology, Vol 10, No 3) by Ariel J. Reyes (Editor); ISBN: 3437116142; http://www.amazon.com/exec/obidos/ASIN/3437116142/icongroupinterna
•
Diuretics IV: Chemistry, Pharmacology, and Clinical Applications: Proceedings (International Congress Series, No 1023) by Jules B. Puschett, Arthur Greenberg (Editor); ISBN: 0444896309; http://www.amazon.com/exec/obidos/ASIN/0444896309/icongroupinterna
•
Diuretics to Emulsions, Volume 8, Encyclopedia of Chemical Technology, 3rd Edition by R.E. Kirk, et al; ISBN: 0471020443; http://www.amazon.com/exec/obidos/ASIN/0471020443/icongroupinterna
•
Diuretics: Basic, Pharmacological, and Clinical Aspects: Proceedings of the International Meeting on Diuretics, Sorrento, Italy, May 26-30 (Develop) by Antonio Dal Canton (Editor), et al; ISBN: 0898388856; http://www.amazon.com/exec/obidos/ASIN/0898388856/icongroupinterna
•
Diuretics: Chemistry, Pharmacology and Clinical Applications by Jules B. Puschett, Arthur Greenberg (Editor); ISBN: 0444009507; http://www.amazon.com/exec/obidos/ASIN/0444009507/icongroupinterna
•
Diuretics: Chemistry, Pharmacology, and Medicine by Edward J. Cragoe; ISBN: 0471083666; http://www.amazon.com/exec/obidos/ASIN/0471083666/icongroupinterna
•
Diuretics: Clinical Pharmacology and Uses in Cardiovascular Medicine, Nephrology and Hepatology (Progress in Pharmacology and Clinical Pharmacology,) by A.J. Reyes (Editor); ISBN: 1560813458; http://www.amazon.com/exec/obidos/ASIN/1560813458/icongroupinterna
•
Diuretics: Physiology, Pharmacology & Clinical Use by John H. Dirks, Roger A. L. Sutton (Photographer); ISBN: 0721612431; http://www.amazon.com/exec/obidos/ASIN/0721612431/icongroupinterna
•
New Advances in Diuretic Treatment by St H. Taylor (Editor); ISBN: 380556001X; http://www.amazon.com/exec/obidos/ASIN/380556001X/icongroupinterna
•
Physiology of Diuretic Action by F. Lang (Editor); ISBN: 3805547692; http://www.amazon.com/exec/obidos/ASIN/3805547692/icongroupinterna
•
Structure and Function of Primary Messengers in Invertebrates: Insect Diuretic and Antidiuretic Peptides (Molecular Comparative Physiology, Vol 12) by Klaus W.
Books
115
Beyenbach (Editor); ISBN: 3805557043; http://www.amazon.com/exec/obidos/ASIN/3805557043/icongroupinterna •
The Biochemical Effects of Drugs in Pregnancy: Diuretics, Digestive and Pulmonary Tract Drugs.(Biochemical & Pharmacology in Medicine & neuroscienc by A. Onnis, P. Grella; ISBN: 0470200618; http://www.amazon.com/exec/obidos/ASIN/0470200618/icongroupinterna
•
The Diuretic Manual by Jules B. Puschett, Arthur Greenberg (Editor); ISBN: 0444008799; http://www.amazon.com/exec/obidos/ASIN/0444008799/icongroupinterna
•
The Physiological Basis of Diuretic Therapy in Clinical Medicine by Garabed Eknoyan, Manuel Martinez-Maldonado (Editor); ISBN: 0808917447; http://www.amazon.com/exec/obidos/ASIN/0808917447/icongroupinterna
Chapters on Diuretics In order to find chapters that specifically relate to diuretics, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and diuretics using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “diuretics” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on diuretics: •
Diuretics Source: in Haybach, P.J. Meniere's Disease: What You Need to Know. Portland, OR: Vestibular Disorders Association. 1998. p. 157-162. Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail:
[email protected]. Website: www.vestibular.org. PRICE: $24.95 plus shipping and handling. ISBN: 0963261118. Summary: This chapter is from a book that provides information for people who have or suspect they have Meniere's disease want to know more about its diagnosis and treatment, as well as strategies for coping with its effects. Written in nontechnical language, the chapter discusses the use of diuretics (water pills) for people with Meniere's disease. Diuretics, which reduce the amount of water throughout the body, are believed to exert the same effect in the inner ear. Endolymph, the fluid in the endolympatic space of the inner ear, is produced by cells in the walls of the scala media of the cochlea. Diuretics are used in Meniere's disease in an effort to reduce the amount of endolymph, thus reducing the symptoms of the disease. The author discusses four categories of diuretics: thiazide diuretics, potassium-sparing diuretics, carbonic anhydrase inhibitors, and loop or high ceiling diuretics. For each category, the author briefly reviews the drugs included, possible side effects, and coping tips. The chapter concludes with a list of answers to common questions about diuretics and their use. 13 references.
117
CHAPTER 8. PERIODICALS AND NEWS ON DIURETICS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover diuretics.
News Services and Press Releases One of the simplest ways of tracking press releases on diuretics is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “diuretics” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to diuretics. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “diuretics” (or synonyms). The following was recently listed in this archive for diuretics: •
Diet, rather than pills, can offset hypokalemia from diuretics after cardiac surgery Source: Reuters Industry Breifing Date: March 02, 2004
•
NICE warns of diabetes risk with diuretic and beta-blocker combination Source: Reuters Industry Breifing Date: February 20, 2004
118
Diuretics
•
Thiazide diuretics may reduce hip fracture risk Source: Reuters Industry Breifing Date: September 15, 2003
•
Diuretic recommended over alpha-blocker as first-line antihypertensive therapy Source: Reuters Industry Breifing Date: September 10, 2003
•
Blood pressure diet may act as diuretic: study Source: Reuters Health eLine Date: May 20, 2003
•
Diuretics for maternal hypertension may increase schizophrenia risk in offspring Source: Reuters Industry Breifing Date: March 14, 2003
•
Outcomes in elderly hypertensives better with ACE inhibitors than diuretics Source: Reuters Medical News Date: February 12, 2003
•
Thiazide diuretics provide best first-step therapy for hypertension Source: Reuters Industry Breifing Date: December 17, 2002
•
Diuretic as good as newer drugs for blood pressure Source: Reuters Health eLine Date: December 17, 2002
•
Colloid/diuretic therapy improves status of hypoproteinemic patients with lung injury Source: Reuters Industry Breifing Date: November 29, 2002
•
Diuretics a risk for kidney patients: US study Source: Reuters Health eLine Date: November 27, 2002
•
Diuretics may be deleterious in oliguric acute renal failure, by delaying dialysis Source: Reuters Industry Breifing Date: November 26, 2002
•
DepoMed extended-release diuretic for CHF patients promising in phase I Source: Reuters Industry Breifing Date: November 13, 2002
•
Diuretic requirement predicts outcome in advanced heart failure patients Source: Reuters Medical News Date: August 19, 2002
•
Captopril superior to diuretics and beta-blockers in diabetic hypertensive patients Source: Reuters Medical News Date: December 18, 2001
•
Certain diuretics may be protective against seizures Source: Reuters Industry Breifing Date: October 22, 2001
Periodicals and News
119
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “diuretics” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “diuretics” (or synonyms). If you know the name of a company that is relevant to diuretics, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “diuretics” (or synonyms).
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly
120
Diuretics
to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “diuretics” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on diuretics: •
Constipation: How to Find Relief Without Laxatives Source: Environmental Nutrition. 22(9): 2. September 1999. Contact: Available from Environmental Nutrition, Inc. 52 Riverside Drive, New York, NY 10024-6599. (800) 829-5384. Summary: Constipation is defined as infrequent or difficult bowel movements, typically three consecutive days without a movement. This brief article offers strategies for dealing with constipation without resorting to the use of laxatives. The author notes that, most often, constipation is temporary, triggered perhaps by a change in routine (like travel) and requires no real intervention beyond a cup of prune juice or a bowl of bran flakes. The author reviews the causes of constipation, including sedentary habits, diets of processed, low fiber foods, and a tendency to drink too few fluids. Additional contributors to constipation, especially for older people, include muscle weakness, poor dentition (which makes it hard to chew high fiber foods), and certain medications, including antidepressants, antacids, antihistamines, diuretics, opiates, tranquilizers, iron supplements, and calcium supplements. Three sidebars offer practical strategies for coping with constipation, preventing problems, and being cautious with herbal remedies.
•
Extreme Eating: Are Teens Compromising Their Health? Source: Food Insight. p.1, 4-5. November- December 1998. Contact: International Food Information Council Foundation, 1100 Connecticut Ave., NW, Suite 430, Washington, DC 20036. http://ificinfo.health.org. Summary: This article examines the eating habits of adolescents. Many activities and products use the term `extreme,' and the author says it can also be applied to how adolescents eat. According to experts interviewed for this article, many teenagers do not get the nutrients they need most. These include calcium, zinc, and iron. Issues include athletes who feel they should be a certain weight, self-esteem, and appearance concerns. The greatest danger, says the author, is the methods many adolescents use to control their weight. These may include purging, fasting, taking diuretics, and over- exercising. Some experts also point to family difficulties, often an area for conflict, as making eating problems worse. The author suggests finding the proper motivator for each individual adolescent, which may be athletics, performance, or body image.
•
Hypertension Drugs: They Can Treat More Than High Blood Pressure Source: Mayo Clinic Health Letter. 17(11): 5. November 1999. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This health newsletter article reviews the drugs used to treat hypertension (high blood pressure). The author focuses on the additional benefits of these drugs. Not only do hypertension drugs help control elevated blood pressure, but some actually
Periodicals and News
121
offer additional health benefits. These can include treating heart failure, diabetes, or symptoms resulting from an enlarged prostate. There are several types of hypertension drugs, and each type helps control elevated blood pressure in a different way. These include diuretics, beta blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, calcium channel blockers, alpha blockers, and central acting agents (central adrenergic inhibitors). In choosing drug therapy to treat a specific patient's hypertension, the physician will consider age, overall health, other medications already being taken, and cost considerations. One table outlines the possible additional health benefits these drugs have beyond treating elevated blood pressure. 1 table. •
Vertigo: Taking the Spin Out of Life Source: Mayo Clinic Health Letter. 18(7): 1-3. July 2000. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This newsletter article explores the issue of vertigo (a spinning type of dizziness) and what can be done to manage or prevent it. True vertigo, the most common form of dizziness, can result from a number of different causes. The author reviews the anatomy and structures of the inner ear and the balance system, including the role of the eyes, sensory nerves, and inner ear. The article also explains the canalith repositioning procedure, a common office procedure used to help relieve benign paroxysmal positional vertigo (BPPV). The author explores some of the causes of dizziness, including BPPV, Meniere's disease, inflammation of the inner ear (labyrinthitis or acute vestibular neuronitis); and some of the treatment options, including dietary changes, diuretics, sedatives, and antihistamines. One sidebar reviews the symptoms that should trigger a visit to the health care provider; these symptoms include vertigo or dizziness along with any of the following: new, different or severe headache, blurred vision, hearing loss, speech impairment, leg or arm weakness, loss of consciousness, falling or difficulty with walking, numbness or tingling, and chest pain or rapid or slow heart rate. 2 figures.
•
Medications and Their Effects on the Voice Source: Voice Foundation Newsletter. 4(3): 1, 5-6. October 1998. Contact: Available from Voice Foundation. 1721 Pine Street, Philadelphia, PA 19103. (215) 735-7999. Fax (215) 735-9293. E-mail:
[email protected]. Summary: This newsletter article familiarizes voice professionals with the potential vocal risks of drug use. The author contends that virtually all medications have some laryngeal effect. In many instances, the effects are clinically insignificant. However, some common medications have substantial impact upon the voice, and all voice professionals should be familiar with drug-induced phenomena that may alter vocal function. The author briefly reviews the possible effects of antibiotics, anti-viral agents, antihistamines, mucolytic and wetting agents, diuretics and other nonsteroid medications for edema, decongestants, corticosteroids, sprays, mists and inhalants, antitussive medications, and antihypertensive agents. This article represents only the first half of the material; the information is continued in the January 1999 edition of the newsletter.
•
Facing Lupus Nephritis Source: Lupus Horizons. 21(2):8-10; Fall 1997.
122
Diuretics
Contact: Greater Atlanta Chapter of the Lupus Foundation of America, 150 Interstate North Parkway, NW, Suite 285, Atlanta, GA 30339-2201. (800) 800-4FLA. (770) 952-3891. Summary: This newsletter article for health professionals and individuals with lupus focuses on lupus nephritis. Reasons why individuals with lupus may fear kidney disease are presented. The types of tests that are useful in the evaluation of patients with suspected nephritis are described, including urinalysis, immunologic tests, and kidney biopsy. In addition, drug therapies that are effective for the treatment of lupus are highlighted, including corticosteroids, chemotherapy, diuretics, and antihypertensives. Dialysis or kidney transplantation may be required if kidney failure develops.
Academic Periodicals covering Diuretics Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to diuretics. In addition to these sources, you can search for articles covering diuretics that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
123
CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for diuretics. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with diuretics. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The
124
Diuretics
following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to diuretics: Antidiabetic Agents, Sulfonylurea •
Systemic - U.S. Brands: Amaryl; DiaBeta; Diabinese; Dymelor; Glucotrol; Glucotrol XL; Glynase PresTab; Micronase; Orinase; Tolinase http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202742.html
Beta-Adrenergic Blocking Agents and Thiazide Diuretics •
Systemic - U.S. Brands: Corzide 40/5; Corzide 80/5; Inderide; Inderide LA; Lopressor HCT; Tenoretic 100; Tenoretic 50; Timolide 10-25; Ziac http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202088.html
Carbamazepine •
Systemic - U.S. Brands: Atretol; Carbatrol; Epitol; Tegretol; Tegretol-XR http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202111.html
Carbonic Anhydrase Inhibitors •
Systemic - U.S. Brands: Ak-Zol; Daranide; Dazamide; Diamox; Diamox Sequels; MZM; Neptazane; Storzolamide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202114.html
Citrates •
Systemic - U.S. Brands: Bicitra; Citrolith; Oracit; Polycitra Syrup; Polycitra-K; Polycitra-K Crystals; Polycitra-LC; Urocit-K http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202144.html
Clofibrate •
Systemic - U.S. Brands: Abitrate; Atromid-S http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202150.html
Clonidine and Chlorthalidone •
Systemic - U.S. Brands: Combipres http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202153.html
Diuretics, Loop •
Systemic - U.S. Brands: Bumex; Edecrin; Lasix; Myrosemide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202205.html
Diuretics, Potassium-Sparing •
Systemic - U.S. Brands: Aldactone; Dyrenium; Midamor http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202206.html
Diuretics, Potassium-Sparing, and Hydrochlorothiazide •
Systemic - U.S. Brands: Aldactazide; Dyazide; Maxzide; Moduretic; Spirozide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202207.html
Researching Medications
125
Diuretics, Thiazide •
Systemic - U.S. Brands: Aquatensen; Diucardin; Diulo; Diuril; Enduron; Esidrix; Hydro-chlor; Hydro-D; HydroDIURIL; Hydromox; Hygroton; Metahydrin; Microzide; Mykrox; Naqua; Naturetin; Oretic; Renese; Saluron; Thalitone; Trichlorex 10; Zaroxolyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202208.html
Glycerin •
Systemic - U.S. Brands: Glyrol; Osmoglyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202263.html
Hydralazine and Hydrochlorothiazide •
Systemic - U.S. Brands: Apresazide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202286.html
Indapamide •
Systemic - U.S. Brands: Lozol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202296.html
Lypressin •
Systemic - U.S. Brands: Diapid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202334.html
Methyldopa and Thiazide Diuretics •
Systemic - U.S. Brands: Aldoclor; Aldoril http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202360.html
Potassium Supplements •
Systemic - U.S. Brands: Cena-K; Effer-K; Gen-K; Glu-K; K+ 10; K+ Care; K+ Care ET; K-8; Kaochlor 10%; Kaochlor S-F 10%; Kaon; Kaon-Cl; Kaon-Cl 20% Liquid; Kaon-Cl-10; Kato; Kay Ciel; Kaylixir; K-Dur; K-Electrolyte; K-G Elixir; K-Ide; KLease; K-Lor; Klor-Con 10; Klor-Con 8 http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202473.html
Prazosin and Polythiazide •
Systemic - U.S. Brands: Minizide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202476.html
Rauwolfia Alkaloids and Thiazide Diuretics •
Systemic - U.S. Brands: Demi-Regroton; Diupres; Diurigen with Reserpine; Diutensen-R; Enduronyl; Enduronyl Forte; Oreticyl; Oreticyl Forte; Rauzide; Regroton http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202504.html
Reserpine, Hydralazine, and Hydrochlorothiazide •
Systemic - U.S. Brands: Cam-Ap-Es; Cherapas; Ser-A-Gen; Seralazide; Ser-ApEs; Serpazide; Tri-Hydroserpine; Unipres http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202506.html
126
Diuretics
Tetracyclines •
Systemic - U.S. Brands: Achromycin V; Declomycin; Doryx; Dynacin; Minocin; Monodox; Terramycin; Vibramycin; Vibra-Tabs http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202552.html
Torsemide •
Systemic - U.S. Brands: Demadex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202740.html
Vasopressin •
Systemic - U.S. Brands: Pitressin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202591.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.
Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.
PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
127
APPENDICES
129
APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
•
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
•
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
•
National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
•
National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
•
National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
•
National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
•
National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
11
These publications are typically written by one or more of the various NIH Institutes.
130
Diuretics
•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
•
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
•
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
•
National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
•
National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
•
National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
•
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
•
National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
•
National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
•
National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
•
National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
•
National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
•
National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
•
Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
•
National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
•
National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
•
Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
•
Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
Physician Resources
131
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
•
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
•
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
•
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
•
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
•
Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
•
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
•
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
•
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
•
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
•
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
12
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.
132
Diuretics
•
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
•
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “diuretics” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 44854 255 1001 36 337 46483
HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “diuretics” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
14
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
15
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
Physician Resources
133
Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
•
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
19 Adapted 20
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
135
APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on diuretics can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to diuretics. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to diuretics. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “diuretics”:
136
•
Diuretics
Other guides Congenital Heart Disease http://www.nlm.nih.gov/medlineplus/congenitalheartdisease.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html Hip Injuries and Disorders http://www.nlm.nih.gov/medlineplus/hipinjuriesanddisorders.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Meniere's Disease http://www.nlm.nih.gov/medlineplus/menieresdisease.html Preeclampsia http://www.nlm.nih.gov/medlineplus/preeclampsia.html
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on diuretics. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Childhood Nephrotic Syndrome Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). 2000. 4 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail:
[email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-141. Summary: Childhood nephrotic syndrome includes high levels of protein in the urine, low levels of protein in the blood, and swelling resulting from buildup of salt (sodium) and water. The nephrotic syndrome can be the first sign of a disease that damages the tiny blood filtering units (glomeruli) in the kidneys, where urine is made. This fact sheet offers information about childhood nephrotic syndrome, how it is diagnosed, and current research efforts to better understand this condition. The syndrome is usually
Patient Resources
137
diagnosed with urine testing (to check for protein) and blood tests (to see how well the kidneys are removing wastes); kidney biopsy may also be indicated. The most common form of the nephrotic syndrome in children is called minimal change disease (children diagnosed with this have normal or nearly normal biopsies). Minimal change disease is usually treated with drugs, including corticosteroids and diuretics. In about 20 percent of children with the nephrotic syndrome, the kidney biopsy reveals scarring or deposits in the glomeruli. Treatment for these children can include ACE inhibitors which help prevent protein from leaking into the urine and keep the kidneys from being damaged. The fact sheet concludes with a list of organizations that can provide readers with more information and a brief description of the activities of the NKUDIC. •
Gout, and What to Do About It Source: American Family Physician. 59(7): 1810. April 1, 1999. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Also available at www.aafp.org. Summary: Gout is a kind of arthritis caused by too much uric acid in the joints. The acid causes joint pain. This patient education handout describes gout and offers suggestions for managing the disease. Written in a question and answer format, the handout first reviews the risk factors for gout, including eating a lot of foods that are rich in purines, being overweight, drinking alcohol, or having high cholesterol; certain medications may also cause gout, including some diuretics, aspirin, niacin (a B complex vitamin), cyclosporine, and some drugs used to treat cancer. The authors then describe a gout attack, which usually features an acute pain in a joint, particularly the joints of the toes and fingers. The authors emphasize that the sooner an attack is treated, the sooner the pain will go away. With treatment, the gout attack can go away in a few days. Without treatment, a gout attack can last for days or even weeks. If recurrent gout attacks are untreated, the patient may develop tophi, which are soft tissue swellings caused by uric acid crystals. Tophi usually form on the toes, fingers, hands, and elbows. Gout patients may also get kidney disease or kidney stones. The patient's physician can prescribe medicines to prevent future gout attacks. These drugs are used to wash the uric acid from the joints, reduce the swelling, or keep uric acid from forming. Readers are encouraged to lose weight if they need to, to reduce high blood pressure (hypertension) and high cholesterol, and to stay away from alcohol and foods that are high in purines (such as salmon, sardines, liver, and herring). Drinking lots of water (to help flush uric acid) is also recommended. The authors of the handout are also the authors of a lengthy article for physicians, published in the same journal issue.
•
Audiological Aspects of Ototoxicity Source: Omaha, NE: Center for Hearing Loss in Children, Boys Town National Research Hospital (BTNRH). 1992. 2 p. Contact: Available from Boys Town National Research Hospital (BTNRH). Information Dissemination Department, 555 North 30th Street, Omaha, NE 68131-2136. (402) 4986749. PRICE: 1-10 copies free; bulk orders available. Item Number A-4 (9-92). Summary: Research has indicated that oncology patients receiving cisplatinum, aminoglycosides and/or loop diuretics as part of a treatment regimen may demonstrate ototoxic effects. This fact sheet reviews the audiological aspects of ototoxicity. Topics covered include the ototoxic effects of these drugs; the use of audiological monitoring during cisplatinum administration; and the benefits of audiological monitoring. The fact
138
Diuretics
sheet stresses that audiological monitoring allows the patient to be aware of possible changes in communication abilities and remediation options. 8 references. (AA-M). •
Keeping Your New Liver Healthy: Facts About Transplant Medications Source: Mount Laurel, NJ: American Society of Transplantation. 200x. 25 p. Contact: Available from American Society of Transplantation, Ptient Care and Education. 17000 Commerce Parkway, Suite C, Mount Laurel, NJ 08054. (856) 439-9986. Fax (856) 439-9982. E-mail:
[email protected]. Website: http://www.a-s-t.org. PRICE: Single copy free. Summary: This booklet offers detailed information about medications for people who have just received a liver transplant. The booklet introduction reminds readers how important transplant medications are (in order to retain the transplanted liver) and cautions readers that many transplant medications have side effects, even side effects that can be difficult enough to warrant taking other medications to cope with those side effects. The booklet also reminds readers that their medications will be changed often and they must work in close tandem with their health care providers. The booklet then discusses medicines for infections, medicines that help to control side effects, the importance of taking medications the right way (timing, dosage, with or without meals, etc.), financial considerations, and specific medications. The booklet categorizes individual drugs and offers fact sheets on each drug or drug group, including: steroids, cyclosporine, azathioprine, sirolimus and rapamycin, tacrolimus, mycophenolate mofetil, trimethoprim-sulfamethoxazole, acyclovir, ganciclovir, nystatin or clotrimazole, medicines for ulcers, diuretics ('water pills'), vitamins and minerals, and blood pressure medications. The fact sheets cover how each drug works, common side effects, dosages, and how to store the drug. Final sections discuss which medications are safe to take together and new research (clinical studies) on drugs for transplant patients. 1 table.
•
JNC-7 Guidelines Source: CKD UPdate. 1(1): [1 p]. September 2003. Contact: Available from National Kidney Foundation, Inc. Medical Department, 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Fax: (212) 689-9261. E-mail:
[email protected]. Website: www.kidney.org. PRICE: Single copy free; Full-text available online at no charge. Summary: This brief newsletter reviews the guidelines that describe how hypertension (high blood pressure) in patients with chronic kidney disease (CKD) must be treated differently from that in patients without CKD. These guidelines are available at www.nhlbi.nih.gov/guidelines/hypertension. According to the guidelines, patients with high blood pressure along with kidney disease need specialized treatment in order to prevent cardiovascular disease, and minimize the progression of kidney disease. The article reviews some of the guidelines for managing hypertension in these patients: keep the blood pressure goal below 130/80; utilize more than one blood pressure medication (combination of ACE inhibitors or angiotensin receptor blockers with diuretics), and emphasize lifestyle changes (losing weight, stopping smoking, reducing salt intake).
•
Meniere's Disease Source: Seattle, WA: University of Washington Virginia Merrill Bloedel Hearing Research Center. 1996. [4 p.].
Patient Resources
139
Contact: Available from Virginia Merrill Bloedel Hearing Research Center. University of Washington, Box 357923, Seattle, WA 98195-7923. (206) 616-4105. E-mail:
[email protected]. Website: weber.u.washington.edu/~hearing. PRICE: Single copy free. Summary: This brochure describes Meniere's disease, a condition involving both the hearing and balance organs and causing multiple symptoms, all associated with excessive fluid in the inner ear. The brochure describes the anatomy of the ear and the physiology of normal hearing, the symptoms of Meniere's disease, diagnostic tests used to confirm the presence of Meniere's disease, medical management of the condition, prognosis, surgical treatments, and where to find more information. Medical management strategies discussed include cessation of smoking, the use of a low salt (sodium) diet, the use of diuretics (to decrease sodium and water in the body), avoiding caffeine, stress avoidance, becoming aware of food allergies, and Innovar therapy (an anesthetic agent, administered in the hospital setting). Surgical options described include endolymphatic sac surgery, vestibular nerve section, and labyrinthectomy. One illustration depicts the anatomy of the middle and inner ear. 1 figure. •
Diabetes and Your Heart Source: New York, NY: Juvenile Diabetes Foundation International. 199x. [4 p.]. Contact: Available from Juvenile Diabetes Foundation International. 120 Wall Street, New York, NY 10005-4001. (800) 533-2873 or (212) 785-9500. Website: www.jdfcure.com. PRICE: Single copy free; bulk copies available. Summary: This brochure discusses the effects of diabetes on the heart. Although diabetes is one of the four major risk factors for developing heart disease, people with diabetes can effectively improve their cardiovascular risk profile. The most common types of cardiovascular disease are hypertension and coronary artery disease. The brochure explains symptoms and identifies the factors that contribute to these diseases in people who have diabetes. Measures that can help prevent heart problems and enhance diabetes control, including weight loss, exercise, and good nutrition, are outlined. In addition, the brochure describes some of the medications used to lower blood pressure and cholesterol levels, including angiotensin-converting enzyme inhibitors, diuretics, vasodilators, beta blockers, and cholesterol lowering agents.
•
Ototoxic Medications: Drugs That Can Cause Hearing Loss and Tinnitus Source: New York, NY: League for the Hard of Hearing. 2000. [4 p.]. Contact: Available from League for the Hard of Hearing. 71 West 23rd Street, New York, NY 10010-4162. Voice (917) 305-7700. TTY (917) 305-7999. Fax (917) 305-7888. Website: www.lhh.org. PRICE: $2.00 plus shipping and handling. Summary: This brochure discusses which commonly used medications could potentially cause damage to one's hearing, or aggravate an already existing problem. Ototoxic medications are drugs that can cause hearing loss and tinnitus. The brochure notes that usually any hearing problem will only be caused by exceeding the recommended dosage of the medications. Often these problems are reversible upon discontinuation of the drug. Occasionally there are times when the change in hearing can be permanent. The bulk of the brochure includes lists and brief descriptions of drugs that can cause hearing loss, including salicylates, nonsteroidal antiinflammatory drugs (NSAIDs), antibiotics, diuretics, chemotherapeutic agents, quinine, mucosal protectant, and narcotic analgesics; and drugs that can cause tinnitus, including vapors, solvents,
140
Diuretics
antibiotics, anti-neoplastics, diuretics, cardiac medications, psychopharmacologic agents, NSAIDs, glucocorticosteroids, anesthetics, antimalarials, and miscellaneous toxic substances. In the lists, the generic name of the drug is given first, with the trade name, if available, followed in parentheses and capitalized. Many times a particular generic drug is manufactured under several trade names. The brochure concludes with information about the activities of the League for the Hard of Hearing (www.lhh.org). •
Understanding Nephrotic Syndrome Source: Rockville, MD: American Kidney Fund. 2000. 12 p. Contact: Available from American Kidney Fund. 6110 Executive Boulevard, Suite 1010, Rockville, MD 20852. (800) 638-8299 or (301) 881-3052. PRICE: Single copy free. Summary: This brochure provides information to parents of children newly diagnosed with nephrotic syndrome. After a brief review of the anatomy and physiology of the healthy kidney, the author defines nephrotic syndrome; discusses diagnostic tests, including kidney biopsy; outlines the treatment options presently available; and presents information about long term prognosis, delaying immunizations, protecting against peritonitis, and monitoring the child's blood pressure. Treatment options discussed include albumin infusions, diuretics, a low sodium diet, and prednisone. The author encourages parents to take an active role in caring for their child and to work closely with other members of the health care team.
•
Managing Gout: Limiting Painful Attacks Source: San Bruno, CA: StayWell Company. 1997. 6 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This brochure provides people who have gout with information on managing this joint disease. Gout is caused by too much uric acid in the blood. The excess uric acid causes crystals to form in the joints and soft tissues, resulting in severe joint inflammation. Attacks may occur weeks or months apart. If left untreated, attacks become more frequent or last longer. Gout can be controlled by avoiding triggers and taking the proper medications. Triggers include too much alcohol, obesity, foods high in purines, a sudden illness or infection, surgery, and diuretics. Medications may be used to reduce the amount of uric acid made by the body or to increase the amount of uric acid passed in the urine. The brochure offers tips on taking medications and reducing joint swelling.
•
Constipation: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1996. 2 p. Contact: Available from American Society of Colon and Rectal Surgeons. 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 2909184. Fax (847) 290-9203. E-mail:
[email protected]. Website: www.fascrs.org. PRICE: Full-text available online at no charge; Single copy free; bulk copies available. Summary: This brochure, from the American Society of Colon and Rectal Surgeons, provides basic information about constipation. Constipation is defined as infrequent bowel movements, but it may also refer to a decrease in the volume or weight of stool,
Patient Resources
141
the need to strain to have a movement, a sense of incomplete evacuation, or the need for enemas, suppositories, or laxatives in order to maintain regularity. The brochure provides information about the causes of constipation, how to know when to consult a health care provider, diagnostic tests used to confirm constipation, and treatment options. Common causes of constipation include inadequate fiber and fluid intake, a sedentary lifestyle, environmental changes (including travel), pregnancy, or colon disease. Many medications, including pain killers, antidepressants, tranquilizers, and other psychiatric medications, blood pressure medication, diuretics, iron supplements, calcium supplements, and aluminum-containing antacids can cause or worsen constipation. The brochure stresses that any persistent change in bowel habit, including increase or decrease in frequency or size of stool or an increased difficulty in evacuating, warrants medical advice. Diagnostic tests used include digital examination of the anorectal area, barium xrays, endoscopy, and other physiologic tests. The brochure concludes that the majority of patients with constipation are successfully treated by adding high fiber foods to the diet, along with increased fluids. In some cases, biofeedback may help to retrain poorly functioning anal sphincter muscles. Only in rare circumstances are surgical procedures necessary to treat constipation. (AA-M). •
Drugs and Tinnitus Source: London, England: Royal National Institute for Deaf People. 1998. 6 p. Contact: Available from RNID Helpline. P.O. Box 16464, London EC1Y 8TT, United Kingdom. 0870 60 50 123. Fax 0171-296 8199. E-mail:
[email protected]. Website: www.rnid.org.uk. Also available from RNID Tinnitus Helpline. Castle Cavendish Works, Norton Street, Radford, Nottingham NG7 5PN, United Kingdom. 0345 090210. Fax 0115-978 5012. E-mail:
[email protected]. PRICE: Single copy free. Summary: This fact sheet from the Royal National Institute for Deaf People (RNID) discusses the relationship between drugs and tinnitus (ringing or noises in the ears). The fact sheet reports on a brief survey of four categories of drugs for tinnitus, drugs for the effects of tinnitus, drugs to relieve other conditions that may be causing the tinnitus, and drugs that might cause or aggravate tinnitus. These include lignocaine, carbamazepine, clonazepam, tocainide, flecainide, mexiletine, frusemide, phenytoin sodium, vigabatrin, nimodipine, alprazolam, betahistine, tranquilizers, diazepam, antidepressants, diuretics, antihypertensives, decongestants and antihistamines, zinc sulfate, sodium fluoride, aspirin, quinine, loop diuretics, aminoglycoside antibiotics, and neomycin. The fact sheet emphasizes the importance of working closely with health care providers before changing any medications. The fact sheet concludes with information on the RNID Tinnitus Helpline (in Nottingham, UK), which is also accessible online at
[email protected]. The RNID website is at www.rnid.org.uk.
•
High Blood Pressure and Diabetes: A Dangerous Combination Source: Clinical Diabetes. 14(4): 95. July-August 1996. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Reproducible. Summary: This fact sheet provides information about high blood pressure and diabetes. Topics include determining if high blood pressure is present; steps to take to lower hypertension without medication; the use of antihypertensive medications, including diuretics, beta blockers, vasodilators, alpha blockers, ACE inhibitors, and calcium channel blockers; and the side effects of some hypertensive medications. One chart lists the ranges of blood pressure readings from high normal to very severe hypertension.
142
Diuretics
The fact sheet includes the toll-free number of the American Diabetes Association (800342-2383). •
Gout Source: American Academy of Family Physicians. 2001. 2 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This fact sheet provides patients with an overview of gout. Gout is a form of arthritis caused by the buildup of uric acid in the joints. This buildup is caused when the body cannot break down waste products known as purines. The joints become swollen and painful. Men, postmenopausal women, and patients who are overweight, drink alcohol, or have high cholesterol are more likely to get gout. Diuretics, niacin, aspirin, cyclosporine, and some cancer drugs may also cause gout. Gout attacks are sudden and usually start at night. Often the big toe is affected. Doctors can prescribe medicine for joint swelling and pain. Bed rest and an ice pack on the affected joint are recommended. With treatment an attack usually lasts only a few days. Soft tissue swellings known as tophi may form on toes, fingers, hands, and elbows and are caused by uric acid crystals. Without treatment patients may develop kidney disease or kidney stones and the bone may be destroyed. To avoid gout attacks lose weight, get treatment for high cholesterol and high blood pressure, and stay away from alcohol, and foods high in purines.
•
Ototoxity Source: Portland, OR: Vestibular Disorders Association (VEDA). 1995. 6 p. Contact: Available from Vestibular Disorders Association (VEDA). P.O. Box 4467, Portland, OR 97208-4467. (503) 229-7705. Fax (503) 229-8064. E-mail:
[email protected]. Website: www.vestibular.org. PRICE: $0.50 per copy. Order number F-19. Summary: This fact sheet provides readers with extensive information about ototoxicity. Written in a question-and-answer format, the fact sheet covers how often problems with ototoxicity are encountered; the different drugs and chemicals that can be ototoxic; ototoxic damage to the acoustic nerve and to the hair cells of the inner ear; symptoms of ototoxicity; diagnosis of ototoxic developments; treatment options; and the major goals for patients who have experienced ototoxicity. One table lists potential ototoxins in the categories of aminoglycoside antibiotics, other antibiotics, anti-neoplastics (anti-cancer drugs), diuretics, aspirin and compounds containing aspirin, quinines, and environmental chemicals. 13 references.
•
Pulmonary Hypertension Source: Danvers, MA: Scleroderma Foundation. 1998. 6 p. Contact: Available from Scleroderma Foundation. 12 Kent Way, Suite 101, Byfield, MA 01922. (800) 722-4673 or (978) 463-5843. Fax (978) 463-5809. E-mail:
[email protected]. Website: www.scleroderma.org. PRICE: Single copy $1.00. Summary: This pamphlet for people with scleroderma uses a question and answer format to provide information about pulmonary artery hypertension. This type of high blood pressure involves the arteries that take blood from the right side of the heart to the lungs. The pamphlet describes the types of pulmonary artery hypertension that occur in scleroderma, including hypertension with or without scarring of the lung
Patient Resources
143
tissue. It also presents the symptoms of pulmonary artery hypertension, highlights the tests that might be conducted to diagnose pulmonary artery hypertension, explains the natural course of this condition in scleroderma, and discusses options for treating this type of hypertension. Pulmonary hypertension not related to scleroderma may be treated with oxygen therapy and anticoagulation therapy. Right-heart failure may be treated with various medications, including calcium channel blockers, diuretics, and an experimental drug known as prostacyclin. In addition, the pamphlet presents the mission of the Scleroderma Foundation. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “diuretics” (or synonyms). The following was recently posted: •
Procedure guideline for diuretic renography in children Source: Society of Nuclear Medicine, Inc - Medical Specialty Society; 1999 February; 18 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1357&nbr=615&am p;string=diuretics The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to diuretics. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/specific.htm
•
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
•
Med Help International: http://www.medhelp.org/HealthTopics/A.html
•
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
•
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
144
•
Diuretics
WebMD®Health: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to diuretics. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with diuretics. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about diuretics. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “diuretics” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “diuretics”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “diuretics” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.
Patient Resources
145
The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “diuretics” (or a synonym) into the search box, and click “Submit Query.”
147
APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
22
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
148
Diuretics
libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
•
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
•
California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
•
California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
•
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
•
California: Gateway Health Library (Sutter Gould Medical Foundation)
•
California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
•
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
•
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
•
California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
•
California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
•
California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
•
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
•
California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
•
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
•
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
23
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries
149
•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
•
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
•
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
•
Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
•
Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
•
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
•
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
•
Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
•
Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
•
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
•
Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
•
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
•
Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
•
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
•
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
•
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
•
Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
•
Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
•
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
•
Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
150
Diuretics
•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
•
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
•
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
•
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
•
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
•
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
•
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
•
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
•
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
•
Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
•
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
•
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
•
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
•
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
•
Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries
151
•
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
•
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
•
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
•
Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
•
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
152
Diuretics
•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
153
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on diuretics: •
Basic Guidelines for Diuretics Diuretics overdose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002637.htm
•
Signs & Symptoms for Diuretics Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Convulsions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Decreased urine output Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003147.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm
154
Diuretics
Difficulty breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Emesis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Excessive salivation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003048.htm Metallic taste Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003050.htm No urine output Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003147.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Thirst Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003085.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm •
Diagnostics and Tests for Diuretics Gastric lavage Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003882.htm
•
Background Topics for Diuretics Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Mercury Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002476.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm Shock Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm Unconscious Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000022.htm
Online Glossaries 155
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
157
DIURETICS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abduction: Forcible pulling of a limb away from its natural position, a risk in road accidents and disasters; move outwards away from middle line. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]
ACE Inhibitor: A type of drug used to lower blood pressure. Studies indicate that it may also help prevent or slow the progression of kidney disease in people with diabetes. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetone: A colorless liquid used as a solvent and an antiseptic. It is one of the ketone bodies produced during ketoacidosis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Actinic keratosis: A precancerous condition of thick, scaly patches of skin. Also called solar or senile keratosis. [NIH] Acute myelogenous leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myeloid leukemia or acute nonlymphocytic leukemia. [NIH] Acute myeloid leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myelogenous leukemia or acute nonlymphocytic leukemia. [NIH] Acute nonlymphocytic leukemia: A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myeloid leukemia or acute myelogenous leukemia. [NIH]
158
Diuretics
Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic betaantagonists are used for treatment of hypertension, cardiac arrythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]
Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU]
Dictionary 159
Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Airway Resistance: Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Aldosterone: (11 beta)-11,21-Dihydroxy-3,20-dioxopregn-4-en-18-al. A hormone secreted by the adrenal cortex that functions in the regulation of electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium. [NIH] Aldosterone Antagonists: Compounds which inhibit or antagonize the biosynthesis or actions of aldosterone. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alkalosis: A pathological condition that removes acid or adds base to the body fluids. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH]
160
Diuretics
Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anemic: Hypoxia due to reduction of the oxygen-carrying capacity of the blood as a result of a decrease in the total hemoglobin or an alteration of the hemoglobin constituents. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH]
Dictionary 161
Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]
Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antiasthmatic: An agent that relieves the spasm of asthma. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidiuretic: Suppressing the rate of urine formation. [EU] Antidote: A remedy for counteracting a poison. [EU]
162
Diuretics
Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antihypertensive Agents: Drugs used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Among the antihypertensive agents are diuretics (especially diuretics, thiazide), adrenergic beta-antagonists, adrenergic alpha-antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. [NIH] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antimycotic: Suppressing the growth of fungi. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]
Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipruritic: Relieving or preventing itching. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Antispasmodic: An agent that relieves spasm. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Aquaporins: Membrane proteins which facilitate the passage of water. They are members of
Dictionary 163
the family of membrane channel proteins which includes the lens major intrinsic protein and bacterial glycerol transporters. [NIH] Aqueous: Having to do with water. [NIH] Aqueous fluid: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Arachidonate 15-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 15-hydroperoxyarachidonate (15-HPETE) which is rapidly converted to 15-hydroxy5,8,11,13-eicosatetraenoate (15-HETE). The 15-hydroperoxides are preferentially formed in neutrophils and lymphocytes. EC 1.13.11.33. [NIH] Arachidonate Lipoxygenases: Enzymes catalyzing the oxidation of arachidonic acid to hydroperoxyarachidonates (HPETES). These products are then rapidly converted by a peroxidase to hydroxyeicosatetraenoic acids (HETES). The positional specificity of the enzyme reaction varies from tissue to tissue. The final lipoxygenase pathway leads to the leukotrienes. EC 1.13.11.- . [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arrestin: A 48-Kd protein of the outer segment of the retinal rods and a component of the phototransduction cascade. Arrestin quenches G-protein activation by binding to phosphorylated photolyzed rhodopsin. Arrestin causes experimental autoimmune uveitis when injected into laboratory animals. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arrhythmogenic: Producing or promoting arrhythmia. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosus: Circle composed of anastomosing arteries derived from two long posterior ciliary and seven anterior ciliary arteries, located in the ciliary body about the root of the iris. [NIH]
Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied
164
Diuretics
in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH] ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrial Natriuretic Factor: A potent natriuretic and vasodilatory peptide or mixture of different-sized low molecular weight peptides derived from a common precursor and secreted by the heart atria. All these peptides share a sequence of about 20 amino acids. [NIH] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Babesiosis: A group of tick-borne diseases of mammals including zoonoses in humans. They are caused by protozoans of the genus babesia, which parasitize erythrocytes, producing hemolysis. In the U.S., the organism's natural host is mice and transmission is by the deer tick ixodes scapularis. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular
Dictionary 165
or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Base Sequence: The sequence of purines and pyrimidines in nucleic acids and polynucleotides. It is also called nucleotide or nucleoside sequence. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzomorphans: Morphine derivatives of the Methanobenzazocine family that act as potent analgesics. [NIH] Beta blocker: A drug used to slow the heart rate and reduce pressure inside blood vessels. It also can regulate heart rhythm. [NIH] Betahistine: N-Methyl-2-pyridineethanamine. A physiological histamine analog vasodilator agent that also acts as a histamine H1 receptor agonist. It is used in Meniere's disease and in vascular headaches but may exacerbate bronchial asthma and peptic ulcers. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioassays: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and
166
Diuretics
protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bisoprolol: A cardioselective beta-1-adrenergic blocker. It is effective in the management of hypertension and angina pectoris. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood Proteins: Proteins that are present in blood serum, including serum albumin, blood coagulation factors, and many other types of proteins. [NIH] Blood urea: A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH]
Dictionary 167
Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Hypoxia: Lack of oxygen leading to unconsciousness. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions), or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Bromine: A halogen with the atomic symbol Br, atomic number 36, and atomic weight 79.904. It is a volatile reddish-brown liquid that gives off suffocating vapors, is corrosive to the skin, and may cause severe gastroenteritis if ingested. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchospasm: Spasmodic contraction of the smooth muscle of the bronchi, as occurs in asthma. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH]
168
Diuretics
Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbonate Dehydratase: A zinc-containing enzyme of erythrocytes with molecular weight
Dictionary 169
of 30 kD. It is among the most active of known enzymes and catalyzes the reversible hydration of carbon dioxide, which is significant in the transport of CO2 from the tissues to the lungs. The enzyme is inhibited by acetazolamide. EC 4.2.1.1. [NIH] Carbonic Anhydrase Inhibitors: A class of compounds that reduces the secretion of H+ ions by the proximal kidney tubule through inhibition of carbonic anhydrase (carbonate dehydratase). [NIH] Carboxy: Cannabinoid. [NIH] Carboxy-terminal: The end of any polypeptide or protein that bears a free carboxyl group. [NIH]
Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular Agents: Agents that affect the rate or intensity of cardiac contraction, blood vessel diameter, or blood volume. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH]
170
Diuretics
Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Dictionary 171
Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chimera: An individual that contains cell populations derived from different zygotes. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chloride Channels: Cell membrane glycoproteins selective for chloride ions. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholecystokinin: A 33-amino acid peptide secreted by the upper intestinal mucosa and also found in the central nervous system. It causes gallbladder contraction, release of pancreatic exocrine (or digestive) enzymes, and affects other gastrointestinal functions. Cholecystokinin may be the mediator of satiety. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or
172
Diuretics
transplantation to replace the work of the kidneys. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH] Cinchona: A genus of rubiaceous South American trees that yields the toxic cinchona alkaloids from their bark; quinine, quinidine, chinconine, cinchonidine and others are used to treat malaria and cardiac arrhythmias. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clathrin: The main structural coat protein of coated vesicles which play a key role in the intracellular transport between membranous organelles. Clathrin also interacts with cytoskeletal proteins. [NIH] Clathrin-Coated Vesicles: Vesicles formed when cell-membrane coated pits invaginate and pinch off. The outer surface of these vesicles is covered with a lattice-like network of the protein clathrin. Shortly after formation, however, the clathrin coat is removed and the vesicles are referred to as endosomes. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment
Dictionary 173
originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]
Clonic: Pertaining to or of the nature of clonus. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Coal: A natural fuel formed by partial decomposition of vegetable matter under certain environmental conditions. [NIH] Coated Vesicles: Vesicles formed when cell-membrane coated pits invaginate and pinch off. The outer surface of these vesicles are covered with a lattice-like network of coat proteins, such as clathrin, coat protein complex proteins, or caveolins. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]
Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Communis: Common tendon of the rectus group of muscles that surrounds the optic foramen and a portion of the superior orbital fissure, to the anterior margin of which it is attached at the spina recti lateralis. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes
174
Diuretics
immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementation: The production of a wild-type phenotype when two different mutations are combined in a diploid or a heterokaryon and tested in trans-configuration. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular
Dictionary 175
degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congenita: Displacement, subluxation, or malposition of the crystalline lens. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [NIH]
Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Conus: A large, circular, white patch around the optic disk due to the exposing of the sclera as a result of degenerative change or congenital abnormality in the choroid and retina. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c.
176
Diuretics
villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Cor pulmonale: Heart disease that results from resistance to the passage of blood through the lungs; it often leads to right heart failure. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneum: The superficial layer of the epidermis containing keratinized cells. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]
Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH]
Dictionary 177
Coumarin: A fluorescent dye. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cranial Nerves: Twelve pairs of nerves that carry general afferent, visceral afferent, special afferent, somatic efferent, and autonomic efferent fibers. [NIH] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytomegalovirus Infections: Infection with Cytomegalovirus, characterized by enlarged cells bearing intranuclear inclusions. Infection may be in almost any organ, but the salivary glands are the most common site in children, as are the lungs in adults. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU]
178
Diuretics
Dehydration: The condition that results from excessive loss of body water. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]
Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermal: Pertaining to or coming from the skin. [NIH] Dermatitis: Any inflammation of the skin. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific
Dictionary 179
gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilated cardiomyopathy: Heart muscle disease that leads to enlargement of the heart's chambers, robbing the heart of its pumping ability. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal
180
Diuretics
consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of single-stranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Dobutamine: A beta-2 agonist catecholamine that has cardiac stimulant action without evoking vasoconstriction or tachycardia. It is proposed as a cardiotonic after myocardial infarction or open heart surgery. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Doping: The action of administering a drug to someone before a sports event (originally to a horse before a race); the substance thus administered. [EU] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Dose-limiting: Describes side effects of a drug or other treatment that are serious enough to prevent an increase in dose or level of that treatment. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also
Dictionary 181
effective in the treatment of hypertension. [NIH] Drug Combinations: Single preparations containing two or more active agents, for the purpose of their concurrent administration as a fixed dose mixture. It is differentiated from combination drug therapy in which two or more drugs are administered separately for a combined effect. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphoria: Disquiet; restlessness; malaise. [EU] Dyspnea: Difficult or labored breathing. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]
Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents (Dorland, 27th ed). [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejection fraction: A measure of ventricular contractility, equal to normally 65 8 per cent; lower values indicate ventricular dysfunction. [EU] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH]
182
Diuretics
Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]
Emetics: Agents that cause vomiting. They may act directly on the gastrointestinal tract, bringing about emesis through local irritant effects, or indirectly, through their effects on the chemoreceptor trigger zone in the postremal area near the medulla. [NIH] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH]
Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]
Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endolymph: The fluid contained in the membranous labyrinth of the ear. [NIH] Endolymphatic Duct: Duct connecting the endolymphatic sac with the membranous labyrinth. [NIH] Endolymphatic Sac: The blind pouch at the end of the endolymphatic duct. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endosomes: Cytoplasmic vesicles formed when coated vesicles shed their clathrin coat. Endosomes internalize macromolecules bound by receptors on the cell surface. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of
Dictionary 183
the failed kidneys. [NIH] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidermoid carcinoma: A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]
Erythrina: A genus of leguminous shrubs or trees, mainly tropical, yielding certain alkaloids, lectins, and other useful compounds. [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]
Ethacrynic Acid: A compound that inhibits symport of sodium, potassium, and chloride primarily in the ascending limb of Henle, but also in the proximal and distal tubules. This
184
Diuretics
pharmacological action results in excretion of these ions, increased urinary output, and reduction in extracelluar fluid. This compound has been classified as a loop or high ceiling diuretic. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excrete: To get rid of waste from the body. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]
Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds.
Dictionary 185
Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Flecainide: A potent anti-arrhythmia agent, effective in a wide range of ventricular and atrial arrhythmias and tachycardias. Paradoxically, however, in myocardial infarct patients with either symptomatic or asymptomatic arrhythmia, flecainide exacerbates the arrhythmia and is not recommended for use in these patients. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or
186
Diuretics
asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganciclovir: Acyclovir analog that is a potent inhibitor of the Herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from AIDS-associated cytomegalovirus infections. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gasoline: Volative flammable fuel (liquid hydrocarbons) derived from crude petroleum by processes such as distillation reforming, polymerization, etc. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH]
Dictionary 187
Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]
Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomeruli: Plural of glomerulus. [NIH] Glomerulonephritis: Glomerular disease characterized by an inflammatory reaction, with leukocyte infiltration and cellular proliferation of the glomeruli, or that appears to be the result of immune glomerular injury. [NIH] Glomerulosclerosis: Scarring of the glomeruli. It may result from diabetes mellitus (diabetic glomerulosclerosis) or from deposits in parts of the glomerulus (focal segmental glomerulosclerosis). The most common signs of glomerulosclerosis are proteinuria and kidney failure. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration
188
Diuretics
following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]
Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]
Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]
Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Graft-versus-host disease: GVHD. A reaction of donated bone marrow or peripheral stem cells against a person's tissue. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Group Practice: Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanine: One of the four DNA bases. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU]
Dictionary 189
Hair Cells: Mechanoreceptors located in the organ of Corti that are sensitive to auditory stimuli and in the vestibular apparatus that are sensitive to movement of the head. In each case the accessory sensory structures are arranged so that appropriate stimuli cause movement of the hair-like projections (stereocilia and kinocilia) which relay the information centrally in the nervous system. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]
Heartbeat: One complete contraction of the heart. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels
190
Diuretics
of 9 percent or more. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Horny layer: The superficial layer of the epidermis containing keratinized cells. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydralazine: A direct-acting vasodilator that is used as an antihypertensive agent. [NIH] Hydration: Combining with water. [NIH] Hydrochlorothiazide: A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It has been used in the treatment of several disorders including edema,
Dictionary 191
hypertension, diabetes insipidus, and hypoparathyroidism. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hypercalciuria: Abnormally large amounts of calcium in the urine. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH]
192
Diuretics
Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunologic Tests: Diagnostic techniques involving the demonstration or measurement of an immune response, including antibody production or assay, antigen-antibody reactions, serologic cross-reactivity, delayed hypersensitivity reactions, or heterogenetic responses. [NIH]
Immunology: The study of the body's immune system. [NIH] Immunophilins: Members of a family of highly conserved proteins which are all cis-trans peptidyl-prolyl isomerases (peptidylprolyl isomerase). They bind the immunosuppressant drugs cyclosporine; tacrolimus and sirolimus. They possess rotomase activity, which is inhibited by the immunosuppressant drugs that bind to them. EC 5.2.1.- [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incidental: 1. Small and relatively unimportant, minor; 2. Accompanying, but not a major part of something; 3. (To something) Liable to occur because of something or in connection with something (said of risks, responsibilities, .) [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU]
Dictionary 193
Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]
Interindividual: Occurring between two or more individuals. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intrahepatic: Within the liver. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if
194
Diuretics
obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iron Chelating Agents: Organic chemicals that form two or more coordination links with an iron ion. Once coordination has occurred, the complex formed is called a chelate. The ironbinding porphyrin group of hemoglobin is an example of a metal chelate found in biological systems. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Keratoacanthoma: A benign, non-neoplastic, usually self-limiting epithelial lesion closely resembling squamous cell carcinoma clinically and histopathologically. It occurs in solitary, multiple, and eruptive forms. The solitary and multiple forms occur on sunlight exposed areas and are identical histologically; they affect primarily white males. The eruptive form usually involves both sexes and appears as a generalized papular eruption. [NIH] Keratosis: Any horny growth such as a wart or callus. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and
Dictionary 195
coma. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Labyrinthitis: Inflammation of the inner ear. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]
Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH]
196
Diuretics
Lethal: Deadly, fatal. [EU] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]
Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Lichenification: Hypertrophy of the epidermis, resulting in thickening of the skin with exaggeration of the normal skin markings, giving the skin a leathery barklike appearance, which is caused by prolonged rubbing or scratching. It may arise on seemingly normal skin, or it may develop at the site of another pruritic cutaneous disorder. [EU] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Linkage Disequilibrium: Nonrandom association of linked genes. This is the tendency of the alleles of two separate but already linked loci to be found together more frequently than would be expected by chance alone. [NIH] Lipid: Fat. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]
Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [NIH]
Dictionary 197
Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lupus Nephritis: Glomerulonephritis associated with systemic lupus erythematosus. It is classified into four histologic types: mesangial, focal, diffuse, and membranous. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Macula: A stain, spot, or thickening. Often used alone to refer to the macula retinae. [EU] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
198
Diuretics
Mammary: Pertaining to the mamma, or breast. [EU] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Median Neuropathy: Disease involving the median nerve, from its origin at the brachial plexus to its termination in the hand. Clinical features include weakness of wrist and finger flexion, forearm pronation, thenar abduction, and loss of sensation over the lateral palm, first three fingers, and radial half of the ring finger. Common sites of injury include the elbow, where the nerve passes through the two heads of the pronator teres muscle (pronator syndrome) and in the carpal tunnel (carpal tunnel syndrome). [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Glycoproteins: Glycoproteins found on the membrane or surface of cells. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH]
Dictionary 199
Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Methyldopa: An alpha-2 adrenergic agonist that has both central and peripheral nervous system effects. Its primary clinical use is as an antihypertensive agent. Before its alphaadrenergic actions became clear, methyldopa was thought to act by inhibiting decarboxylation of DOPA leading to depletion of norepinephrine or by conversion to and release as the false transmitter alpha-methylnorepinephrine. [NIH] Metolazone: A potent, long acting diuretic useful in chronic renal disease. It also tends to lower blood pressure and increase potassium loss. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Mexiletine: Antiarrhythmic agent pharmacologically similar to lidocaine. It may have some anticonvulsant properties. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microglia: The third type of glial cell, along with astrocytes and oligodendrocytes (which together form the macroglia). Microglia vary in appearance depending on developmental stage, functional state, and anatomical location; subtype terms include ramified, perivascular, ameboid, resting, and activated. Microglia clearly are capable of phagocytosis and play an important role in a wide spectrum of neuropathologies. They have also been suggested to act in several other roles including in secretion (e.g., of cytokines and neural growth factors), in immunological processing (e.g., antigen presentation), and in central nervous system development and remodeling. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH]
200
Diuretics
Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Probes: A group of atoms or molecules attached to other molecules or cellular structures and used in studying the properties of these molecules and structures. Radioactive DNA or RNA sequences are used in molecular genetics to detect the presence of a complementary sequence by molecular hybridization. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Monogenic: A human disease caused by a mutation in a single gene. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]
Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or glycoprotein, the chief constituent of mucus. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive
Dictionary 201
system becomes inflamed. Often seen as sores in the mouth. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multiple Myeloma: A malignant tumor of plasma cells usually arising in the bone marrow; characterized by diffuse involvement of the skeletal system, hyperglobulinemia, Bence-Jones proteinuria, and anemia. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Mycophenolate mofetil: A drug that is being studied for its effectiveness in preventing graft-versus-host disease and autoimmune disorders. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelogenous: Produced by, or originating in, the bone marrow. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myotonia: Prolonged failure of muscle relaxation after contraction. This may occur after voluntary contractions, muscle percussion, or electrical stimulation of the muscle. Myotonia is a characteristic feature of myotonic disorders. [NIH] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Nalorphine: A narcotic antagonist with some agonist properties. It is an antagonist at mu opioid receptors and an agonist at kappa opioid receptors. Given alone it produces a broad spectrum of unpleasant effects and it is considered to be clinically obsolete. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH]
202
Diuretics
Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Natriuresis: The excretion of abnormal amounts of sodium in the urine. [EU] Natriuretic Hormone: A low-molecular weight substance, possibly from the hypothalamus, which is released due to plasma volume expansion. It causes natriuresis in part by inhibiting sodium potassium ATPase. The development of hypertension may be the consequence of an abnormality in volume regulation induced by a defect in the renal response to the natriuretic effect of the natriuretic hormone. Do not confuse with atrial natriuretic factor or cardionatrin which is a different, well characterized hormone. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nephrolithiasis: Kidney stones. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephron: A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood. [NIH] Nephropathy: Disease of the kidneys. [EU] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Nephrotic Syndrome: Clinical association of heavy proteinuria, hypoalbuminemia, and
Dictionary 203
generalized edema. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]
Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nimodipine: A calcium channel blockader with preferential cerebrovascular activity. It has marked cerebrovascular dilating effects and lowers blood pressure. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular
204
Diuretics
endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omeprazole: A highly effective inhibitor of gastric acid secretion used in the therapy of gastric ulcers and Zollinger-Ellison syndrome. The drug inhibits the H(+)-K(+)-ATPase (H(+)-K(+)-exchanging ATPase) in a pH-dependent manner. This ATPase is considered the proton pump in the secretory membrane of the parietal cell. [NIH] Oncology: The study of cancer. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH]
Dictionary 205
Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]
Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Osteocalcin: Vitamin K-dependent calcium-binding protein synthesized by osteoblasts and found primarily in bone. Serum osteocalcin measurements provide a noninvasive specific marker of bone metabolism. The protein contains three residues of the amino acid gammacarboxyglutamic acid (GLA), which, in the presence of calcium, promotes binding to hydroxyapatite and subsequent accumulation in bone matrix. [NIH] Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone. An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ototoxic: Having a deleterious effect upon the eighth nerve, or upon the organs of hearing and balance. [EU]
206
Diuretics
Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxidants: Oxidizing agents or electron-accepting molecules in chemical reactions in which electrons are transferred from one molecule to another (oxidation-reduction). In vivo, it appears that phagocyte-generated oxidants function as tumor promoters or cocarcinogens rather than as complete carcinogens perhaps because of the high levels of endogenous antioxidant defenses. It is also thought that oxidative damage in joints may trigger the autoimmune response that characterizes the persistence of the rheumatoid disease process. [NIH]
Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Paracentesis: A procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument. [NIH] Parasympathetic Nervous System: The craniosacral division of the autonomic nervous system. The cell bodies of the parasympathetic preganglionic fibers are in brain stem nuclei and in the sacral spinal cord. They synapse in cranial autonomic ganglia or in terminal ganglia near target organs. The parasympathetic nervous system generally acts to conserve resources and restore homeostasis, often with effects reciprocal to the sympathetic nervous system. [NIH]
Dictionary 207
Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]
Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH]
208
Diuretics
Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacogenetics: A branch of genetics which deals with the genetic components of variability in individual responses to and metabolism (biotransformation) of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH]
Dictionary 209
Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Phototransduction: The transducing of light energy to afferent nerve impulses, such as takes place in the retinal rods and cones. After light photons are absorbed by the photopigments, the signal is transmitted to the outer segment membrane by the cyclic GMP second messenger system, where it closes the sodium channels. This channel gating ultimately generates an action potential in the inner retina. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH]
210
Diuretics
Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]
Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyarteritis Nodosa: A form of necrotizing vasculitis involving small- and medium-sized arteries. The signs and symptoms result from infarction and scarring of the affected organ system. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Portosystemic Shunt: An operation to create an opening between the portal vein and other veins around the liver. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiate: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH]
Dictionary 211
Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Preload: The tension in the heart muscle at the end of diastole (before the contraction). [EU] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prickle: Several layers of the epidermis where the individual cells are connected by cell bridges. [NIH] Probenecid: The prototypical uricosuric agent. It inhibits the renal excretion of organic anions and reduces tubular reabsorption of urate. Probenecid has also been used to treat patients with renal impairment, and, because it reduces the renal tubular excretion of other drugs, has been used as an adjunct to antibacterial therapy. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is
212
Diuretics
emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Pronation: Applies to movements of the forearm in turning the palm backward or downward or when applied to the foot, a combination of eversion and abduction movements in the tarsal and metatarsal joints, (turning the foot up and in toward the midline of the body). [NIH] Pronator: A muscle which turns a part into the prone position. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]
Protein Binding: The process in which substances, either endogenous or exogenous, bind to
Dictionary 213
proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein Kinases: A family of enzymes that catalyze the conversion of ATP and a protein to ADP and a phosphoprotein. EC 2.7.1.37. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]
Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Proton Pump Inhibitors: Medicines that stop the stomach's acid pump. Examples are omeprazole (oh-MEH-prah-zol) (Prilosec) and lansoprazole (lan-SOH-prah-zol) (Prevacid). [NIH]
Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pseudohypoaldosteronism: A hereditary disorder characterized by salt wasting and growth retardation, presenting in infancy as high levels of urinary sodium despite hyponatremia, hyperkalemia, hyperreninemia, and elevated aldosterone levels. The mode of inheritance is probably autosomal dominant, affecting electrolyte secretion in the kidney tubule. [NIH] Psoralens: Substances found in many different plants, especially Psoralea corylifolia (Legume). They are used for skin diseases, especially vitiligo and as sunscreens. They
214
Diuretics
interact with nucleic acids and are also used as research tools. Psoralens have a coumarin molecule with a furan ring. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary congestion: Fluid accumulation in the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alphaadrenergic neurotransmission. [NIH] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an
Dictionary 215
antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radioisotope Renography: Graphic tracing over a time period of radioactivity measured externally over the kidneys following intravenous injection of a radionuclide which is taken up and excreted by the kidneys. [NIH] Radionuclide Angiography: The measurement of visualization by radiation of any organ after a radionuclide has been injected into its blood supply. It is used to diagnose heart, liver, lung, and other diseases and to measure the function of those organs, except renography, for which radioisotope renography is available. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Rarefaction: The reduction of the density of a substance; the attenuation of a gas. [NIH] Rationalization: A defense mechanism operating unconsciously, in which the individual attempts to justify or make consciously tolerable, by plausible means, feelings, behavior, and motives that would otherwise be intolerable. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombinant Proteins: Proteins prepared by recombinant DNA technology. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH]
216
Diuretics
Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal cell carcinoma: A type of kidney cancer. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal Osteodystrophy: Decalcification of bone due to hyperparathyroidism secondary to chronic kidney disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Renal tubular: A defect in the kidneys that hinders their normal excretion of acids. Failure to excrete acids can lead to weak bones, kidney stones, and poor growth in children. [NIH] Renal tubular acidosis: A rare disorder in which structures in the kidney that filter the blood are impaired, producing using that is more acid than normal. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability
Dictionary 217
to get enough oxygen. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinae: A congenital notch or cleft of the retina, usually located inferiorly. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoid: Vitamin A or a vitamin A-like compound. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Rhabdomyolysis: Necrosis or disintegration of skeletal muscle often followed by myoglobinuria. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Ryanodine: Insecticidal alkaloid isolated from Ryania speciosa; proposed as a myocardial depressant. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salicylic: A tuberculosis drug. [NIH] Salicylic Acids: Derivatives and salts of salicylic acid. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the
218
Diuretics
mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight
Dictionary 219
78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine
220
Diuretics
production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Sodium Fluoride: A source of inorganic fluoride which is used topically to prevent dental caries. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmolytic: Checking spasms; antispasmodic. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way
Dictionary 221
is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH]
222
Diuretics
Stenosis: Narrowing or stricture of a duct or canal. [EU] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S,
Dictionary 223
atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]
Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above
224
Diuretics
100 beats per minute. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermography: Measurement of the regional temperature of the body or an organ by infrared sensing devices, based on self-emanating infrared radiation. [NIH] Thiamine: 3-((4-Amino-2-methyl-5-pyrimidinyl)methyl)-5-(2methylthiazolium chloride. [NIH]
hydroxyethyl)-4-
Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin.
Dictionary 225
(Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]
Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymidine: A chemical compound found in DNA. Also used as treatment for mucositis. [NIH]
Thymidine Kinase: An enzyme that catalyzes the conversion of ATP and thymidine to ADP and thymidine 5'-phosphate. Deoxyuridine can also act as an acceptor and dGTP as a donor. (From Enzyme Nomenclature, 1992) EC 2.7.1.21. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroid Hormones: Hormones secreted by the thyroid gland. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Timolol: A beta-adrenergic antagonist similar in action to propranolol. The levo-isomer is the more active. Timolol has been proposed as an antihypertensive, antiarrhythmic, antiangina, and antiglaucoma agent. It is also used in the treatment of migraine and tremor. [NIH]
Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of
226
Diuretics
an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tissue Distribution: Accumulation of a drug or chemical substance in various organs (including those not relevant to its pharmacologic or therapeutic action). This distribution depends on the blood flow or perfusion rate of the organ, the ability of the drug to penetrate organ membranes, tissue specificity, protein binding. The distribution is usually expressed as tissue to plasma ratios. [NIH] Tocainide: An antiarrhythmic agent which exerts a potential- and frequency-dependent block of sodium channels. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Topical: On the surface of the body. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Traction: The act of pulling. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is
Dictionary 227
analogous to bacterial transformation. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Trimethoprim-sulfamethoxazole: An antibiotic drug used to treat infection and prevent pneumocystis carinii pneumonia. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tyramine: An indirect sympathomimetic. Tyramine does not directly activate adrenergic receptors, but it can serve as a substrate for adrenergic uptake systems and monoamine oxidase so it prolongs the actions of adrenergic transmitters. It also provokes transmitter release from adrenergic terminals. Tyramine may be a neurotransmitter in some invertebrate nervous systems. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the
228
Diuretics
deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Uricosuric: 1. Pertaining to, characterized by, or promoting uricosuria (= the excretion of uric acid in the urine). 2. An agent that promotes uricosuria. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]
Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urine Testing: Checking urine to see if it contains glucose (sugar) and ketones. Special strips of paper or tablets (called reagents) are put into a small amount of urine or urine plus water. Changes in the color of the strip show the amount of glucose or ketones in the urine. Urine testing is the only way to check for the presence of ketones, a sign of serious illness. However, urine testing is less desirable then blood testing for monitoring the level of glucose in the body. [NIH] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Headaches: A group of disorders characterized by recurrent headaches associated with abnormal dilation and constriction of cerebral blood vessels. Representative disorders from this category include migraine, cluster headache, and paroxysmal hemicrania. [NIH] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For
Dictionary 229
dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VATER: A word made from the first letters of a group of birth defects. It is used when all of these birth defects affect the same child. The birth defects are [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventilator: A breathing machine that is used to treat respiratory failure by promoting ventilation; also called a respirator. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Ventricular Remodeling: The geometric and structural changes that the ventricle undergoes, usually following myocardial infarction. It comprises expansion of the infarct and dilatation of the healthy ventricle segments. While most prevalent in the left ventricle, it can also occur in the right ventricle. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibular Nerve: The vestibular part of the 8th cranial nerve (vestibulocochlear nerve). The vestibular nerve fibers arise from neurons of Scarpa's ganglion and project peripherally to vestibular hair cells and centrally to the vestibular nuclei of the brain stem. These fibers mediate the sense of balance and head position. [NIH] Vestibular Neuronitis: That due to a lesion in the labyrinth or vestibule. [NIH] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear
230
Diuretics
part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vibrio: A genus of Vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Vibrio cholerae: The etiologic agent of cholera. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Proteins: Proteins found in any species of virus. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitiligo: A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH] Wetting Agents: A surfactant that renders a surface wettable by water or enhances the spreading of water over the surface; used in foods and cosmetics; important in contrast media; also with contact lenses, dentures, and some prostheses. Synonyms: humectants; hydrating agents. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Dictionary 231
Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xanthine: An urinary calculus. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]
233
INDEX A Abdomen, 157, 167, 193, 196, 207, 221, 222 Abdominal, 153, 157, 186, 206, 207, 208, 211 Abdominal Pain, 157, 186, 208 Abduction, 157, 198, 212 Acceptor, 157, 206, 225, 227 ACE, 4, 6, 13, 23, 25, 28, 29, 32, 36, 38, 40, 78, 95, 100, 102, 118, 121, 137, 138, 141, 157 ACE Inhibitor, 78, 157 Acetaminophen, 13, 157 Acetone, 86, 157, 194 Acetylcholine, 96, 157, 203, 204 Acidosis, 21, 110, 157, 194 Acoustic, 142, 157, 230 Actinic keratosis, 80, 157 Acute myelogenous leukemia, 13, 157 Acute myeloid leukemia, 157 Acute nonlymphocytic leukemia, 157 Acute renal, 3, 25, 27, 28, 29, 32, 34, 110, 111, 118, 158, 190 Acyclovir, 138, 158, 186 Adenine, 158, 214 Adenosine, 77, 96, 99, 158, 164, 167, 209, 224 Adjustment, 13, 79, 158 Adjuvant, 158, 186 Adrenal Cortex, 158, 159, 176, 183, 211, 216 Adrenal Glands, 158, 160 Adrenal Medulla, 158, 170, 183, 204 Adrenergic beta-Antagonists, 158, 162 Adverse Effect, 78, 89, 104, 158, 208, 219 Aerobic, 25, 158 Aerosol, 85, 158 Afferent, 158, 177, 209 Affinity, 19, 20, 76, 158, 164, 220 Agonist, 6, 19, 82, 90, 101, 158, 165, 180, 199, 201 Airway, 14, 159, 220 Airway Resistance, 14, 159 Albumin, 4, 26, 140, 159, 199, 209 Aldosterone, 9, 11, 25, 29, 32, 40, 78, 84, 95, 104, 159, 213 Aldosterone Antagonists, 25, 40, 159 Alertness, 81, 159, 167 Algorithms, 159, 165
Alkaline, 157, 159, 160, 165, 168, 224 Alkaloid, 159, 200, 214, 217, 224 Alkalosis, 12, 20, 21, 110, 159, 224 Alleles, 12, 17, 159, 196 Allergen, 91, 92, 159, 178 Alopecia, 90, 91, 159 Alpha Particles, 159, 215 Alpha-1, 17, 159, 180 Alprenolol, 159, 199 Alternative medicine, 119, 159 Aluminum, 141, 159 Alveoli, 160, 178, 229 Ameliorated, 91, 160 Ameliorating, 86, 91, 160 Amenorrhea, 160, 161 Amino Acid Sequence, 92, 160, 161, 187 Ammonia, 160, 223, 227 Amyloidosis, 54, 111, 113, 160 Anabolic, 95, 160 Anal, 17, 141, 160 Analgesic, 48, 52, 76, 101, 110, 157, 160, 200, 205, 215 Analog, 92, 158, 160, 165, 185, 186 Anatomical, 79, 85, 160, 164, 171, 175, 179, 192, 199, 218 Androgens, 158, 160, 176 Anemia, 160, 185, 201 Anemic, 96, 160 Anesthesia, 159, 160, 177 Anesthetics, 140, 160, 183 Aneurysm, 160, 186, 229 Angina, 96, 102, 158, 161, 166, 199, 201, 212 Angina Pectoris, 102, 158, 161, 166, 199, 201, 212 Angiotensin converting enzyme inhibitor, 6, 31, 79, 88, 95, 101, 161 Angiotensin-Converting Enzyme Inhibitors, 17, 23, 32, 33, 34, 109, 139, 161, 162 Angiotensinogen, 9, 11, 161, 216 Anions, 159, 161, 194, 211, 219 Anomalies, 96, 161, 224 Anorectal, 141, 161 Anorexia, 96, 161, 186 Anorexia Nervosa, 96, 161 Antagonism, 24, 161, 167, 179, 224 Antiarrhythmic, 80, 96, 161, 199, 225, 226
234
Diuretics
Antiasthmatic, 90, 161 Antibacterial, 80, 161, 211, 221 Antibiotic, 91, 161, 202, 204, 207, 221, 227 Antibodies, 15, 16, 20, 161, 189, 192, 209 Antibody, 20, 158, 161, 162, 174, 183, 189, 190, 192, 198, 221 Anticoagulant, 161, 213 Anticonvulsant, 96, 161, 168, 172, 199, 208 Antidiuretic, 82, 85, 86, 104, 114, 161 Antidote, 96, 161 Antifungal, 80, 162, 204, 220 Antigen, 158, 161, 162, 174, 190, 191, 192, 198, 199 Antihypertensive Agents, 102, 105, 121, 162 Anti-infective, 112, 162 Anti-inflammatory, 31, 48, 88, 89, 90, 96, 104, 157, 162, 163, 176, 187, 211, 217 Anti-Inflammatory Agents, 162, 163, 176 Antimetabolite, 158, 162, 185, 199 Antimicrobial, 162, 178 Antimycotic, 162, 173 Antineoplastic, 91, 103, 162, 176, 185, 187, 199, 220 Antineoplastic Agents, 91, 103, 162 Antioxidant, 162, 163, 206 Antipruritic, 18, 162 Antipyretic, 157, 162, 215 Antiseptic, 157, 162 Antispasmodic, 52, 162, 205, 220 Antitussive, 121, 162, 205 Antiviral, 80, 97, 158, 162 Anuria, 162, 195 Anus, 160, 161, 162, 167, 173 Anxiety, 96, 158, 162, 212 Anxiolytic, 96, 162 Aorta, 162, 176, 229 Apnea, 162 Aquaporins, 15, 162 Aqueous, 15, 48, 49, 85, 163, 165, 172, 177, 195 Aqueous fluid, 85, 163 Arachidonate 15-Lipoxygenase, 163, 196 Arachidonate Lipoxygenases, 163, 196 Arachidonic Acid, 89, 104, 163, 196, 212 Arginine, 104, 163, 203 Aromatic, 163, 208 Arrestin, 19, 163 Arrhythmia, 54, 161, 163, 185, 229 Arrhythmogenic, 96, 163 Arterial, 6, 10, 79, 84, 163, 167, 168, 175, 191, 213, 223
Arteries, 35, 142, 162, 163, 166, 176, 199, 201, 210, 214, 225 Arteriolar, 163, 167, 216 Arterioles, 79, 163, 166, 168, 199, 201, 228 Arteriosus, 163, 214 Arteriovenous, 163, 199 Artery, 77, 79, 97, 139, 142, 160, 163, 176, 179, 216 Articular, 163, 205 Ascorbic Acid, 42, 96, 163, 191 Aspirate, 14, 163 Aspirin, 13, 107, 137, 141, 142, 163 Assay, 164, 192 Astrocytes, 164, 199, 200 Asymptomatic, 164, 185 Atenolol, 13, 58, 60, 164 ATP, 164, 180, 187, 209, 213, 225 Atrial, 3, 6, 17, 83, 84, 94, 164, 175, 185, 202, 227 Atrial Fibrillation, 17, 164 Atrial Natriuretic Factor, 83, 164, 202 Atrioventricular, 164, 175 Atrium, 164, 175, 227, 229 Attenuation, 21, 164, 215 Auditory, 164, 189 Autonomic, 88, 96, 157, 164, 177, 186, 204, 206, 207, 220, 223 Autonomic Nervous System, 88, 164, 206, 207, 220, 223 Axons, 164, 203 B Babesiosis, 164, 215 Bacteria, 161, 162, 164, 165, 178, 184, 199, 219, 221, 226, 228 Bacterium, 164, 190 Bacteriuria, 165, 228 Barium, 141, 165 Base, 21, 110, 111, 113, 158, 159, 165, 178, 187, 194, 195, 224 Base Sequence, 165, 187 Benign, 54, 121, 165, 186, 189, 194, 202 Benzene, 78, 165 Benzomorphans, 76, 165 Beta blocker, 6, 18, 32, 109, 121, 139, 141, 165 Betahistine, 141, 165 Bile, 59, 165, 186, 196, 222 Biliary, 165, 168 Biliary Tract, 165, 168 Bilirubin, 159, 165 Bioassays, 52, 165 Bioavailability, 17, 106, 165
Index 235
Biochemical, 8, 15, 18, 20, 115, 159, 162, 165, 188, 195, 205, 208, 219 Biopsy, 112, 122, 137, 140, 165 Biotechnology, 22, 23, 84, 119, 131, 165 Biotransformation, 166, 208 Bisoprolol, 59, 64, 166 Bladder, 26, 86, 166, 174, 192, 203, 212, 216, 228 Blood Coagulation, 166, 168, 225 Blood Coagulation Factors, 166 Blood Platelets, 166, 219 Blood pressure, 6, 10, 11, 12, 15, 37, 78, 84, 94, 102, 105, 108, 110, 113, 118, 120, 137, 138, 139, 140, 141, 142, 157, 162, 166, 168, 169, 171, 186, 191, 199, 200, 203, 204, 214, 220 Blood Proteins, 166 Blood urea, 40, 166, 195 Blood Volume, 6, 166, 169 Body Fluids, 87, 111, 159, 166, 181, 220 Body Image, 120, 166 Body Mass Index, 166, 206 Bone Density, 12, 166 Bone Marrow, 80, 157, 165, 166, 177, 188, 197, 201 Bone scan, 166, 218 Bowel, 83, 120, 140, 160, 167, 179, 193, 195, 208, 222 Bowel Movement, 120, 140, 167, 179, 222 Brachial, 167, 198 Brachial Plexus, 167, 198 Bradykinin, 167, 204, 209 Brain Hypoxia, 167 Brain Infarction, 167 Brain Ischemia, 96, 167 Brain Stem, 88, 167, 206, 229 Branch, 151, 167, 207, 208, 221, 224 Breakdown, 83, 166, 167, 179, 186 Bromine, 100, 167 Bronchi, 167, 183, 224 Bronchial, 35, 90, 165, 167, 190, 224 Bronchospasm, 90, 167 Buccal, 167, 197 Bulimia, 54, 95, 167 C Caffeine, 108, 139, 167, 214 Calcitonin, 7, 22, 168 Calcium channel blocker, 6, 18, 28, 33, 34, 38, 102, 121, 141, 143, 162, 168, 229 Calcium Channel Blockers, 18, 28, 33, 34, 38, 102, 121, 141, 143, 162, 168 Calcium Channels, 7, 168
Calculi, 110, 168, 188 Callus, 168, 194 Cannula, 168, 206 Capillary, 79, 167, 168, 187, 229 Capsules, 81, 168, 180, 186, 187 Captopril, 40, 64, 95, 118, 168 Carbamazepine, 124, 141, 168 Carbohydrate, 102, 168, 176, 188 Carbonate Dehydratase, 168, 169 Carbonic Anhydrase Inhibitors, 115, 124, 169 Carboxy, 19, 101, 169 Carboxy-terminal, 19, 169 Carcinogenic, 165, 169, 222 Carcinogens, 169, 171, 201, 206 Carcinoma, 169 Cardiac Output, 4, 6, 104, 169 Cardiomyopathy, 54, 95, 169 Cardioselective, 164, 166, 169, 212 Cardiotonic, 169, 180 Cardiovascular, 5, 8, 17, 33, 34, 37, 40, 48, 54, 73, 78, 83, 84, 92, 95, 96, 104, 105, 107, 114, 138, 139, 168, 169, 196, 201, 219, 220 Cardiovascular Agents, 107, 169 Cardiovascular disease, 78, 95, 105, 138, 139, 169, 201 Cardiovascular System, 84, 92, 169 Carnitine, 81, 169 Carpal Tunnel Syndrome, 54, 109, 169, 198 Case report, 25, 169, 172 Case series, 169, 172 Case-Control Studies, 13, 17, 170 Catecholamine, 170, 180 Catheterization, 6, 170, 194 Cations, 170, 194 Caudal, 170, 179, 191, 210 Causal, 10, 170 Cecum, 170, 195 Cell Differentiation, 170, 219 Cell Division, 164, 170, 209, 212 Cell membrane, 108, 168, 170, 171, 173, 178, 209, 220 Cell proliferation, 80, 170, 219 Cellulose, 170, 209 Central Nervous System Infections, 170, 189 Cerebral, 167, 170, 171, 175, 183, 185, 214, 224, 228 Cerebral hemispheres, 167, 170, 171 Cerebrovascular, 76, 79, 168, 169, 170, 203
236
Diuretics
Cerebrum, 170, 171 Cervical, 167, 171, 198 Character, 109, 161, 171, 177 Chemoreceptor, 171, 182 Chemotherapeutic agent, 90, 139, 171 Chemotherapy, 91, 97, 122, 171 Chest Pain, 121, 171 Chimera, 15, 171 Chin, 171, 199 Chloride Channels, 7, 171 Chlorine, 100, 171 Cholecystokinin, 99, 171 Cholera, 85, 171, 230 Cholesterol, 6, 55, 97, 108, 137, 139, 142, 165, 171, 176, 180, 222 Chromium, 81, 171 Chromosome, 171, 189, 196 Chronic Disease, 12, 171 Chronic renal, 4, 102, 110, 113, 171, 186, 199 Ciliary, 163, 172 Ciliary processes, 163, 172 Cinchona, 172, 214 Circulatory system, 84, 172 Cirrhosis, 4, 15, 21, 55, 98, 108, 172 CIS, 91, 172, 192, 217 Cisplatin, 90, 91, 172 Citrus, 163, 172 Clamp, 8, 12, 20, 172 Clathrin, 19, 172, 173, 182 Clathrin-Coated Vesicles, 19, 172 Clear cell carcinoma, 172, 178 Clinical Medicine, 115, 172, 211 Clinical study, 11, 172 Clinical trial, 5, 14, 73, 74, 131, 172, 175, 177, 180, 213, 215 Clonazepam, 141, 172 Clone, 7, 8, 172 Clonic, 172, 173 Cloning, 12, 19, 165, 173 Clotrimazole, 138, 173 Coal, 165, 173 Coated Vesicles, 172, 173, 182 Cochlea, 115, 173, 193 Cochlear, 110, 173, 225, 229, 230 Cochlear Diseases, 173, 225 Codon, 94, 173, 187 Coenzyme, 103, 163, 173 Cofactor, 173, 213, 225 Collagen, 160, 173, 186, 209 Collapse, 167, 173, 220 Colloidal, 159, 173, 219
Colon, 140, 173, 195 Communis, 65, 173 Complement, 173, 174, 187, 197, 209 Complementary and alternative medicine, 47, 48, 70, 174 Complementary medicine, 48, 174 Complementation, 8, 174 Complete remission, 174, 216 Compliance, 9, 14, 174 Computational Biology, 131, 174 Computed tomography, 166, 174, 218 Concomitant, 11, 22, 47, 108, 174 Concretion, 168, 174 Conduction, 96, 175 Cone, 175, 223 Confounding, 13, 175 Congenita, 175, 215 Congestion, 95, 175 Connective Tissue, 163, 166, 173, 175, 185, 186, 217, 223, 224 Consciousness, 121, 160, 175, 178, 180 Constipation, 120, 140, 175, 208 Constriction, 175, 194, 228 Constriction, Pathologic, 175, 228 Consumption, 108, 175, 178, 186, 206 Continuous infusion, 36, 175 Contractility, 104, 161, 175, 181 Contraindications, ii, 108, 175 Contrast Media, 175, 230 Control group, 17, 175 Conus, 175, 214 Convulsions, 153, 161, 175, 181, 211 Coordination, 175, 194 Cor, 14, 175, 176 Cor pulmonale, 14, 176 Cornea, 163, 176, 228 Corneum, 86, 176, 183 Coronary, 6, 7, 31, 32, 77, 139, 161, 169, 176, 199, 201 Coronary Artery Bypass, 7, 176 Coronary Circulation, 161, 176 Coronary heart disease, 6, 169, 176 Coronary Thrombosis, 176, 199, 201 Cortex, 176, 185 Cortical, 20, 26, 95, 176, 184, 218 Corticosteroid, 77, 176, 211 Cortisol, 159, 176 Cortisone, 176, 211 Cost Savings, 18, 176 Coumarin, 177, 214 Cranial, 88, 177, 189, 193, 206, 207, 229 Cranial Nerves, 88, 177
Index 237
Craniocerebral Trauma, 177, 189, 225 Creatinine, 5, 177, 195 Curare, 177, 201 Curative, 177, 203, 224 Cutaneous, 55, 177, 194, 196, 197 Cyclic, 167, 177, 188, 204, 209, 212, 224 Cyclosporine, 137, 138, 142, 177, 192 Cyst, 163, 177 Cytokine, 177, 219 Cytomegalovirus, 177, 186 Cytomegalovirus Infections, 177, 186 Cytoplasm, 86, 170, 177, 188, 197, 217 Cytotoxic, 177, 219 Cytotoxicity, 172, 177 D Deamination, 177, 200, 228 Decarboxylation, 177, 190, 199 Decompensation, 9, 177 Degenerative, 79, 175, 177, 205, 217 Dehydration, 27, 86, 171, 178 Dementia, 83, 178 Dendrites, 178, 203 Density, 12, 166, 178, 204, 215, 220 Dental Caries, 178, 185, 220 Dentition, 120, 178 Dentures, 178, 230 Depolarization, 178, 219 Depressive Disorder, 178, 196 Deprivation, 96, 178 Dermal, 87, 178 Dermatitis, 80, 178, 181 DES, 178 Desensitization, 19, 178 Detergents, 16, 178 Deuterium, 178, 191 Developed Countries, 8, 178 Diabetes Insipidus, 178, 191 Diabetes Mellitus, 4, 79, 110, 179, 187, 188, 189 Diagnostic procedure, 75, 119, 179 Dialyzer, 179, 189 Diarrhoea, 83, 179, 186 Diastole, 179, 211 Diastolic, 5, 104, 179, 191 Diastolic blood pressure, 5, 179 Diencephalon, 179, 191, 224 Digestion, 165, 167, 179, 181, 193, 196, 207, 222 Digestive system, 74, 179, 201 Digestive tract, 179, 220, 221 Dilatation, 32, 36, 160, 179, 229 Dilatation, Pathologic, 179, 229
Dilated cardiomyopathy, 38, 41, 179 Dilation, 77, 167, 179, 228 Diltiazem, 61, 102, 179 Dilution, 111, 179, 183 Dimethyl, 82, 179 Diploid, 174, 179, 209 Direct, iii, 6, 11, 15, 16, 101, 109, 123, 172, 179, 180, 190, 215, 216, 223 Disposition, 4, 179 Dissociation, 86, 158, 179 Dissociative Disorders, 179, 180 Distal, 7, 9, 15, 16, 20, 21, 27, 86, 95, 98, 109, 176, 180, 183, 213 Diuresis, 16, 18, 30, 81, 82, 84, 93, 97, 98, 167, 180, 224 Diuretics, Thiazide, 25, 40, 125, 162, 180 Dizziness, 98, 121, 180, 229 DNA Topoisomerase, 180, 187 Dobutamine, 7, 180 Dopamine, 3, 27, 96, 180, 200, 203, 208 Doping, 36, 180 Dorsal, 180, 210, 221 Dosage Forms, 98, 180 Dose-limiting, 91, 180 Double-blind, 30, 180 Double-blinded, 30, 180 Doxazosin, 6, 180 Drug Combinations, 47, 181 Drug Interactions, 36, 108, 112, 126, 181 Drug Resistance, 80, 108, 181 Drug Tolerance, 181, 226 Duct, 15, 21, 86, 168, 170, 181, 182, 184, 218, 222, 223 Duodenum, 165, 181, 222 Dyspepsia, 89, 181 Dysphoria, 18, 82, 181 Dyspnea, 177, 181 E Eating Disorders, 37, 53, 55, 181 Echocardiography, 30, 181 Eclampsia, 181, 211 Eczema, 80, 181 Edema, 15, 26, 55, 82, 98, 108, 110, 121, 177, 181, 186, 190, 193, 201, 203, 204, 211 Effector, 88, 157, 174, 181, 203 Effector cell, 181, 203 Efferent, 177, 181, 200 Efficacy, 14, 36, 53, 78, 102, 181 Ejection fraction, 6, 181 Elastic, 181, 220, 223 Elasticity, 84, 181 Elective, 182
238
Diuretics
Electrolyte, 16, 41, 48, 100, 110, 125, 159, 176, 182, 189, 195, 200, 210, 213, 220 Emesis, 154, 182 Emetics, 95, 96, 182 Enalapril, 61, 64, 95, 182 Encapsulated, 106, 182 Endemic, 171, 182 Endogenous, 81, 82, 89, 103, 166, 180, 181, 182, 183, 206, 212 Endolymph, 115, 182 Endolymphatic Duct, 182 Endolymphatic Sac, 139, 182 Endorphins, 182, 203 Endoscopy, 141, 182 Endosomes, 172, 182 Endothelial cell, 94, 182, 225 Endothelium, 89, 103, 182, 203 Endothelium, Lymphatic, 182 Endothelium, Vascular, 182 Endothelium-derived, 89, 103, 182, 203 End-stage renal, 171, 182 Enkephalins, 183, 203 Environmental Health, 130, 132, 183 Enzymatic, 160, 168, 174, 178, 183, 190, 217 Enzyme Inhibitors, 22, 23, 24, 101, 183, 209 Epidermal, 80, 86, 87, 183, 194 Epidermis, 80, 176, 183, 190, 194, 196, 211, 214 Epidermoid carcinoma, 183, 221 Epinephrine, 158, 180, 183, 203, 204, 227 Epithelial, 7, 8, 10, 15, 16, 80, 85, 86, 95, 183, 194 Epithelial Cells, 7, 8, 10, 86, 95, 183 Epithelium, 16, 85, 182, 183 Epitope, 19, 183 Erythrina, 65, 67, 183 Erythrocyte Volume, 166, 183 Erythrocytes, 160, 164, 166, 168, 183, 216 Esophagus, 179, 183, 222 Estradiol, 7, 183 Estrogen, 17, 183 Estrogen receptor, 17, 183 Ethacrynic Acid, 92, 183 Evacuation, 141, 175, 184, 195, 214 Excitability, 184, 201, 214 Excitation, 171, 184, 203 Excitatory, 184, 188 Excrete, 162, 184, 195, 216 Exhaustion, 161, 184 Exocrine, 171, 184, 206 Exogenous, 8, 166, 168, 181, 182, 184, 212 Extensor, 184, 214, 230
Extracellular, 8, 15, 77, 84, 99, 108, 164, 175, 184, 205, 220, 224 Extracellular Matrix, 175, 184, 205 Extracellular Space, 108, 184 Extraction, 16, 184 Extrapyramidal, 180, 184 Extremity, 167, 184, 198 F Faecal, 179, 184 Family Planning, 131, 184 Fat, 81, 163, 166, 175, 176, 184, 194, 196, 206, 217, 220, 223 Fatigue, 81, 98, 184, 189 Fatty acids, 159, 184, 196, 212, 225 Feces, 175, 184, 222 Fetus, 184, 209, 211 Fibrin, 166, 184, 208, 224, 225 Fibrinogen, 184, 209, 224 Fibrosis, 85, 185, 218 Filtration, 100, 111, 185, 195 Fissure, 173, 185 Flecainide, 141, 185 Flexion, 185, 198 Fluorescence, 8, 185 Fluorine, 100, 185 Fluorouracil, 80, 185 Flush, 137, 185 Flushing, 185 Folate, 96, 185 Folic Acid, 42, 96, 185 Foramen, 171, 173, 185, 208 Forearm, 166, 185, 198, 212 Free Radicals, 162, 179, 185 Friction, 159, 185 Fungi, 162, 185, 188, 199, 231 Furosemide, 6, 16, 26, 31, 90, 92, 95, 98, 106, 186 G GABA, 96, 172, 186, 219 Gallbladder, 157, 165, 171, 179, 186 Ganciclovir, 138, 186 Ganglia, 157, 167, 186, 203, 206, 207, 223 Ganglion, 186, 229, 230 Ganglionic Blockers, 162, 186 Gas, 31, 160, 171, 185, 186, 191, 201, 203, 204, 215, 222, 229 Gas exchange, 186, 229 Gasoline, 165, 186 Gastric, 83, 98, 99, 154, 169, 180, 186, 190, 204, 207 Gastrin, 99, 186, 190 Gastroenteritis, 167, 186
Index 239
Gastrointestinal, 83, 89, 90, 91, 99, 103, 104, 167, 171, 182, 183, 186, 196, 219, 220, 222, 230 Gastrointestinal tract, 182, 186, 196, 219 Gelatin, 106, 186, 188, 223, 224 Gels, 16, 186 Gene, 8, 10, 11, 17, 94, 159, 165, 187, 200 Genetic Code, 97, 187, 204 Genetic Engineering, 165, 173, 187 Genetics, 11, 13, 187, 200, 208 Genistein, 52, 187 Genotype, 13, 187, 208 Germ Cells, 187, 204, 206, 224 Ginseng, 62, 67, 187 Gland, 94, 158, 176, 187, 206, 207, 209, 212, 218, 222, 223, 225 Glomerular, 5, 84, 100, 110, 111, 112, 187, 194, 195, 216 Glomerular Filtration Rate, 5, 84, 111, 187, 195 Glomeruli, 109, 136, 187 Glomerulonephritis, 109, 112, 187, 197 Glomerulosclerosis, 112, 187 Glomerulus, 84, 187, 202 Glucocorticoid, 187, 211 Glucose, 79, 163, 170, 171, 179, 187, 189, 193, 218, 228 Glucose Intolerance, 179, 187 Glutamate, 96, 188 Glutamic Acid, 81, 185, 188, 203 Glutathione Peroxidase, 188, 219 Glycerol, 163, 188, 209 Glycine, 160, 188, 203, 219 Glycoprotein, 184, 188, 200, 225 Glycosylation, 20, 188 Gonadal, 188, 222 Gout, 137, 140, 142, 188 Governing Board, 188, 211 Graft, 188, 192, 201 Grafting, 176, 188 Graft-versus-host disease, 188, 201 Granulocytes, 188, 196, 219, 230 Grasses, 185, 188 Group Practice, 18, 188 Growth, 80, 94, 160, 161, 162, 170, 188, 194, 197, 199, 202, 205, 209, 213, 216, 225, 227, 230 Guanine, 188, 214 Guanylate Cyclase, 188, 204 H Habitual, 171, 188 Hair Cells, 142, 189, 229
Half-Life, 189, 201 Haploid, 189, 209 Haplotypes, 17, 189 Haptens, 158, 189 Headache, 121, 167, 189, 211, 228 Headache Disorders, 189 Heart attack, 96, 169, 189 Heart Transplantation, 7, 189 Heartbeat, 189, 222 Hematuria, 110, 112, 189 Hemodialysis, 111, 112, 179, 189, 195, 227 Hemodynamics, 108, 189 Hemofiltration, 111, 189, 227 Hemoglobin, 160, 183, 189, 194 Hemolytic, 111, 190 Hemorrhage, 14, 177, 189, 190, 214, 222 Hemostasis, 190, 219 Hepatic, 80, 159, 190, 196, 200 Hereditary, 110, 188, 190, 213 Heredity, 187, 190 Herpes, 97, 158, 190 Heterogeneity, 13, 158, 190 Histamine, 165, 190 Homeostasis, 8, 9, 12, 21, 30, 82, 92, 94, 190, 206, 220 Homologous, 15, 159, 190, 223 Hormonal, 7, 10, 88, 176, 190 Hormone Replacement Therapy, 13, 190 Horny layer, 183, 190 Hybrid, 20, 172, 190 Hybridization, 190, 200 Hydralazine, 6, 63, 64, 125, 190 Hydration, 30, 169, 190 Hydrochlorothiazide, 11, 13, 44, 58, 63, 64, 69, 73, 112, 124, 125, 190 Hydrogen, 100, 104, 157, 165, 168, 178, 188, 191, 200, 203, 206, 208, 213 Hydrolysis, 166, 172, 191, 208, 213 Hydrophilic, 98, 178, 191 Hydrophobic, 178, 191 Hydroxyproline, 160, 173, 191 Hypercalcemia, 8, 31, 32, 191 Hypercalciuria, 83, 191 Hypersensitivity, 159, 178, 191, 192, 196, 217 Hyperthyroidism, 191, 212 Hypertrophy, 176, 191, 196, 227 Hyperuricemia, 78, 188, 191 Hypotension, 4, 20, 175, 186, 191 Hypotensive, 48, 50, 102, 191 Hypothalamic, 88, 191
240
Diuretics
Hypothalamus, 82, 88, 105, 164, 179, 191, 202, 209, 224 I Id, 42, 53, 143, 150, 152, 191 Idiopathic, 38, 41, 191 Ileostomy, 191, 202 Illusion, 191, 229 Imidazole, 173, 190, 191 Immune function, 97, 191 Immune response, 158, 162, 176, 189, 191, 192, 197, 222, 230 Immune system, 110, 181, 191, 192, 196, 208, 228, 230 Immunohistochemistry, 15, 192 Immunologic, 122, 192 Immunologic Tests, 122, 192 Immunology, 158, 192 Immunophilins, 192, 220 Immunosuppressant, 185, 192, 199, 220 Immunosuppressive, 47, 187, 192, 224 Immunotherapy, 178, 192 Impairment, 121, 192, 199, 211 In situ, 16, 192 In vitro, 12, 17, 22, 52, 98, 192, 224, 226 In vivo, 91, 98, 192, 206, 224, 225 Incidental, 37, 192 Incontinence, 112, 192 Indicative, 113, 192, 207, 228 Infancy, 192, 213 Infarction, 167, 192, 210, 216 Infection, 4, 14, 56, 57, 113, 140, 172, 177, 186, 191, 192, 197, 203, 207, 217, 222, 227, 230 Infiltration, 187, 192 Infusion, 4, 15, 193 Ingestion, 185, 193, 210, 224 Inhalation, 158, 193, 210 Inner ear, 115, 121, 139, 142, 173, 193, 195 Innervation, 167, 193, 198 Inorganic, 172, 193, 201, 220 Inotropic, 164, 180, 193 Insomnia, 193, 211 Insulin, 14, 193, 194 Insulin-dependent diabetes mellitus, 193 Intensive Care, 3, 193 Interindividual, 11, 193 Intermittent, 193, 208 Internal Medicine, 4, 17, 25, 30, 31, 38, 51, 53, 193, 202 Interstitial, 21, 111, 184, 193, 202, 216 Intestinal, 8, 84, 171, 193 Intestinal Mucosa, 171, 193
Intestine, 8, 167, 193, 195 Intracellular, 8, 167, 168, 172, 192, 193, 198, 204, 210, 212, 215, 219 Intracellular Membranes, 193, 198 Intracranial Hypertension, 189, 193, 225 Intrahepatic, 21, 193 Intravascular, 94, 193 Intravenous, 32, 34, 193, 215 Intrinsic, 158, 163, 193 Intubation, 170, 193 Inulin, 187, 194 Involuntary, 194, 201, 220 Ions, 31, 104, 106, 165, 168, 169, 171, 179, 180, 182, 184, 191, 194, 213, 220 Iron Chelating Agents, 91, 194 Irritants, 86, 194 Ischemia, 79, 96, 167, 194, 216 J Joint, 137, 140, 142, 163, 194, 205, 223 K Kb, 130, 194 Keratin, 194 Keratinocytes, 80, 194 Keratoacanthoma, 80, 194 Keratosis, 80, 157, 194 Ketoacidosis, 157, 194 Ketone Bodies, 157, 194 Kidney Disease, 5, 74, 109, 110, 112, 122, 130, 136, 137, 138, 142, 157, 195, 216 Kidney Failure, 12, 113, 122, 182, 187, 195 Kidney Failure, Acute, 195 Kidney Failure, Chronic, 195 Kidney stone, 110, 111, 112, 137, 142, 195, 202, 216, 228 Kidney Transplantation, 122, 195 Kinetics, 4, 168, 195 L Labyrinth, 173, 182, 193, 195, 219, 229 Labyrinthitis, 121, 195 Large Intestine, 8, 170, 179, 193, 195, 215, 220 Laryngeal, 121, 195 Larynx, 195 Latency, 13, 195 Lavage, 154, 195 Laxative, 40, 50, 195 Lectin, 195, 198 Lens, 163, 175, 195 Lethal, 85, 196, 201 Leucocyte, 159, 196 Leukemia, 196 Leukocytes, 166, 188, 196
Index 241
Leukotrienes, 163, 196 Library Services, 150, 196 Lichenification, 80, 196 Lidocaine, 196, 199 Ligament, 196, 212 Ligands, 20, 99, 196 Linkage, 10, 12, 17, 93, 94, 196 Linkage Disequilibrium, 17, 196 Lipid, 25, 27, 34, 40, 86, 102, 188, 193, 196 Lipoxygenase, 103, 163, 196 Lisinopril, 64, 196 Lithium, 51, 111, 196 Liver Cirrhosis, 82, 196 Liver scan, 197, 218 Localization, 20, 192, 197 Localized, 80, 160, 167, 178, 182, 192, 197, 200, 204, 209, 218, 227 Locomotion, 197, 209 Lumen, 9, 85, 168, 182, 197 Lupus, 110, 121, 122, 197, 223 Lupus Nephritis, 110, 121, 122, 197 Lymph, 171, 172, 182, 197 Lymphatic, 182, 192, 197, 204, 221 Lymphocytes, 162, 163, 196, 197, 221, 224, 230 Lymphoid, 161, 196, 197 M Macula, 16, 197 Magnetic Resonance Imaging, 197, 218 Major Histocompatibility Complex, 189, 197 Malaise, 181, 197 Malignancy, 8, 197 Malignant, 5, 162, 197, 201, 202 Malignant tumor, 197, 201 Malnutrition, 40, 159, 197 Mammary, 176, 198 Manic, 196, 198 Manifest, 4, 198 Mechanical ventilation, 14, 198 Median Nerve, 109, 169, 198 Median Neuropathy, 109, 198 Mediate, 18, 85, 96, 100, 105, 180, 198, 229 Mediator, 171, 198, 219 Medical Staff, 180, 198 Medicament, 97, 103, 198, 223 MEDLINE, 131, 198 Medullary, 20, 21, 26, 111, 198 Megaloblastic, 185, 198 Melanin, 198, 208, 227 Membrane Glycoproteins, 198 Membrane Proteins, 15, 198, 213
Memory, 81, 161, 178, 198 Meninges, 170, 177, 198 Menopause, 198, 210, 212 Menstrual Cycle, 198, 211 Menstruation, 160, 198, 199, 211 Mental, iv, 5, 74, 81, 130, 132, 171, 178, 179, 184, 198, 199, 214, 218, 228 Mental Disorders, 74, 199, 214 Mental Processes, 179, 199, 214 Metabolic disorder, 178, 188, 199 Metabolite, 97, 166, 179, 199 Methionine, 90, 91, 179, 199, 223 Methotrexate, 80, 96, 199 Methyldopa, 60, 64, 125, 199 Metolazone, 22, 199 Metoprolol, 64, 66, 199 Mexiletine, 141, 199 MI, 12, 17, 36, 104, 155, 199 Microbe, 199, 226 Microcirculation, 79, 196, 199 Microglia, 164, 199, 200 Microorganism, 173, 199, 230 Milliliter, 166, 200 Mineralocorticoids, 158, 176, 200 Modification, 26, 77, 160, 187, 200, 214 Molecular, 8, 11, 12, 15, 16, 18, 114, 131, 133, 164, 165, 168, 174, 185, 200, 202, 215, 226 Molecular Probes, 16, 200 Molecule, 162, 165, 173, 174, 179, 181, 182, 183, 184, 191, 195, 200, 206, 214, 215, 219 Monitor, 177, 200 Monoamine, 47, 200, 227 Monoamine Oxidase, 47, 200, 227 Monogenic, 35, 200 Monotherapy, 102, 200 Morphine, 76, 165, 200, 202, 205 Morphological, 15, 200 Morphology, 15, 200 Motility, 87, 200, 219 Motion Sickness, 200, 202 Motor nerve, 200, 201 Mucolytic, 121, 200 Mucosa, 197, 200, 202 Mucositis, 200, 225 Mucus, 200, 201 Multiple Myeloma, 113, 201 Muscle relaxant, 95, 96, 201, 208 Muscle Spindles, 201, 208 Muscle tension, 201 Mustard Gas, 194, 201 Mycophenolate mofetil, 138, 201
242
Diuretics
Mydriatic, 179, 201 Myelogenous, 201 Myocardial infarction, 6, 12, 17, 32, 95, 105, 176, 180, 199, 201, 212, 229 Myocardial Ischemia, 161, 201 Myocardium, 104, 161, 199, 201 Myotonia, 201, 215 N Nadolol, 58, 201 Nalorphine, 76, 201 Narcosis, 201, 202 Narcotic, 139, 200, 201, 202 Nasal Cavity, 202 Nasal Mucosa, 92, 202 Natriuresis, 84, 161, 202 Natriuretic Hormone, 84, 202 Nausea, 105, 180, 186, 202, 211, 228 NCI, 1, 74, 129, 172, 202 Necrotizing Enterocolitis, 14, 202 Neomycin, 141, 202 Neoplasia, 111, 202 Neoplasm, 202 Neoplastic, 80, 194, 202 Nephritis, 109, 111, 113, 122, 202 Nephrolithiasis, 110, 111, 202 Nephrology, 4, 26, 27, 32, 50, 51, 109, 112, 114, 202 Nephron, 4, 9, 21, 51, 86, 95, 111, 187, 202 Nephropathy, 110, 111, 112, 195, 202 Nephrosis, 202 Nephrotic, 4, 15, 108, 109, 112, 136, 140, 202 Nephrotic Syndrome, 4, 15, 108, 109, 112, 136, 140, 202 Nerve Fibers, 88, 167, 203, 229 Nervous System, 82, 88, 96, 99, 157, 158, 164, 165, 167, 168, 170, 171, 181, 186, 188, 189, 196, 198, 199, 200, 203, 206, 207, 210, 219, 223, 224, 227 Neural, 91, 158, 186, 199, 200, 203, 220 Neuroeffector Junction, 96, 203 Neurogenic, 26, 203 Neuromuscular, 157, 203 Neuromuscular Junction, 157, 203 Neuronal, 96, 168, 201, 203 Neurons, 88, 178, 184, 186, 201, 203, 223, 229, 230 Neuropathy, 79, 203 Neuropeptides, 99, 203 Neurotoxicity, 90, 203 Neurotransmitter, 81, 157, 158, 160, 167, 180, 186, 188, 190, 203, 204, 219, 222, 227
Neutrons, 159, 203, 215 Neutrophil, 96, 203 Niacin, 137, 142, 203, 227 Nimodipine, 141, 203 Nitric Oxide, 14, 89, 103, 203 Nitrogen, 40, 159, 160, 195, 204, 227 Norepinephrine, 105, 158, 180, 199, 203, 204 Normotensive, 78, 204 Nuclei, 105, 159, 187, 197, 203, 204, 206, 213, 229, 230 Nucleic acid, 165, 187, 190, 204, 214 Nucleus, 177, 178, 197, 203, 204, 212, 213, 220, 222, 230 Nursing Care, 204, 207 Nystatin, 138, 204 O Oedema, 83, 93, 113, 204 Ointments, 180, 204 Oliguria, 195, 204 Omeprazole, 204, 213 Oncology, 137, 204 Oocytes, 15, 19, 204 Opacity, 178, 204 Opiate, 76, 200, 205 Opium, 200, 205 Optic Chiasm, 191, 205 Orbital, 173, 205 Organ Culture, 205, 226 Organelles, 172, 177, 205 Osmolality, 105, 106, 111, 205 Osmoles, 205 Osmosis, 205 Osmotic, 15, 86, 102, 159, 205, 219 Osteoarthritis, 89, 104, 205 Osteoblasts, 53, 205 Osteocalcin, 53, 205 Osteoclasts, 168, 205 Osteoporosis, 8, 56, 205 Ototoxic, 90, 137, 139, 142, 205 Outpatient, 18, 206 Ovary, 183, 206 Overactive bladder, 112, 206 Overdose, 153, 206 Overweight, 41, 137, 142, 206 Oxidants, 86, 206 Oxidation, 157, 162, 163, 166, 188, 206 Oxidation-Reduction, 166, 206 Oxygen Consumption, 77, 206 P Pacemaker, 96, 206 Palliative, 206, 224
Index 243
Pancreas, 157, 179, 193, 206 Pancreatic, 169, 171, 206 Paracentesis, 4, 21, 206 Parasympathetic Nervous System, 88, 206 Parathyroid, 7, 207, 224 Parathyroid Glands, 207 Parathyroid hormone, 7, 207 Paroxysmal, 121, 161, 189, 207, 228 Partial remission, 207, 216 Patch, 8, 12, 20, 175, 207 Pathogenesis, 3, 20, 108, 109, 111, 207 Pathologic, 109, 157, 165, 176, 191, 207, 214 Pathophysiology, 9, 12, 108, 111, 112, 207 Patient Care Management, 113, 207 Patient Education, 136, 137, 148, 150, 155, 207 Pelvic, 32, 36, 207, 212 Pelvis, 157, 207 Penicillin, 161, 207 Peptic, 165, 207 Peptic Ulcer, 165, 207 Peptide, 3, 16, 20, 22, 81, 82, 83, 84, 92, 94, 160, 164, 168, 171, 194, 207, 213, 225 Perfusion, 48, 207, 226 Pericardium, 207, 223 Peripheral Nervous System, 88, 96, 183, 199, 203, 207, 222 Peritoneal, 111, 112, 204, 207, 208 Peritoneal Cavity, 204, 208 Peritoneal Dialysis, 111, 112, 208 Peritoneum, 207, 208 Peritonitis, 140, 208 PH, 166, 208 Phagocyte, 206, 208 Pharmaceutical Preparations, 170, 186, 208 Pharmaceutical Solutions, 180, 208 Pharmacodynamics, 4, 208 Pharmacogenetics, 12, 17, 208 Pharmacologic, 7, 12, 52, 160, 189, 208, 226 Phenotype, 8, 19, 174, 208 Phenyl, 93, 100, 104, 208 Phenylalanine, 81, 208, 227 Phenytoin, 141, 168, 208 Phospholipases, 7, 208, 219 Phospholipids, 184, 209 Phosphorus, 168, 207, 209 Phosphorylated, 19, 163, 173, 209 Phosphorylation, 16, 19, 20, 209, 213 Phototransduction, 163, 209 Physiologic, 109, 141, 158, 189, 194, 198, 199, 209, 212, 215, 227
Physiology, 15, 21, 24, 34, 110, 111, 113, 114, 139, 140, 202, 209 Pigmentation, 80, 209 Pituitary Gland, 176, 209 Placenta, 183, 209, 211 Plants, 40, 49, 50, 52, 159, 172, 187, 194, 195, 200, 204, 209, 213, 218, 226, 227 Plasma cells, 161, 201, 209 Plasma protein, 159, 182, 209, 213, 219 Platelet Activation, 209, 219 Platelet Aggregation, 105, 204, 209, 225 Platelets, 105, 204, 209, 210, 225 Platinum, 90, 91, 172, 197, 210 Pleural, 204, 210 Pleural cavity, 204, 210 Pneumonia, 175, 210, 227 Poisoning, 186, 202, 210 Polyarteritis Nodosa, 112, 210 Polymerase, 97, 210 Polymorphism, 12, 17, 23, 210 Polyuria, 20, 210 Pons, 167, 210 Portal Vein, 210 Portosystemic Shunt, 21, 210 Posterior, 105, 160, 163, 180, 206, 210 Postmenopausal, 13, 30, 142, 205, 210 Postnatal, 14, 210 Postsynaptic, 203, 210, 219 Potentiate, 83, 210 Potentiating, 79, 210 Potentiation, 90, 211, 219 Practice Guidelines, 132, 143, 211 Precancerous, 157, 211 Preclinical, 111, 211 Precursor, 94, 161, 163, 164, 180, 181, 182, 183, 204, 208, 211, 213, 227 Prednisolone, 211 Prednisone, 140, 211 Preeclampsia, 56, 136, 211 Preload, 92, 211 Premenstrual, 56, 83, 88, 211 Premenstrual Syndrome, 56, 83, 88, 211 Prenatal, 32, 36, 211 Presynaptic, 203, 211 Prevalence, 85, 105, 211 Prickle, 194, 211 Probenecid, 36, 211 Progesterone, 211, 222 Progression, 138, 157, 211 Progressive, 27, 113, 170, 171, 172, 178, 181, 188, 195, 205, 209, 211, 216 Projection, 204, 211
244
Diuretics
Pronation, 198, 212 Pronator, 198, 212 Prone, 87, 212 Prophase, 204, 212, 223 Prophylaxis, 108, 212 Proportional, 6, 205, 212 Propranolol, 64, 67, 164, 212, 225 Prostaglandin, 89, 104, 161, 212, 225 Prostaglandins A, 212 Prostate, 56, 121, 212 Protective Agents, 91, 168, 212 Protein Binding, 212, 226 Protein C, 95, 159, 160, 172, 173, 194, 205, 213, 228 Protein Conformation, 160, 194, 213 Protein Kinases, 7, 19, 213 Protein S, 19, 166, 187, 202, 205, 213, 217 Protein-Tyrosine Kinase, 187, 213 Proteinuria, 110, 112, 187, 201, 202, 211, 213 Proteolytic, 159, 174, 185, 213 Prothrombin, 213, 224 Protocol, 10, 11, 27, 213 Proton Pump, 103, 204, 213 Proton Pump Inhibitors, 103, 213 Protons, 159, 191, 213, 215 Proximal, 7, 9, 16, 86, 98, 109, 169, 180, 183, 202, 211, 213 Pruritic, 181, 196, 213 Pseudohypoaldosteronism, 12, 213 Psoralens, 81, 213 Psoriasis, 32, 80, 201, 214 Psychiatric, 141, 199, 214 Psychiatry, 30, 51, 214, 222, 229 Psychic, 199, 214, 218 Psychology, 179, 214 Psychomotor, 168, 214 Psyllium, 67, 214 Public Policy, 131, 214 Pulmonary, 6, 14, 56, 57, 85, 115, 142, 159, 166, 171, 175, 176, 189, 195, 196, 214, 223, 229 Pulmonary Artery, 6, 142, 166, 214, 229 Pulmonary congestion, 85, 214 Pulmonary Edema, 56, 171, 195, 214 Pulmonary hypertension, 14, 143, 176, 214 Pupil, 176, 179, 201, 214 Purgative, 195, 214 Purines, 137, 140, 142, 165, 214, 219 Purpura, 112, 214 Pyrimidines, 165, 214, 219
Q Quality of Life, 9, 214, 223 Quinidine, 67, 91, 172, 214 Quinine, 91, 139, 141, 172, 214 R Race, 13, 108, 180, 215 Radiation, 13, 90, 91, 161, 185, 215, 218, 224, 231 Radioactive, 166, 189, 191, 197, 200, 215, 218 Radioisotope, 183, 215, 226 Radioisotope Renography, 215 Radionuclide Angiography, 6, 215 Randomized, 5, 14, 18, 21, 30, 31, 34, 181, 215 Randomized clinical trial, 30, 215 Rarefaction, 79, 215 Rationalization, 21, 215 Reagent, 171, 215 Receptors, Serotonin, 215, 219 Recombinant, 16, 20, 215 Recombinant Proteins, 20, 215 Rectum, 94, 161, 162, 167, 173, 179, 186, 192, 195, 212, 215, 223 Red blood cells, 183, 190, 216, 218 Reductase, 199, 216 Refer, 1, 140, 167, 173, 180, 182, 186, 190, 197, 203, 216, 226, 229 Refraction, 216, 221 Refractory, 4, 21, 31, 99, 216 Regimen, 6, 40, 81, 137, 181, 216 Relaxant, 94, 208, 216 Remission, 110, 216 Renal cell carcinoma, 13, 216 Renal failure, 6, 8, 82, 98, 105, 111, 113, 216 Renal Osteodystrophy, 111, 216 Renal pelvis, 195, 216 Renal tubular, 7, 21, 110, 211, 216 Renal tubular acidosis, 21, 110, 216 Renin, 9, 11, 17, 32, 78, 94, 101, 102, 104, 108, 161, 168, 216 Renin-Angiotensin System, 9, 17, 101, 161, 168, 216 Reperfusion, 96, 216 Reperfusion Injury, 216 Respirator, 198, 216, 229 Respiratory distress syndrome, 82, 216 Respiratory Physiology, 217, 229 Retina, 175, 195, 205, 209, 217, 228 Retinae, 197, 217 Retinal, 163, 175, 205, 209, 217 Retinoid, 86, 217
Index 245
Retinopathy, 5, 14, 217 Rhabdomyolysis, 32, 217 Rheumatism, 217 Rheumatoid, 57, 80, 89, 104, 206, 217 Rheumatoid arthritis, 80, 89, 104, 217 Rhodopsin, 163, 217 Ribose, 158, 217 Ribosome, 217, 227 Rigidity, 209, 217 Risk factor, 5, 40, 78, 108, 137, 139, 217 Rod, 62, 164, 172, 217 Ryanodine, 12, 217 S Salicylate, 217 Salicylic, 217 Salicylic Acids, 217 Saliva, 217, 218 Salivary, 177, 179, 217, 218 Salivary glands, 177, 179, 217, 218 Salivation, 154, 218 Saphenous, 176, 218 Saphenous Vein, 176, 218 Saponins, 218, 222 Scans, 17, 218 Schizophrenia, 30, 118, 218 Scleroderma, 142, 218 Sclerosis, 113, 218 Screening, 20, 36, 52, 172, 218, 228 Sebaceous, 194, 218 Sebaceous gland, 194, 218 Secretion, 16, 21, 82, 83, 86, 99, 169, 176, 190, 193, 199, 200, 201, 204, 213, 218, 219 Secretory, 85, 111, 203, 204, 218 Sedative, 76, 218 Sedentary, 120, 141, 218 Sediment, 218, 228 Segmental, 10, 21, 108, 112, 187, 218 Segmentation, 218 Seizures, 118, 168, 172, 207, 208, 218 Selenium, 38, 41, 218 Semen, 212, 219 Semicircular canal, 193, 219 Senile, 157, 205, 219 Sepsis, 4, 219 Sequencing, 20, 219 Serine, 96, 219 Serologic, 192, 219 Serotonin, 36, 96, 200, 203, 215, 219, 227 Serous, 182, 219 Serum, 5, 6, 11, 37, 40, 57, 78, 82, 94, 159, 166, 173, 180, 195, 200, 205, 208, 219 Serum Albumin, 166, 219
Signal Transduction, 19, 219 Signs and Symptoms, 95, 210, 216, 219 Sirolimus, 138, 192, 219 Skeletal, 51, 160, 172, 177, 201, 214, 217, 220 Skeleton, 194, 212, 220 Skull, 177, 220, 224 Sleep apnea, 108, 220 Small intestine, 8, 170, 181, 190, 193, 220 Smooth muscle, 90, 167, 168, 190, 200, 216, 220, 222 Social Environment, 214, 220 Sodium Channels, 209, 215, 220, 226 Sodium Fluoride, 141, 220 Soft tissue, 137, 140, 142, 166, 220 Solitary Nucleus, 164, 220 Solvent, 15, 86, 157, 165, 188, 205, 208, 220 Somatic, 177, 207, 220 Sound wave, 175, 220 Spasm, 161, 162, 220, 224 Spasmolytic, 48, 220 Spatial disorientation, 180, 220 Specialist, 144, 179, 221 Species, 82, 92, 99, 177, 183, 186, 190, 204, 214, 215, 221, 222, 227, 230 Specificity, 158, 163, 168, 221, 226 Spectrum, 12, 173, 199, 201, 221 Sphincter, 141, 195, 221 Spinal cord, 26, 88, 164, 167, 170, 171, 186, 198, 203, 206, 207, 221, 223 Spinal Nerves, 88, 207, 221 Spinous, 183, 194, 221 Spleen, 160, 177, 197, 221 Squamous, 80, 183, 194, 221 Squamous cell carcinoma, 80, 183, 194, 221 Squamous cells, 221 Stabilization, 208, 221 Staging, 218, 221 Statistically significant, 13, 221 Steel, 99, 172, 221 Stenosis, 222 Sterile, 84, 207, 222 Steroid, 14, 80, 84, 96, 109, 176, 218, 222 Stimulant, 167, 180, 190, 222 Stimulus, 175, 181, 184, 193, 195, 222, 224 Stomach, 87, 157, 179, 183, 186, 190, 195, 202, 208, 213, 220, 221, 222 Stool, 140, 173, 192, 195, 222 Strand, 210, 222 Stress, 14, 56, 100, 108, 112, 139, 164, 170, 176, 185, 186, 202, 217, 222
246
Diuretics
Stricture, 97, 222 Stroke, 6, 12, 17, 74, 96, 105, 130, 169, 222 Stupor, 201, 202, 222 Subacute, 192, 222 Subarachnoid, 189, 222 Subclinical, 192, 218, 222 Subcutaneous, 87, 181, 204, 222 Subspecies, 221, 222 Substance P, 199, 218, 222 Substrate, 8, 12, 89, 103, 183, 222, 227 Suction, 185, 222 Sudden death, 73, 222 Sulfur, 100, 199, 222 Supplementation, 51, 223 Supportive care, 3, 223 Suppositories, 141, 186, 223 Suppression, 50, 90, 91, 176, 223 Surfactant, 14, 223, 230 Sweat, 85, 223 Sweat Glands, 223 Sympathetic Nervous System, 88, 101, 104, 161, 164, 206, 223 Sympathomimetic, 180, 183, 204, 223, 227 Symphysis, 171, 212, 223 Symptomatic, 90, 95, 185, 223 Synapse, 88, 158, 203, 206, 211, 223, 227 Synaptic, 203, 219, 223 Synergistic, 81, 223 Systemic disease, 5, 110, 223 Systemic lupus erythematosus, 111, 112, 197, 223 Systolic, 104, 191, 223 T Tachycardia, 96, 180, 223 Tacrolimus, 138, 192, 224 Tear Gases, 194, 224 Temporal, 7, 110, 189, 224 Tendon, 173, 186, 224 Teratogenic, 179, 224 Terminator, 173, 224 Testis, 183, 224 Tetany, 207, 224 Theophylline, 214, 224 Therapeutics, 18, 126, 200, 224 Thermal, 179, 203, 224 Thermography, 109, 224 Thiamine, 8, 42, 224 Thigh, 86, 224 Third Ventricle, 191, 224 Thoracic, 31, 167, 198, 224 Threonine, 96, 219, 224 Threshold, 79, 184, 191, 224
Thrombin, 103, 184, 209, 213, 224, 225 Thrombocytes, 210, 225 Thrombomodulin, 213, 225 Thrombosis, 213, 222, 225 Thromboxanes, 163, 225 Thrombus, 176, 192, 201, 209, 225 Thymidine, 97, 225 Thymidine Kinase, 97, 225 Thyroid, 168, 191, 207, 225, 227 Thyroid Gland, 191, 207, 225 Thyroid Hormones, 225, 227 Thyrotropin, 14, 225 Thyroxine, 159, 208, 225 Timolol, 64, 69, 225 Tin, 121, 169, 210, 225 Tinnitus, 139, 141, 225, 230 Tissue Culture, 16, 225 Tissue Distribution, 15, 226 Tocainide, 141, 226 Tolerance, 18, 172, 188, 226 Tomography, 174, 218, 226 Tone, 96, 204, 226 Tonic, 169, 172, 226 Tonus, 226 Topical, 80, 87, 226 Toxaemia, 211, 226 Toxic, iv, 91, 100, 111, 140, 165, 172, 177, 188, 203, 219, 226 Toxicity, 14, 40, 50, 51, 80, 89, 90, 91, 103, 104, 181, 226 Toxicology, 132, 226 Toxin, 226 Trace element, 171, 185, 225, 226 Tracer, 8, 15, 226 Traction, 172, 226 Transduction, 219, 226 Transfection, 165, 226 Transferases, 188, 227 Translation, 94, 160, 202, 227 Transmitter, 157, 164, 180, 198, 199, 204, 227 Transplantation, 6, 107, 110, 111, 112, 138, 172, 197, 227 Trees, 172, 183, 227 Tremor, 201, 225, 227 Triamterene, 22, 69, 227 Tricuspid Atresia, 176, 227 Trigger zone, 182, 227 Trimethoprim-sulfamethoxazole, 138, 227 Tryptophan, 173, 219, 227 Tyramine, 200, 227 Tyrosine, 81, 180, 213, 227
Index 247
U Ulcer, 107, 207, 227 Ulceration, 89, 104, 227 Ultrafiltration, 189, 227 Unconscious, 154, 160, 191, 227 Urea, 166, 223, 227, 228 Uremia, 111, 195, 216, 228 Ureters, 195, 228 Urethra, 212, 228 Uric, 37, 78, 112, 137, 140, 142, 188, 191, 214, 228 Uricosuric, 211, 228 Urinalysis, 122, 228 Urinary, 11, 30, 57, 98, 110, 111, 112, 113, 165, 168, 184, 192, 204, 210, 213, 228, 231 Urinary tract, 30, 110, 111, 112, 113, 165, 228 Urinary tract infection, 110, 111, 112, 113, 165, 228 Urine Testing, 137, 228 Uveitis, 163, 228 V Vaccine, 158, 213, 228 Vagina, 178, 199, 228 Vascular Headaches, 165, 228 Vascular Resistance, 79, 104, 228 Vasculitis, 112, 210, 228 Vasoconstriction, 100, 180, 183, 228 Vasodilation, 100, 161, 228 Vasodilator, 32, 162, 165, 167, 180, 190, 229 VATER, 111, 229 VE, 25, 229 Vein, 160, 163, 193, 210, 218, 229 Venous, 95, 163, 167, 177, 204, 213, 227, 229 Ventilation, 14, 229 Ventilator, 198, 216, 229 Ventral, 191, 210, 221, 229 Ventricle, 164, 175, 214, 223, 224, 227, 229 Ventricular, 27, 29, 30, 94, 175, 181, 185, 227, 229
Ventricular Dysfunction, 27, 94, 181, 229 Ventricular Remodeling, 29, 229 Venules, 166, 168, 182, 199, 229 Verapamil, 12, 69, 229 Vertebrae, 221, 229 Vertigo, 121, 229, 230 Vestibular, 110, 115, 121, 139, 142, 189, 229, 230 Vestibular Nerve, 139, 229, 230 Vestibular Neuronitis, 121, 229 Vestibule, 173, 193, 219, 229 Vestibulocochlear Nerve, 225, 229, 230 Vestibulocochlear Nerve Diseases, 225, 230 Veterinary Medicine, 131, 230 Vibrio, 171, 230 Vibrio cholerae, 171, 230 Viral, 80, 97, 121, 226, 230 Viral Proteins, 97, 230 Virulence, 226, 230 Virus, 97, 170, 187, 226, 230 Visceral, 164, 177, 208, 230 Visceral Afferents, 164, 230 Viscosity, 84, 230 Vitamin A, 8, 217, 230 Vitiligo, 213, 230 Vitro, 230 Vivo, 230 W Wart, 194, 230 Wetting Agents, 121, 230 White blood cell, 161, 196, 197, 201, 203, 209, 230 Wound Healing, 80, 89, 96, 104, 231 X Xanthine, 77, 93, 231 X-ray, 13, 166, 174, 185, 218, 231 Y Yeasts, 185, 208, 231 Z Zymogen, 213, 231
248
Diuretics
