High-ceiling/Loop diuretics:
• eg frusemide, ethacrynic acid, bumetanide, torasemide
• most effective diuretics as site of action is the loop of Henle – especially in patients with low glomerular filtration rates
• generally used for more rapid effects or when large effect is needed (eg pulmonary oedema, hypertension unresponsive to other diuretics)
• inhibit resorption of Cl- and Na+ in ascending loop of Henle and distal tubule prevent passive reabsorption of water
• adverse effects – hypokalaemia (main side effect) metabolic alkalosis, hypovolaemia, hypomagnesia, dehydration, hyponatraemia, orthostatic hypotension
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