Dopamine agonist (apomorphine) 0.25-1 mg bid; ephedrine 5-20 mg qid, protriptyline 100-300 mg 3 times daily, topiramate 200-400 mg tid, phenelzine 10 or 20mg/day
Pts should be monitored for urinary retention and other side effects of the dopamine agonists.
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B. Osmotic diuretics (loop diuretics) reduce excess fluid in the body from extravasation from capillaries into tissues or plasma. These drugs are called osmotic because they inhibit a reabsorption process that takes place within cells to maintain osmolarity in a narrow range set by intracellular water concentrations and extracellular sodium concentration [see Chapter 19]. Loop diuretics also enhance renal tubular excretion of water and salt by increasing flow rate through proximal tubules while inhibiting secretion through distal nephron segments [see Chapters 24 and 25]. In addition to their neutralizing action on local electrolyte concentrations, these agents increase serum volume diluting RBCs so that blood viscosity is decreased [see Chapter 23] which decreases chance of clotting due to low shear forces at low flows due to increased platelet activity as well as decreasing risk for thrombosis caused by high cell aggregation rates associated with anemia. Furthermore