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In this video from our Fluids and Electrolytes Masterclass, you'll discover how thiazide diuretics work, the differences between them, and what makes them unique among other diuretics.",{"id":215,"name":216},1,"Course previews",[218,228,233,238,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},321,{"platform":223,"name":212,"url":224,"size":225},"YouTube","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=lO127zQRtZE",{"width":226,"height":227},200,113,{"type":229,"data":230},"free_text",{"readDurationInSeconds":231,"text":232},16.266666666666666,"\u003Cp>\u003C!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}-->Thiazide diuretics are great for preventing kidney stones, but do you know which patients respond best to them? In this video from our Fluids and Electrolytes Masterclass, you'll discover how thiazide diuretics work, the differences between them, and what makes them unique among other diuretics.\u003C\u002Fp>\u003Cp>In case you missed the first two videos in this series, you can find them here:\u003Cbr>\u003Ca href=\"https:\u002F\u002Fpublic-nuxt.frontend.prod.medmastery.io\u002Fmagazine\u002Fphilosophy-diuretics\" target=\"_blank\">1. The philosophy of diuretics\u003C\u002Fa>\u003Cbr>\u003Ca href=\"https:\u002F\u002Fpublic-nuxt.frontend.prod.medmastery.io\u002Fmagazine\u002Floop-diuretics\" target=\"_blank\">2. Loop diuretics\u003C\u002Fa>\u003C\u002Fp>",{"type":229,"data":234},{"readDurationInSeconds":235,"title":236,"text":237},16.8,"Join our Fluids and Electrolytes Masterclass course now!","\u003Cp>If you are a clinician working in internal medicine, you are probably taking care of patients with fluid and electrolyte problems on a daily basis. This course teaches you the nuts and bolts of fluid and electrolyte management. You'll discover what it really means when sodium or potassium levels are abnormal, learn how to diagnose and treat imbalances, and get expert tips for prescribing diuretics.\u003C\u002Fp>",{"type":239,"data":240},"cta",{"readDurationInSeconds":241,"text":242,"buttonText":243,"buttonUrl":244,"teachIllustration":245},4,"Start the first chapter of our Fluids and Electrolytes Masterclass course for free","Start chapter 1 now","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister?target=%2Fcourses%2Ffluids-and-electrolytes-masterclass","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55eb7-10af-4c65-8174-3df202658892",{"type":229,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},145.6,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:00:00] \u003C\u002Fb>Thiazide diuretics act at the distal convoluted tubule. This is the third stop in the kidneys, as we wrap through the nephron, looking at sodium handling. Thiazide diuretics act after the loop diuretics. So, thiazide diuretics are active in the tubular fluid. In order to get there, they would need to be filtered. However, they are protein \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:00:30] \u003C\u002Fb>bound and cannot be filtered at the glomerulus and so they enter the tubular fluid by secretion in the proximal tubule. Secretion is GFR dependent. So, the lower the GFR, the less diuretic that reaches the tubule. Let's take a closer look at the mechanism of thiazide diuretics at the cellular level. So, taking a look at the distal convoluted tubule, you have the sodium chloride cotransporter on the basolateral membrane, you have the sodium-potassium \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:01:00] \u003C\u002Fb>ATPase, you have a potassium channel and a chloride channel. Remember, the basolateral membrane is the side that's touching the blood, that's going to be returned to the body and the apical membrane is the tubular side, where the fluid is going to end up in the urine. So sodium is reabsorbed through the sodium chloride cotransporter and then exits the cell via the sodium-potassium ATPase that exchange with potassium and potassium is recycled \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:01:30] \u003C\u002Fb>through a potassium channel. Chloride is reabsorbed and then exits the cell via a basolateral chloride transporter. Thiazide acts by blocking the sodium chloride cotransporter and that shuts down all the movement of these molecules. Thiazide diuretics increase the renal excretion of sodium, like all diuretics, increased renal excretion of potassium, and increase excretion of hydrogen ions, causing metabolic alkalosis. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:02:00] \u003C\u002Fb>Unique to the thiazide diuretics is they decrease renal excretion of calcium, lower renal loss of calcium, which makes them useful to prevent kidney stones. We primarily use them to prevent calcium-containing stones and they work best in patients that have primary hypercalciuria, that is patients with excess calcium in the urine, for women that's over 250 milligrams in a \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:02:30] \u003C\u002Fb>24-hour collection, for men that's over 300 milligrams in a 24-hour collection. There are a number of different thiazides but I want to talk about three in particular. So, the one that most people are most familiar with is hydrochlorothiazide. This is the most popular thiazide found in drug combinations. Metolazone, trade name is Zaroxolyn, is a drug with a much longer half-life and is typically used in patients with low GFRs. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:03:00]\u003C\u002Fb> Chlorthalidone has the longest half-life of all. Half-life measured in days rather than hours and it was the drug in the largest hypertension trial ever conducted, AllHat. AllHat randomized 42,000 people, enough people to fill a major league baseball stadium. They were assigned to one of four groups: chlorthalidone, amlodipine, lisinopril or doxazosin. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:03:30] \u003C\u002Fb>The doxazosin group was stopped early because of increased rates of heart failure. The other three went to completion. What they found was there was lowest blood pressure with chlorthalidone compared to the other two controlled drugs. But the idea of the study was to keep the blood pressures the same across the groups and then measure if there was a difference in outcomes at the same blood pressure. So, to this degree, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:04:00] \u003C\u002Fb>the study wasn't perfectly conducted because there was a difference in blood pressure and they didn't want that. Nonetheless, there was no difference in outcomes across all three drugs. In subgroup analysis, chlorthalidone was superior to amlodipine for the intermediate outcome of heart failure. I'm not sure if anybody was surprised that the diuretic was better than the calcium channel blocker for heart failure. Chlorthalidone versus lisinopril also showed \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-fc9679e5-7fff-5e45-6f1d-9c223e54616f\">[00:04:30] \u003C\u002Fb>an advantage for heart failure and in addition showed an advantage for stroke. On the basis of this subgroup analysis, looking at heart failure stroke, chlorthalidone was declared the winner of AllHat. Final summary on thiazides. 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This course teaches you the nuts and bolts of fluid and electrolyte management. You'll discover what it really means when sodium or potassium levels are abnormal, learn how to diagnose and treat imbalances, and get expert tips for prescribing diuretics.",{"duration":269,"quizzes":270,"lessons":271},12323,9,54,{"id":273,"name":261,"image":274,"profession":275,"relativeUrl":278,"specializations":279},2118,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cefc-8e10-40f7-ba94-3b1be2090eaa",{"name":276,"description":277},"Nephrologist","Board certified nephrologist. Author of several medical textbooks. Social media aficionado.","\u002Fteachers\u002Fjoel-topf-md",[259],195,"4m",[283,310,329],{"id":284,"title":285,"text":286,"image":287,"author":295,"path":303,"readDuration":304,"readDurationFormatted":305,"internal":306},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":288,"title":289,"size":290,"location":292},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":291,"height":291},1200,{"bucket":293,"key":294},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":296,"title":297,"relativeURL":298,"image":299,"professionLong":300,"profession":301,"weight":241},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":302},"Internist","\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":307,"updated":308,"published":309},1778115738,1778118425,1778118255,{"id":311,"title":312,"text":313,"image":314,"author":320,"path":322,"readDuration":323,"readDurationFormatted":324,"internal":325},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":315,"title":289,"size":316,"location":318},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":317,"height":317},600,{"bucket":293,"key":319},"\u002F2026-04\u002FC121_magazine image.png",{"id":296,"title":297,"relativeURL":298,"image":299,"professionLong":300,"profession":321,"weight":241},{"name":302},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":326,"updated":327,"published":328},1777403036,1777572381,1777412421,{"id":330,"title":331,"text":332,"image":333,"author":338,"path":347,"readDuration":348,"readDurationFormatted":281,"internal":349},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":334,"title":289,"size":335,"location":336},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":317,"height":317},{"bucket":293,"key":337},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":339,"title":340,"relativeURL":341,"image":342,"professionLong":343,"profession":344,"weight":346},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":345},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,{"created":350,"updated":351,"published":352},1776705362,1776710540,1776710541,{"seo":354,"og":356},{"title":355,"description":213},"Thiazide diuretics | Medmastery",{"title":355,"description":213,"image":357},{"alt":289,"title":289,"size":358,"location":360},{"width":359,"height":359},2133,{"bucket":293,"key":361},"\u002Fmigrated-images\u002Fshutterstock_198221939.png",{"id":363,"created":364,"updated":365,"published":364},60,1565618955,1731352577]