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Diuretics. By S.Bohlooli, PhD. Renal Tubular Transport Mechanism. Proximal Tubule Loop of Henle Distal Convoluted Tubule Collecting Tubule. Renal Tubular Transport. Basic Pharmacology of Diuretic agents. Carbonic anhydrase inhibitors Loop diuretics Thiazides
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Diuretics By S.Bohlooli, PhD
Renal Tubular Transport Mechanism • Proximal Tubule • Loop of Henle • Distal Convoluted Tubule • Collecting Tubule
Basic Pharmacology of Diuretic agents • Carbonic anhydrase inhibitors • Loop diuretics • Thiazides • Potassium-sparing diuretics
NaHCO3 reabsorption in proximal tubule and mechanism of diuretic action of carbonic anhydrase inhibitors
Applications • Glaucoma • Urinary alkalinization • Metabolic alkalosis • Acute mountain disease • Epilepsy, hypokalemic periodic paralysis
Toxicity • Hyperchloremic metabolic acidosis • Renal stones • Renal potassium wasting • Hypersensivity reactions • Contraindicated in patients with cirrhosis
NaCl reabsorption in thick ascending limb and mechanism of diuretic action of Na+-K+-2Cl- symport inhibitors
Applications • Acute pulmonary edema • Acute hypercalcemia • Hyperkalemia • Acute renal failure • Anion overdose
Toxicity • Hypokalemic metabolic acidosis • Ototoxicity • Hyperuricemia • Hypomagnesimia • Allergic reactions • Contraindicated in hepatic cirrhosis, borderline renal failure and heart failure
Applications • Hypertension • Heart failure • Nephrolithiasis • Nephrogenic diabetes
Toxicity • Hypokalemic metabolic alkalosis • Hyperuricemia • Impaired carbohydrate tolerance • Hyperlipidemia • Hyponatremia • Allergic reactions
Applications • State of mineralocorticoid excess
Toxicity • Hyperkalemia • Hyperchloremic metabolic acidosis • Gynecomastia • Acute renal failure: triamterene & indomethacin • Kidney stones: triamterene is insoluble
Clinical Pharmacology of Diuretic Agents • Edematous states • Heart Failure • Kidney Diseases • Hepatic cirrhosis • Idiopatic edema • Nonedematous states • Hypertension • Nerphrolithiasis • Hypercalcemia • Diabetes insipidus