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DIURETICS

DIURETICS. SONG Hui. OUTLINE. BACKGROUND CLASSIFICATION OF DIURETICS REVIEW AND QUESTIONS. BACKGROUND. The essential of urine. How urine formation. Which ion play an important role in this procedure. Ald, ADH The action sites of diuretics. Look at the diagram. CLASSIFICATION.

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DIURETICS

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  1. DIURETICS SONG Hui

  2. OUTLINE • BACKGROUND • CLASSIFICATION OF DIURETICS • REVIEW AND QUESTIONS

  3. BACKGROUND • The essential of urine. • How urine formation. • Which ion play an important role in this procedure. • Ald, ADH • The action sites of diuretics. • Look at the diagram

  4. CLASSIFICATION • High effect diuretics: Lasix • Mediate effect: Thiazide diuretics • Mild (Low)effect: K+ sparing diuretics • Osmotic diuretics: Mannitol • Others

  5. High effect diuretics • High ceiling (loop) diuretics • Agent furosemide (lasix) • Action site thick ascending loop (AL) • Mechanism 1. Cl K-Na-2Cl

  6. High effect diuretics • 2. PGE • P.E. • Cl Na • Renal Blood Flow (RBF) • P.K. • Onset in 5 min by i.v. 30 min by p.o. t1/2=2hr last for 4-6 hr • ADR • Ototoxicity (etacrynic acid>lasix>bumetanide)

  7. Mediate effect diuretics • Thiazides • Agent • Hydrochlorothiazide (HCT) • Action site • Distal convoluted tubule (DCT) • Mechanism • Na-K-2Cl, CA, PDE

  8. Mediate effect diuretics • ADR • Hypokalemia ---be careful when use with digitalis. • Hyperuricemia--- compete with uric acid • Hyperglycemia--- insulin • Hypercalcemia--- Ca

  9. Low effect diuretics • K+ sparing diuretics • Agent • Antisterone, Triamterene & amiloride • Action site • DCT & CT (Collecting Tubule) • Mechanism • 1. Ald-R • 2. Na channel Na K

  10. Low effect diuretics • ADR • Hyperkalemia, sex hormone like effects (antisterone) • Others • Carbonic anhydrase inhibitors (acetazolamide) H2O + CO2 H + HCO3 -------- inside cell Na ----- outside cell CA

  11. Osmotic diuretics • Agents (characters) • Mannitol, Glucose • Action site • PCT, AL; Vessels, gastrointestinal tract • Mechanism • 1. Hyperosmolarity • 2. Blood volume RBF

  12. Osmotic diuretics • P.E. • H2O • ADR • BV CHF • Dehydration • Hypernatremia

  13. CLINIC USES of DIURETICS • Edema • CHF • ARF • Hypertension • Poisoning • Hypercalciuria • Hypercalciumia • Glaucoma • Diabetes insipidus

  14. ADR of Diuretics

  15. Review & questions • The classes of diuretics. • The mechanisms of each. • The Common ADR of diuretics • The common P.E of diuretics • The clinic uses of diuretics. • Why DM patients have a lot of urine?

  16. SEE YOU LATER

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