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DIURETICS

DIURETICS.

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DIURETICS

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  1. DIURETICS Diuretics are drugs which increase the excretion of sodium and water from the body by an action on the kidney. Their primary effect is to decrease the reabsorption of sodium and chloride from the filtrate, increased water loss being secondary to the increased excretion of salt.

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

  3. urine formation & the action sites of diuretics • Glomerulus and its filtration • Tubules and its reabsorption and secretion • Proximal convoluted tubule Na+-H+-antiporter axetazolamide H+ • Ascending limb of the loop of Henle dilution & concentration K+-Na+-2Cl- -cotransporter • Distal tubule and collecting duct Na+ - K+-exchanger Na+ • Furosemide • Thiazides • Spironolactone • Trianterene

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

  5. High effect diuretics • 2. PGE • P.E. • Cl Na • Renal Blood Flow (RBF) • ADR • Ototoxicity (etacrynic acid>lasix>bumetanide) • Disturbance of water and electrolyte • Hyperuricemia • Others toxicities: allergic reactions,nausea et al. • P.K. • Onset in 5 min by i.v. 30 min by p.o. t 1/2=2hr last for 4-6 hr

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

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

  8. 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

  9. 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

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

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

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

  13. ADR of Diuretics

  14. 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.

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