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    Diuretics

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    nk999999
    The document discusses urine formation and diuretic drugs. It covers the physiology of urine formation in the proximal tubule, ascending loop of Henle, cortical diluting segment, and distal tubule/collecting duct. It then discusses diuretic classes including high efficacy sodium-potassium-chloride inhibitors, medium efficacy sodium-chloride inhibitors, and weak or adjunctive diuretics. Specific diuretics are also mentioned like thiazides, loop diuretics, and potassium-sparing diuretics.

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    Diuretics

    Uploaded by

    nk999999
    67 views15 pages
    The document discusses urine formation and diuretic drugs. It covers the physiology of urine formation in the proximal tubule, ascending loop of Henle, cortical diluting segment, and distal tubule/collecting duct. It then discusses diuretic classes including high efficacy sodium-potassium-chloride inhibitors, medium efficacy sodium-chloride inhibitors, and weak or adjunctive diuretics. Specific diuretics are also mentioned like thiazides, loop diuretics, and potassium-sparing diuretics.

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    The document discusses urine formation and diuretic drugs. It covers the physiology of urine formation in the proximal tubule, ascending loop of Henle, cortical diluting segment, and distal tubule/collecting duct. It then discusses diuretic classes including high efficacy sodium-potassium-chloride inhibitors, medium efficacy sodium-chloride inhibitors, and weak or adjunctive diuretics. Specific diuretics are also mentioned like thiazides, loop diuretics, and potassium-sparing diuretics.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    67 views15 pages

    Diuretics

    Uploaded by

    nk999999
    The document discusses urine formation and diuretic drugs. It covers the physiology of urine formation in the proximal tubule, ascending loop of Henle, cortical diluting segment, and distal tubule/collecting duct. It then discusses diuretic classes including high efficacy sodium-potassium-chloride inhibitors, medium efficacy sodium-chloride inhibitors, and weak or adjunctive diuretics. Specific diuretics are also mentioned like thiazides, loop diuretics, and potassium-sparing diuretics.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 15

    By: Ajay Alex Varughese

    PharmacologyCMC2008

    Relevant physiology of urine formation


    1.Proximal Tubule

    Direct Na+ entry (electrogenic) Na+/K+ -glu/aa/org anion/PO43- (symporters) Na+-H+ exchange (antiporter) Na+ along with Cl-

    2.Asc LH
    Na+-K+-2Cl- (symporter)

    3.Cortical Diluting Segment


    Na+-Cl- (sympoter)
    PharmacologyCMC2008

    4.DT & CD
    Passive Cl- diffusion H+ & K+ secretion Na+ reabspn (aldosterone regulated channel)

    PharmacologyCMC2008

    Diuretics
    Thesse are drugs which cause a net loss of Na+ & water

    in urine Most widely prescribed drugs Hypertension, Edema etc (uses)

    PharmacologyCMC2008

    Diuretics

    High efficacy (Na+K+2Cl- Inhibitor)

    Medium efficacy (Na+-Cl- Inhibitor)

    Weak or adjunctive

    Sulphonyl Eg:Furosemide

    Thiazides Hydrochlorothiazide

    CA inhibitors Eg:Acetazolamide

    K+ sparing Phenoxyacetate Eg:Ethacrynate Thiazide like Eg:Chlorthalidone Eg:Spironolactone Amiloride

    Organomercurials Eg:Mersalyl

    Osmotic Eg:Mannitol

    Xanthines
    PharmacologyCMC2008

    Eg:Theophylline

    Thiazides & Related Diuretics


    Inhibitors of Na+ Cl- Symport
    Site of action: Cortical diluting segment(early DT) Decrease +ve free water clearance Do not affect ve free water clearance Some have additional Case inhibition (in PT) Moderately efficacious (90% filtrate reabsorbed in PT) Decrease renal Ca2+ excretion Increase Mg2+ excretion

    PharmacologyCMC2008

    Drugs:
    Thiazides Hydrochlorothiazide Benzthiazide Hydroflumethiazide Chlorothiazide Clopamide Thiazide Like Metolazone Xipamide Indapamide Chlorthalidone

    PharmacologyCMC2008

    Actions
    Decrease blood vol
    Intrarenal haemodynamic changes Extrarenal actions:

    gfr

    Slowly developing fall in BP in Hypertensives Elevation of blood glucose ( insulin release)

    PharmacologyCMC2008

    Kinetics
    Well absorbed orally
    V= more for lipid soluble agents Low clearance rates Long acting Little hepatic metabolism(excreted as such) Secreted at PT Lipid soluble agents highly reabsorbed

    PharmacologyCMC2008

    Drug

    Daily Dose(mg)

    CAse inhibition

    Duration of action(hr)
    6-12 8-12 12-18 12 48

    Chlorthiazide Hydrochlorothiazi de Benzthiazide Hydroflumethiazi de Chlorthalidone

    500-2000 25-100 25-100 25-100 50-100

    ++ + ++ +/++

    Metolazone Xipamide Indapamide


    Clopamide

    5-20 20-40 2.5-5


    10-60
    PharmacologyCMC2008

    + + +/-

    18 24 24-36
    12-18

    Uses
    Edema- cardiac,hepatic,renal(not in renal failure)
    Hypertension Diabetes Insipidus Hypercalciuria

    PharmacologyCMC2008

    Complications
    Hypokalemia

    Prevention: Dietary K+ intake Supplements (KCl 24-72mEq/day) Concurrent use of K+ sparing diuretics Acute saline depletion Dilutional hyponatremia GIT & CNS disturbances Hearing loss Allergic manifestations
    PharmacologyCMC2008

    Complications contd
    Aggravate renal insufficiency
    In cirrhotics: mental disturbances & hepatic coma C/I in toxaemia of pregnancy Hyperuricemia Hyperglycemia & hyperlipidemia Hypercalcemia Magnesium depletion

    PharmacologyCMC2008

    Interactions
    Thiazides with High ceiling diuretics- potentiate all other

    anti HTs Hypokalemia : enhances digitalis toxicity incidence of polymorphic ventricular tachycardia with quinidine & other antiarrhythmics potentiate NM blockers & sulphonylurea action Probenecid competitively inhibits tubular secretion of thiazides

    PharmacologyCMC2008

    Thank you

    PharmacologyCMC2008

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