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A brief tutorial on diuretics for students of physiotherapy
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Dr.Rathnakar U P MD.DIH.PGDHMDept of PharmacologyKMC, Mangalore
Introduction
Renal function•Excrete waste product of metabolism,drugs
•Maintain water electrolyte balance
Diuretics:
•Diuretics are the drugs that promote the excretion of Na+ and water from the body by an action on the kidney.
NEPHRON
Classification
DIURETICS• High efficacy diuretics
[Loop diuretics ] (High ceiling diuretics):
• Medium efficacy diuretics
[Thiazide diuretics]
• Weak diuretics1. Potassium sparing diuretics
2. Carbonic anhydrase inhibitors
3. Osmotic diuretics:
• Furosemide, Bumetanide, Torsemide
• Hydrochlorthiazide, Metolazone
• Aldosterone receptor antagonist: Spironolactone, Triamterene, amiloride
• Acetazolamide
• Mannitol, glycerol
MOA• High Efficacy
• Medium Efficacy• Low Efficacy1.Tiamterene,
Amiloride
2.Spironolactone3.CA inhibitors
4.Osmotic
• Inhibition of Na-K-2Cl co-transporter of ascending loop of Henle
• Inhibit Na+-Cl- symport in the DCT
• Inhibit Na+ channel in DT & CT
• Aldosterone antagonist
• Inhibit CA in PT
• Osmotically @ PCT
[Potassium sparing]
Adverse effects: High and Medium Efficacy
• Hypokalaemia• Nausea, vomiting, diarrhoea, Head
ache, Giddiness• Allergic• MetabolicHyperurecemiaHyperglycemiaHypercalcemia[Thiazides]Hypocalcemia[Furosemide]
Uses
High efficacy•Edema: Any causeHeart failure,
Cirrhosis, RenalAcute pulmonary
edemaCerebral edema HTN
Medium efficacy[Thiazides]
•Edema•Hypertension
Potassium Sparing [weak]
Tiamterene & Amiloride
• UsesUsed along with
Thiazides to reduce potassium loss
• Adverse effectsNausea,
Vomiting, diarrhoea
Spironolactone
• UsesEdema-Cirrhosis,
nephroticHeart failure• Adverse effects• Drowsiness,
Hirsutism, Hyperkalemia
CA Inhibitors-Acetazolamide[weak]
• Uses• WeakGlaucomaMountain
sicknessTo alkalinise
urineEpilepsy
• Adverse effectsCommonAcidosis,
hypokalemiaDrowsinessHepatic coma
Osmotic diuretics-Mannitol, Glycerol
• UsesI.VRaise intracranial
tensionAcute glaucomaShould not be
given in Heart failure, pulmonary edema etc.
• Adverse effectsHead acheNauseaVomitingAllergic
reactions
Summary• Diuretics reduce water reabsorption and
increase urine volume • Loop diuretics such as furosemide (frusemide)
inhibit the NaK2Cl cotransporter in the loop of Henle
• Thiazide diuretics inhibit the NaCl cotransporter in the distal tubule
• Amiloride inhibits the epithelial Na channel in the collecting duct
• Spironolactone is an aldosterone antagonist • Mannitol is an osmotic diuretic • Acetazolamide inhibits carbonic anhydrase
inhibitor• Loop diuretics and Thiazide diuretics increase
potassium excretion, • Amiloride and spironolactone reduce
potassium excretion • Used in edema
Antidiuretic hormone (ADH)/Vasopressin
• Synthesized in the hypothalamus
• Secreted from the posterior lobe of pituitary gland
• Rise in plasma osmolarity; contraction of extracellular fluid volume.
• Lypressin• Telipressin• Desmopressin –given
intranasally/orally/im- Diabetes insipidus due to damage to
posterior pituitary- Nocturnal enuresis in patients with
normal pituitary function – intranasal/oral at bed time
Therapeutic uses