Diuretics By S.Bohlooli, PhD.

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Chapter 51 Diuretic Agents

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Presentation transcript:

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 Potassium-sparing diuretics

Carbonic anhydrase inhibitors

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

Loop diuretics

Loop diuretics

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

Thiazides

Thiazides

Thiazides

Applications Hypertension Heart failure Nephrolithiasis Nephrogenic diabetes

Toxicity Hypokalemic metabolic alkalosis Hyperuricemia Impaired carbohydrate tolerance Hyperlipidemia Hyponatremia Allergic reactions

Potassium-sparing diuretics: channel blockers

Potassium-sparing diuretics

ANTAGONISTS OF MINERALOCORTICOID RECEPTORS

ANTAGONISTS OF MINERALOCORTICOID RECEPTORS

Applications State of mineralocorticoid excess

Toxicity Hyperkalemia Hyperchloremic metabolic acidosis Gynecomastia Acute renal failure: triamterene & indomethacin Kidney stones: triamterene is insoluble

Diuretics: summery

Clinical Pharmacology of Diuretic Agents Edematous states Heart Failure Kidney Diseases Hepatic cirrhosis Idiopatic edema Nonedematous states Hypertension Nerphrolithiasis Hypercalcemia Diabetes insipidus

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