1. Diuretics

2. Nephron Speed of primary urine formation – 120–127 ml/min
There are about 1mln. nephrons in a kidney, reabsorbtive surface of which is – 6-8 m2.
Along the nephron 99% of ultrafiltrate is reabsorbed and l of secondary urine forms from l of primary urine.

3. 1) with the concentration gradient
Apical (lumenal) membrane
Na+ enters a cell
1) with the concentration gradient
2) with the help of protein transporters – permeases (synthesized under the influence of aldosterone)
Na+
Basal membrane
Na+ enters interstitial space against concentration gradient with energy consumption and with the help of specific transport systems (K+, Na+-ATPases, cАMP-adenilatcyclases and phosphodiesterases, etc.)
Na+

4. Decreasing of reabsorbtion for 10% ( 1% of volume of primary urine)
Filtration
Primary
urine
Reabsorbtion
Quantity of diuresis
Decreasing of reabsorbtion for 10%
( 1% of volume of primary urine)
Norm
Increasing of filtration 10%more

5. Classifiction of diuretics accordingly to power of action
І Strong (slowing down of Na+ reabsorbtion for
10-20%)
furosemide, etacrynic acid, clopamide, bufenox
ІІ Medial power of action (slowing down of Na reabsorbtion for 5-8%)
dichlothiaside, oxodoline
ІІІ Light (slowing down of Na+ reabsorbtion not more than for 3%)
diacarb, spironolactone, amiloride, triamteren, xanthines (theophylline)

6. Mannitol 15 % solution rapid intravenous introduction
intravenous dropping
introduction
diuretic
action
dehydrating
action
diuretic
action

7. Brain oedema (in case of maintaining ofHEB permeability)
Mannitol
Indicatoins
Brain oedema (in case of maintaining ofHEB permeability)
Toxic lung oedema (poisoning with gasoline, gass, formaline, skipidar etc.)
3. Larynx oedema of allergic or inflammatory genesis
4. Holding of forced diuresis (poisoning with barbiturates, salycylates, sulphonamides, PASA, metanole, boric acid, haemolytic poisons, antifreezers; in case of trasfusing of incompatible blood, massive hemoglobinuria etc.
In oliguric phase of acute nephral insufficiency
Burns, osteomielitis, peritonitis, sepsys
Contrainidications
Acute cardiac insufficiency, skull trauma, intracranial hemorrhages, arterial hypertension

8. FUROSEMIDE Properties : 1. diuretic action
High ceiling (loop) diuretic
Properties :
1. diuretic action
2. dilation of peripheral venous
3. decrease left ventricular filling pressure
4. potent anti-inflammatory effect (similar to indometacine and other NSAID)
Administration: hypertensive emergencies, long-term treatment of arterial hypertension
Adverse reactions: dehydration, hypokalemia, hearing loss - deafness, hypocalcaemia

9. Furosemide (lazix)
Effective even in case of decreased glomerular filtration less than 10 ml/min. (norm – 127ml/min)
Indications
Acute left ventricular insufficiency, lung oedema
Chronic cardiac insufficiency
Arterial hypertension, including hypertensive crisis
Brain oedema of any etiology
Acute nephral insufficiency
Performing of forced diuresis
For excretion of Calcium ions (hypervitaminosis D)

10. Hypopotassiumaemia, hypopotassiumhystia
Side effects of furosemide
Hypopotassiumaemia, hypopotassiumhystia
Hypovolemia, vascular collapse, hyposodiumaemia, hypocalciumaemia, hypochloraemia, metabolic alkalosis
Ototoxic action
Contrinsular action (manifestation of latent diabetes mellitus)
Formation of oxalate and phosphate stones in urinary tracts
Decreasing of secretion of uric acid (acute attack of gout)
It should not be combined with antibiotics, aminoglycosides and cephalosporines!

11. Furosemide (diuretic)

12. Furosemide (diuretic)

13. THIAZIDES and RELATED DIURETICS
Medium efficacy diuretics
Benzothiadiazines (chlorothiazide, hydrochlorothiazide, clopamide), related thiazide like (chlorthalidone, indapamide)
for long-term treatment of arterial hypertesion (oral administration)
Duration of action (6-12 hours for hydrochlorothiazide, hours for clopamide, hours for chlorthalidone)
Adverse reactions: dehydration, hypokalemia, hyperuricaemia (rise of blood urate level)

14. Indications Side effects
Dichlotiaside (hypothiaside)
Indications
Oedema in case of chronic cardiac insufficiency
Oedema in case of chronic pathology of liver and kidneys
Treatment of arterial hypertension
Diabetes insipidus
Side effects
Hypopotassiumaemia, hypopotassiumhystia
Hypochloraemic alkalosis
Retention of uric acid - artralgy, acute attack of gout, chronic nephropathy
Hyposodiumaemia of dilution: nausea, vomitting, diarrhea, weakness
Pancreatitis

15. Indapamide (ariphone – sulphamoil benzamide)

16. Pharmacokinetics of some diuretic drugs
Way of administration
Latent period
Duration of action
Sulfonyl derivates
Oxololin (chlortalidon, hyhroton)
peroral
2-4 hours
Till 3 days
Clopamide
1-3 hours
8-18 (till 24) hours
Bufenox (bumetanide)
intravenous
20-40 min.
2-5 min.
4-6 hours
Potassium-, magnesium-sparing
Spironolactone
2-5 days
2-3 days
Triamteren (pterophen)
20-30 min.
6-8 hours
Amiloride
2 hours
till 24 hour

17. Spironolactone (aldactone)

18. Combined administration of diuretics
Mannitol + furosemide (etacrynic acid)
Dichlotiaside + triamteren (spironolactone)
Furosemide + spironolactone
Furosemide (excretes Calcium ions) + dichlotiaside
(retains Calcium ions)

19. Triampur (triamteren + hydrochlorthiaside)

20. Fol. Orthosiphoni – kidney tea

21. Shots of birch tree
(Gemmae Betulae)

22. Leaves of red bilberries (fol.Vitisidaeae)

23. Herba Equiseti

24. Blue corn-flowers (Flores Centaureae cyani)

25. Juniper berries
(Fructus Juniperi)

26. Drugs affecting myometrium
І Influence mostly on myometrium contraction
1. Increase contractions
Oxytocine Dinoprost (prostaglandine F2α )
Pituitrine Dinoproston (prostaglandine E2 )
Hyphotocine
2. Decrease contraction (tokolytic substances)
Fenoterol Sodium oxybutyrate
Salbutamol Magnesium sulphate
ІІ Increase mostly myometrium tone
Ergometrini maleas Cotarnine chloride
Ergotamine hydrotartrate
Ergotal
ІІІ Decrease tone of uterus cervix
Atropine sulphate Dinoprost Dinoproston