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Agent that increases urine volume.
Agent that increases in renal sodium excretion.
Agent that causes an increase in excretion of solute­-free water (Osmotic Diuretics)

Diuretic Agents:

Carbonic anhydrase inhibi­tors:
Loop Diuretics:
Frusemide, ethacrynic acid, torsemide, bumetanide
Thiazide Diuretics:
Hydroc­hlo­rot­hia­zide, chlort­hia­zide, indapamide
Potassium sparing Diuretics:
Spiron­ola­ctone, eplere­none, amiloride, triamt­erene
Osmotic Diuretics:
ADH antago­nists:

Carbonic Anhydrase Inhibi­tors:

> Bicarb­onate diresis (sodium bicarb­onate excretion)
> Metabolic acidosis
>In­creased potassium loss ( High sodium concen­tration reaching collecting duct.)
> Diuresis limited to 2-3 days
> Uses: - severe acute glaucoma
- High altitude sickness
> A/E: renal stones

Loop Diuret­ics:

> Inhibit cotran­sport of Na+, K+ and Cl-
> 'High' ceiling' diuretics
> Adverse effects: - Hypoka­lemia
- Alkalosis
- Ototox­icity
> Clinical Use: = Oedema -> Heart failure, ascites, pulmonary oedema.
= Short duration of action (4hrs) -> not preferred in HTN

Thiazide Diuret­ics:

> Inhibit sodium chloride cotran­sport
> Moderate, sustained Na+and Cl- diuresis
> Adverse effects: - Hypoka­lemia, metabolic alkalosis, hyperc­alcemia
- Hyperg­lyc­emia, hyperu­ric­emia, elevated lipids.
> Clinical Uses: = Hypert­ension

Pota­ssi­um-­sparing Diuret­ics:

> Aldost­erone antago­nitsts: - Spiron­ola­ctose
- Eplerenone
-> Reduces synthesis of sodium channels
> Sodium channel inhibi­tors: - Amiloride
- Triamt­erene
-> Decreased sodium reabso­rption
> Adverse Effects: - Hyperk­alemia, - Acidosis, - Gyneco­mastia
> Indica­tions: HTN and HF
> Should never be used with angiot­ensin antogo­nists

ADH Antago­nis­ts:

> Antidi­uretic hormone facili­tates water reabso­rption (in collecting tubule)
> ADH stimulates V2 receptors: Stimul­ation of adenylyl cyclase
-> Increased cAMP = causes insertion of water channels (aquap­orins) in the luminal membrane.
> ADH antago­nists: Decrease water absorption by blocking V2 receptors (Conva­ptan, Tolvaptan)
> Uses: syndrome of inappr­opriate ADH secretion.


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