Definitions:Diuretic: | Agent that increases urine volume. | Natriuretic: | Agent that increases in renal sodium excretion. | Aquaretics: | Agent that causes an increase in excretion of solute-free water (Osmotic Diuretics) |
Diuretic Agents:Carbonic anhydrase inhibitors: | Acetazolamide | Loop Diuretics: | Frusemide, ethacrynic acid, torsemide, bumetanide | Thiazide Diuretics: | Hydrochlorothiazide, chlorthiazide, indapamide | Potassium sparing Diuretics: | Spironolactone, eplerenone, amiloride, triamterene | Osmotic Diuretics: | Mannitol | ADH antagonists: | Conivaptan |
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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