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Carbonic Anhydrase Inhibitors (CAIs) - diuretics
Overview
- inhibit activity of enzyme carbonic anhydrase (found in kidneys, eyes, and other parts of body) |
- work at the location of the carbon anhydrase enzyme system along nephron (primarily proximal tubule |
- Medications: Acetazolamide |
Indications
- treatment of glaucoma |
- edema |
- high-altitude sickness symptoms (headache, nausea, shortness of breath, dizziness, drowsiness, fatigue) |
- adjunct drugs in long-term management of open-angle glaucoma |
- short term in conjunction with miotics to lower intraocular pressure in preparation for ocular surgery |
- adjunct in treatment of secondary glaucoma |
- manage edema secondary to heart failure that has become resistant to other diuretics |
Interactions
- digoxin: hypokalemia, toxicity |
- corticosteroids: hypokalemia |
- amphetamines, carbamazepine, cyclosporine, phenytoin, and quinidine: effects may be increased |
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Mechanism of Action and Drug Effects
- increase sodium excretion by decreasing sodium-hydrogen ion exchange throughout the renal tubule |
- can induce respiratory and metabolic acidosis --> increase oxygenation by increasing ventilation |
- also decrease secretion of aqueous humor in the eye and thus decrease intraocular pressure |
- elevation of blood glucose level and glycosuria in diabetic patients |
- reduce formation of hydrogen and bicarbonate ions from carbon dioxide and water through inhibition of carbonic anhydrase activity - results in availability of ions (hydrogen) |
Contraindications
- drug allergy |
- severe renal or hepatic dysfunction |
- hyponatremia |
- adrenal gland insufficiency |
- hypokalemia |
- cirrhosis |
Adverse Effects
- metabolic abnormalities (ex: acidosis and hypokalemia) |
- drowsiness |
- anorexia |
- paresthesias |
- hematuria |
- urticaria |
- photosensitivity |
- melena (blood in stool) |
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