Diuretic agents

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×‘×’×“×•×œ - ×ž×” × ×•×ª× ×™×: carbonic unhydrase inhibitors - acetazolamide
loop diuretics - furosemide
tiazide diuretics - hydroclorotiazide
potassium sparing drugs - spironolate, eplerenone
osmotic diuretics - mannitol
Acetazolamide Effects: Bicarbonate diuresis - metabolic acidosis + K+ wasting
** self limited after 2-3 days.
reduction in intraocular pressure - (glucoma)
CNS acidosis - hyperventilation (high altitude sickness)
Acetazolamide Toxicity: hypokalemia, metabolic acidosis
rena stones
× ×™×ž×•×œ
Loop diuretics (××™×œ×• ×ª×¨×•×¤×•×ª ×™×© ×‘×§×˜×’×•×¨×™×” ×–×•?): Furosemide
Ethacrynic acid
Loop diuretics What is the mechanism of action?: They inhibits the cotransporter of Na/K/Cl
Loop diuretics Effect: Edema fluid is rapidly excreted and blood pressure may be significantly reduced.
Ca excretion is increased (×¤×—×•×ª ×§×œ×¦×™×•× ×™×¡×¤×’ ×‘×œ×•×¤)
Increased K wasting - hypokalemia and alkalosis
Pulmonary vasodilation
Loop diuretics Clinical use: Edematous states
acut pulmonary edema
hypertension
sever hypercalcemia
Loop diuretics Toxicity: Hypokalemia - metabolic alkalosis
ototoxicity (×¤×’×™×¢×” ×‘××•×–×Ÿ)
Tiazide ×“×•×’×ž× ×œ×©× ×©×œ ×ª×¨×•×¤×” ×‘×§×˜×’×•×¨×™×” ×–×•: Hydrochlorotiazide
Tiazide Mechanism of action: Blocks the Na Cl active transporter, result in hypokalemia metabolic alkalosis
reduce blood pressure
Chronic renal stones formation can be controled.
Tiazide Toxicity: Hypokalemia, hyponatremia
×‘×—×•×œ×™ ×¡×›×¨×ª - hyperglycemia
K sparring drugs ×“×•×’×ž××•×ª ×œ×ª×¨×•×¤×•×ª: Spironolactone
Eperenone
K sparring drugs Mechanisn of action: Steroids derivatives - antagonists to aldosterone
reduce the expretion of genes controlling the synthesis of Na channels and Na/K pump.
K sparring drugs Effect and clinical use: Increase Na clearance
Decrease K + H clearance
clinical use:
Aldosterism
Heart failure
K sparring drugs Toxicity: Hyperkalemia + acidosis
endocrine abnormalities
(×›×ž×• ×’×‘×¨ ×¢× ×©×“×™×™×...)
Osmotic diuretics ×©× ×”×ª×¨×•×¤×”: Mannitol
Osmotic diuretics Mechanism of action: ×¢×•×‘×¨ ×‘×§×œ×•×ª ×“×¨×š ×”×’×œ×•×ž×¨×•×œ×•×¡ ××š ×œ× × ×¡×¤×’ ×—×–×¨×” ×ž×”×©×ª×Ÿ, ×›×œ×•×ž×¨ × ×©××¨ ×‘×œ×•×ž×Ÿ ×•×¡×•×¤×— ×ž×™× ××œ ×”×œ×•×ž×Ÿ
Osmotic diuretics Effect: The volume of the urine increases
Na excretion increases
Reduce brain volune and intracranial pressure
Reduces intraocular pressure
Osmotic diuretics Toxicity: Hypokalemia
Pulmonary edema
Headache, nausea and vomiting
ADH agonidts ×©×ž×•×ª ×”×ª×¨×•×¤×•×ª: Desmopressin
play a role somewhere after the elevation of cAMP.
ADH agonists clinical use and toxicity: used in pituitary diabetes insipidus
Toxicity - hypertension
ADH antagonidts ×©×ž×•×ª ×”×ª×¨×•×¤×•×ª: Lithium
Demeclocycline
ADH antagonists clinical use and toxicity: SIADH
Demeclocycline - ×’×•×¨× ×œ×”×¤×¨×¢×•×ª ×‘×’×“×™×œ×” ×©×œ ×¢×¦×ž×•×ª ×•×©×™× ×™×™ ×™×œ×“×™× ×ž×ª×—×ª ×œ×’×™×œ 8
Lithium - can cause diabetes insipidos

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