diuretics

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powerpoint presentation theme: diuretics from knauf & mutschler klin. wochenschr. 1991 69:239-250 70% 20% 5% 4.5% 0.5% volume 1.5 l/day urine na 100 meq/l na excretion 155 meq/day 100% gfr 180 l/day plasma na 145 meq/l filtered load 26,100 meq/day ca inhibitors proximal tubule loop diuretics loop of henle thiazides distal tubule antikaliuretics collecting duct thick ascending limb principles important for understanding effects of diuretics interference with na+ reabsorption at one nephron site interferes with other renal functions linked to it it also leads to increased na+ reabsorption at other sites increased flow and na+ delivery to distal nephron stimulates k + (and h +) secretion diuretics act only if na+ reaches their site of action. the magnitude of the diuretic effect depends on the amount of na+ reaching that site diuretic actions at different nephron sites can produce synergism all, except spironolactone, act from the lumenal side of the …

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tate 82±5 k acetate 95±5 disodium sulfate 152±22 dipotassium sulfate 118±12 trisodium citrate 112±5 correlation of the daily clinical doses of thiazide diuretics with their affinity for high-affinity 3h-metolazone binding sites in rat kidney. correlation coefficient r=0.7513. from beaumont et al.: thiazide diuretic drug receptors in rat kidney: identification with [3h]metolazone. proc. natl. acad. sci. usa 1988, 85:2311-2314. thiazides - pharmacokinetics rapid gi absorption distribution in extracellular space elimination unchanged in kidney variable elimination kinetics and therefore variable half-lives of elimination ranging from hours to days. clinical uses of thiazides-1 1) hypertension thiazides reduce blood pressure and associated risk of cva and mi in hypertension they should be considered first-line therapy in hypertension (effective, safe and cheap) mechanism of action in hypertension is uncertain – involves vasodilation that is not a direct effect but a consequence of the diuretic/natriuretic effect from birkenhäger, wh: diuretics and blood pressure reduction: physiological aspects. …

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ffects. lower doses now used cause fewer adverse effects. among them are: hypokalemia dehydration (particularly in the elderly) leading to postural hypotension hyperglycemia possibly because of impaired insulin release secondary to hypokalemia hyperuricemia because thiazides compete with urate for tubular secretion adverse effects of thiazides-2 hyperlipidemia; mechanism unknown but cholesterol increases usually trivial (1% increase) impotence hyponatremia due to thirst, sodium losloss, inappropriate adh secretion (can cause confusion in the elderly), usually after prolonged use less common problems hypersensitivity - may manifest as interstitial nephritis, pancreatitis, rashes, blood dyscrasias (all very rare) metabolic alkalosis due to increased sodium load at the distal convoluted tubule which stimulates the sodium/hydrogen exchanger to reabsorb sodium and excrete hydrogen hypercalcemia adverse effects of thiazides-3 loop diuretics secreted in proximal tubule by acid mechanisms act on the ascending loop of henle to inhibit sodium and chloride transport cause a greater natriuresis than thiazides effective at …

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limination: unchanged in kidney or by conjugation in the liver and secretion in bile. from brater, dc. pharmacodynamic considerations in the use of diuretics. ann. rev. pharmacol. toxicol 1983, 23:45-62. clinical uses of loop diuretics edema due to chf, nephrotic syndrome or cirrhosis acute heart failure with pulmonary edema hypercalcemia not in widespread use for the treatment of hypertension (except in a few special cases e.g. hypertension in renal disease) hypokalemia, metabolic alkalosis, hypercholesterolemia, hyperuricemia, hyperglycemia, hyponatremia dehydration and postural hypotension hypocalcemia (in contrast to thiazides) hypersensitivity ototoxicity (especially if given by rapid iv bolus) adverse effects of loop diuretics similar to thiazides in many respects edema: therapeutic considerations therapy is palliative (except with pulmonary edema). need a mild sustained response. specific consideration to potassium homeostasis, i.e. supplement with k-salt or use k-sparing diuretic. therefore, in most cases start with a thiazide. if resistant, move to loop diuretic. from brater, …

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r < 50 80 160 renal insufficiency clcr < 20 200 400 nephrotic syndrome 120 240 cirrhosis 40 80 congestive heart failure 40-80 80-160 powerpoint presentation from knauf & mutschler klin. wochenschr. 1991 69:239-250 70% 20% 5% 4.5% 0.5% volume 1.5 l/day urine na 100 meq/l na excretion 155 meq/day 100% gfr 180 l/day plasma na 145 meq/l filtered load 26,100 meq/day ca inhibitors proximal tubule loop diuretics loop of henle thiazides distal tubule antikaliuretics collecting duct thick ascending limb principles important for understanding effects of diuretics interference with na+ reabsorption at one nephron site interferes with other renal functions linked to it it also leads to increased na+ reabsorption at other sites increased flow and na+ delivery to distal nephron stimulates k + (and h +) secretion diuretics act only if na+ reaches their site of action. the magnitude of the diuretic effect depends on the amount of na+ …

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powerpoint presentation theme: diuretics from knauf & mutschler klin. wochenschr. 1991 69:239-250 70% 20% 5% 4.5% 0.5% volume 1.5 l/day urine na 100 meq/l na excretion 155 meq/day 100% gfr 180 l/day plasma na 145 meq/l filtered load 26,100 meq/day ca inhibitors proximal tubule loop diuretics loop of henle thiazides distal tubule antikaliuretics collecting duct thick ascending limb principles important for understanding effects of diuretics interference with na+ reabsorption at one nephron site interferes with other renal functions linked to it it also leads to increased na+ reabsorption at other sites increased flow and na+ delivery to distal nephron stimulates k + (and h +) secretion diuretics act only if na+ reaches their site of action. the magnitude of the …

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