Diuretics - PowerPoint PPT Presentation

1 / 26
About This Presentation
Title:

Diuretics

Description:

Title: 1 Author: Pasha Last modified by: Created Date: 11/17/2002 11:09:37 AM Document presentation format: (4:3) Company – PowerPoint PPT presentation

Number of Views:753
Avg rating:3.0/5.0
Slides: 27
Provided by: Pas127
Category:
Tags: diuretics | oedema

less

Transcript and Presenter's Notes

Title: Diuretics


1
Diuretics
Lector prof. Posokhova K.A.
2
Nephron
Speed of primary urine formation 120127
ml/min There are about 1mln. nephrons in a
kidney, reabsorbtive surface of which is 6-8
m2. Along the nephron 99 of ultrafiltrate is
reabsorbed and 1.2-1.5 l of secondary urine forms
from 150-200 l of primary urine.
3
Apical (lumenal) membrane
Na enters a cell 1) with the concentration
gradient 2) with the help of protein transporters
permeases (synthesized under the influence of
aldosterone)
Na
Basal membrane
Na enters interstitial space against
concentration gradient with energy consumption
and with the help of specific transport systems
(K, Na-ATPases, c?MP-adenilatcyclases and
phosphodiesterases, etc.)
Na
4
Quantity of diuresis
Filtration
Primary urine
Reabsorbtion
Decreasing of reabsorbtion for 10
( 1 of volume of primary urine) Norm
Increasing of filtration 10more
5
Classifiction of diuretics accordingly to power
of action ? Strong (slowing down of Na
reabsorbtion for 10-20) furosemide,
etacrynic acid, clopamide, bufenox ?? Medial
power of action (slowing down of Na
reabsorbtion for 5-8) dichlothiaside,
oxodoline ??? Light (slowing down of Na
reabsorbtion not more than for 3)
diacarb, spironolactone, amiloride, triamteren,
xanthines (theophylline)
6
Mannitol
15 solution
rapid intravenous introduction
intravenous dropping introduction
diuretic action
dehydrating action
diuretic action
7

  • Mannitol
  • Indicatoins
  • Brain oedema (in case of maintaining ofHEB
    permeability)
  • Toxic lung oedema (poisoning with gasoline, gass,
    formaline, skipidar etc.)
  • 3. Larynx oedema of allergic or inflammatory
    genesis
  • 4. Holding of forced diuresis (poisoning with
    barbiturates, salycylates, sulphonamides, PASA,
    metanole, boric acid, haemolytic poisons,
    antifreezers in case of trasfusing of
    incompatible blood, massive hemoglobinuria etc.
  • In oliguric phase of acute nephral insufficiency
  • Burns, osteomielitis, peritonitis, sepsys
  • Contrainidications
  • Acute cardiac insufficiency, skull trauma,
    intracranial hemorrhages, arterial hypertension

8
FUROSEMIDE
  • High ceiling (loop) diuretic
  • Properties
  • 1. diuretic action
  • 2. dilation of peripheral venous
  • 3. decrease left ventricular filling pressure
  • 4. potent anti-inflammatory effect (similar to
    indometacine and other NSAID)
  • Administration hypertensive emergencies,
    long-term treatment of arterial hypertension
  • Adverse reactions dehydration, hypokalemia,
    hearing loss - deafness, hypocalcaemia

9
  • Furosemide (lazix)
  • Effective even in case of decreased
    glomerular filtration less than 10 ml/min. (norm
    127ml/min)
  • Indications
  • Acute left ventricular insufficiency, lung oedema
  • Chronic cardiac insufficiency
  • Arterial hypertension, including hypertensive
    crisis
  • Brain oedema of any etiology
  • Acute nephral insufficiency
  • Performing of forced diuresis
  • For excretion of Calcium ions (hypervitaminosis
    D)

10

  • Side effects of furosemide
  • Hypopotassiumaemia, hypopotassiumhystia
  • Hypovolemia, vascular collapse, hyposodiumaemia,
    hypocalciumaemia, hypochloraemia, metabolic
    alkalosis
  • Ototoxic action
  • Contrinsular action (manifestation of latent
    diabetes mellitus)
  • Formation of oxalate and phosphate stones in
    urinary tracts
  • Decreasing of secretion of uric acid (acute
    attack of gout)
  • It should not be combined with antibiotics,
    aminoglycosides and cephalosporines!

11
Furosemide (diuretic)
12
Furosemide (diuretic)
13
THIAZIDES and RELATED DIURETICS
  • Medium efficacy diuretics
  • Benzothiadiazines (chlorothiazide,
    hydrochlorothiazide, clopamide), related thiazide
    like (chlorthalidone, indapamide)
  • for long-term treatment of arterial hypertesion
    (oral administration)
  • Duration of action (6-12 hours for
    hydrochlorothiazide, 12-18 hours for clopamide,
    48-50 hours for chlorthalidone)
  • Adverse reactions dehydration, hypokalemia,
    hyperuricaemia (rise of blood urate level)

14

  • Dichlotiaside (hypothiaside)
  • Indications
  • Oedema in case of chronic cardiac insufficiency
  • Oedema in case of chronic pathology of liver and
    kidneys
  • Treatment of arterial hypertension
  • Diabetes insipidus
  • Side effects
  • Hypopotassiumaemia, hypopotassiumhystia
  • Hypochloraemic alkalosis
  • Retention of uric acid - artralgy, acute attack
    of gout, chronic nephropathy
  • Hyposodiumaemia of dilution nausea, vomitting,
    diarrhea, weakness
  • Pancreatitis

15
Indapamide (ariphone sulphamoil benzamide)
16
Pharmacokinetics of some diuretic drugs
Drug Way of administration Latent period Duration of action
Sulfonyl derivates Sulfonyl derivates Sulfonyl derivates Sulfonyl derivates
Oxololin (chlortalidon, hyhroton) peroral 2-4 hours Till 3 days
Clopamide peroral 1-3 hours 8-18 (till 24) hours
Bufenox (bumetanide) intravenous 20-40 min. 2-5 min. 4-6 hours 1-3 hours
Potassium-, magnesium-sparing Potassium-, magnesium-sparing Potassium-, magnesium-sparing Potassium-, magnesium-sparing
Spironolactone peroral 2-5 days 2-3 days
Triamteren (pterophen) peroral 20-30 min. 6-8 hours
Amiloride peroral 2 hours till 24 hour
17
Spironolactone
(aldactone)
18
  • Combined administration of diuretics
  • Mannitol furosemide (etacrynic acid)
  • Dichlotiaside triamteren (spironolactone)
  • Furosemide spironolactone
  • Furosemide (excretes Calcium ions)
    dichlotiaside
  • (retains Calcium ions)

19
Triampur (triamteren
hydrochlorthiaside)
20
Fol. Orthosiphoni kidney tea
21
Shots of birch tree (Gemmae Betulae)
22
Leaves of red bilberries (fol.Vitisidaeae)
23
Herba Equiseti
24
Blue corn-flowers (Flores Centaureae cyani)
25
Juniper berries (Fructus Juniperi)
26
Drugs affecting myometrium ? Influence mostly on
myometrium contraction 1. Increase
contractions Oxytocine Dinoprost
(prostaglandine F2a ) Pituitrine Dinoprosto
n (prostaglandine E2 ) Hyphotocine 2.
Decrease contraction (tokolytic substances)
Fenoterol Sodium oxybutyrate
Salbutamol Magnesium sulphate ?? Increase mostly
myometrium tone Ergometrini
maleas Cotarnine chloride Ergotamine
hydrotartrate Ergotal ??? Decrease tone of
uterus cervix Atropine sulphate Dinoprost D
inoproston
Write a Comment
User Comments (0)
About PowerShow.com