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Renal PHARMACOLOGY
- 1. RENAL PHARMACOLOGY F O R V E D I O V I S T M Y Y O U T U B E C H A N N E L P H A R M A C A R E BY :-ANIL SHARMA
- 2. NEPHRON :-
- 3. INTRODUCTION :- • Kidney is mainly a regulatory organ • It has also a excretory function • The functional unit of kidney is nephron • Each kidney contain about 1 million nedphron FUNCTION OF KIDNEY :- 1. Regulatory :- acid –base fluid and electrolyte balance 2. Excretory :- excretion of nitrogenous waste products 3. Hormonal :- activation of vitamin D , production of renin and erythropoietin
- 4. CLASSIFICATION OF DIURETICS :- According to primary site of action in the nephron :- 1. Drugs acting to PCT (site 1):- carbonic anhydrase inhibitor :_ Acetazolamide 2. Drugs acting at thick ascending limb of loop of henle (site 2):- Loop diuretics :- furosemide , bumetanide, torsemide 3. Drugs acting at early distal tubule (site 3) :- a) Thiazide :-chlorothiazide , hydrochlorothiazide ,hydroflumethiazide ,bezthiazide b) Thiazide related diuretics :- chlorthalidone ,indapamide metolazone 4. Drug acting at late distal tubule and collecting duct (site 4):- a) Aldosterone antagonists :- spironolactone ,eplerenone b) Direct acting inhibitor of renal epithelial Na+ channel:-Amiloride , triamterene 5. Drug acting on entire nephron (main site action is loop of henle ):- a) osmotic diuretics :- mannitol , glycerol , isosorbide
- 5. CARBONIC ANHYDRASE INHIBITORS:- MECHANISM OF ACTION :-
- 6. USES :- • Acetazolamide is not used as diuretics because of low efficacy 1. Glaucoma :- carbonic anhydrase inhibitors decreases IOP by reducing formation of aqueous humour 2. To alkalinize urine in acidic drug poisoning 3. Acute mountain sickness :- used for both symptomatic relief and prophylaxis of acute mountain sickness 4. Miscellaneous :- epilepsy , familial periodic paralysis
- 7. ADVERSE EFFECT :- •Hypersensitivity reaction:- skin rashes ,fever , nephritistis) •Drowsiness •Paraesthesia •Hypokalaemia •Metabolic acidosis •Headache •Renal stone
- 8. CONTRAINDICATION:- 1. Liver disease :- hepatic coma may precipitate in patient with cirrhosis due to decrease excretion of NH3 in alkaline urine 2. COPD:- worsening of metabolic acidosis in patient with COPD
- 9. 2. OSMOTIC DIURETICS:- • MECHANISM OF ACTION :-
- 10. PHARMACOKINETICS:- • Administered IV neither metabolised in body nor reabsorbed from renal tubules . • Pharmacodynamically inert , is freely filtered at Glomerulus
- 11. USES :- • Mannitol is used to reduce the elevated intra cranial tension (ICT) head injury or tumour • Mannitol (20%) IV , glycerol(50%) oral is used to reduce IOP in acute congestive glaucoma • Mannitol is used to maintain the osmolality of ECF after dialysis
- 12. ADVERSE EFFECT:_ •Too rapid ,too much quantity of IV mannitol cause expansion of ECF volume leads to pulmonary oedema . •Headache •Nausea •Vomiting •Glycerol cause hyperglycaemia
- 13. CONTRAINDICATION:- •Mannitol is contraindication in CCF and pulmonary oedema because it expand ECF volume •In chronic oedema •Renal disease •Acute tubular necrosis
- 14. 3.LOOP DIURETICS:- • MECHANISM OF ACTION :- -
- 15. PHARMACOKINNETICS:- Rapidly absorbed through GIT Furosemide and bumetanide is given orally , IV and IM routes. Torsemide is given oral and IM Furosemide has rapid onset of action
- 16. USES:- Useful in initial stages of renal and cardiac oedema Useful in hepatic oedema –vigorous diuretics should be avoided to prevent hepatic coma Acute oedema Hypertension
- 17. ADVERSE EFFECT :- Electrolytic disturbance :- hypokalaemia , hyponatraemia , hypocalcaemia and hypomagnesaemia Metabolic disturbance :- hyperglycaemia , hyperuricaemia , hyperlipidaemia Ototoxicity Hypersensitivity :-skin rashes , photosensitivity
- 18. THIAZIDE AND THIAZIDE LIKE DIURETIC:-
- 19. USES:- Hypertension Oedema :- thiazide and loop diuretics both are effective in hepatic oedema Diabetes insipidus
- 20. POTASSIUM SPARING DIURETICS:- MECHANISM OF ACTION :-
- 21. PHARMACOKINETICS :- Administered orally , get partially absorbed , highly bound to plasma protein Metabolized in liver and forms active metabolites
- 22. ADVERSE EFFECT :- • Hyperkalaemia
- 23. USES:- In oedema condition associated with CCF , hepatic cirrhosis CCF:-used in moderate – severe Heart failure because it block effect of aldosterone Used with thiazides /loop diuretics :- serum K+ level is maintained and antihypertensive efficacy is enhanced .