Antidiuretics

1. ANTIDIURETICS
PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING
ARSI UNIVERSITY,ASELLA,ETHIOPIA,
SOUTH EAST AFRICA.

2. Antidiuretics ( inhibit the water excretion
without affecting salt excretion) are drugs that
reduce urine volume, particularly in diabetes
insipidus(DI).
ANTIDIURETICS

3. -Antidiuretic hormone (ADH): vasopressin,
desmopressin, lypressin, terlipressin
-Thiazide diuretics : Amiloride
-Miscellaneous : Indomethacin,
chlorpropamide, carbamazepine
CLASSIFICATION

4. ANTIDIURETIC HORMONE (ADH) is secreted
by the posterior pituitary gland.
ANTIDIURETIC HORMONE (ADH)

5. ADH MOA
 ADH enhances water reabsorption by
acting on collecting on the collecting duct.
 ADH activates the V2 receptors present on
the cell membrane of the collecting duct
and increases the water permeability of
these cells.

6.  ADH causes vasoconstriction and raises
BP mediated by V1receptors.
 Vasopressin is given parently as injection of
SC,IM,IV.

7. DOSES OF ADH
 Drug: Lypressin
 Injections : 20 IU, 10 IU-IM or SC or 20 IU
diluted in 100-200 ml of dextrose solution
and infused IV in 10-20 min.

8.  Terlipressin: 2mg, repeat 1-2 mg every 4-6
h
 Desmopressin : IV or SC; 2-4Ug/day
 Intranasal ; adult-10-40 Ug/day in 2-3
divided doses, children – 5-10 Ug/day at
bed time.

9. INDICATIONS
 Diabetes insipidus of pituitary origin-
desmopressin is the preparation used.
 It should be used lifelong.
 Bleeding esophageal varices-ADH
constricts mesenteric blood vessels (v1
receptors ) and may help.

10.  Before abdomonal radiography-expels
gases from the bowel.
 Hemophilia and von willebrand’s disease-
ADH may release factor VIII and prevent
bleeding.

11. CONTRAINDICATIONS
 Patient suffering from vascular disease,
especially disease of coronary arteries.

12. ADVERSE EFFECTS
 When used intranasally ADH can cause
nasal irritation, allergy,rhinitis and atrophy
of nasal mucosas.
 Other effects include nausea, abdominal
cramps and backache (due to constriction
of the uterus).

13. NURSING RESPONSIBILITIES
 Monitor 24 hour output of the patient.
 The ADH therapy lifelong required Iike in
DI.
 Assess any nasal irritation,atrophy of nasal
mucosa in local application.

14. THIAZIDE DIURETICS

15. THIAZIDE DIURETICS
 Thiazide diuretics paradoxically exert an
antidiuretic effect in DI.
 High-ceiling diuretics are also effective, but
are less desirable because of their short
and brisk action.

16. MOA
 Thiazide diuretics paradoxically exert an
antidiuretic effect in DI.
 Thiazide reduce urine volume in both
pituitary origin as well as renal DI by an
unknown mechanism.

17. INDICATIONS
 Diabetes insipidus
 Nephrogenic (DI)
 Mobilization of edema fluid
 Dosage :
 Hydrochlorothiazide 50-150 mg in daily
divided dose.

18. CONTRAINDICATIONS
 Hypokalemia
 Inhibition of insulin secretion
 Risk of atherosclerosis
 Hyperglycemia

19. SIDE EFFECTS
 Depletion of K+
 Inhibition of insulin secretion
 Risk of atherosclerosis
 Hyperglycemia

20. NURSING RESPONSIBILITIES
 Monitor I and O , serum electrolytes and
BP
 Assess for effects of hypokalemia
 Moderate restriction of Na+ cl- intake has
been shown to enhance the antidiuretic
effect.
 Monitor the client for hyperglycemia.

21. MISCELLANEOUS

22. CHLORPROPAMIDE
 Chlorpropamide has a long duration of
action oral hypoglycemic, found to reduce
urine volume in DI of pituitary origin,
 But not in renal DI is sensitize the kidney to
ADH action its efficacy depends on small
amount of the circulating home one.

23.  It is not active when ADH is totally absent.
 It also directly prone salt reabsorption in the
ascending limb C-may contribute to its
antidiuretic action.

24. MOA
 The principle action is B-cells of islets stimulate
insulin secretion, reducing plasma glucose
cone.
 Dose :
 Initially 250 mg/day (100-125 mg/day in old
patients)
 Maintenance 100-500 mg/day (usual 250
mg/day) depending on condition.

25. INDICATION
 To lower blood glucose level.
CONTRAINDICATIONS
 Mild renal impairment
 Liver dysfunction
 Fever
 Infection or trauma.

26. SIDE EFFECTS
 Hypoglycemia
 Nausea
 Vomiting
 Diarrhoea or constipation
 Headache
 Weight gain
 Cholestatic jaundice
 Dilutional hyponatremia
 Intolerance to alcohol

27. NURSING RESPONSIBILITIES
 Carefully observe the patient for signs of
hypoglycemia.
 Patient should be taught the cause of
hypoglycemia reactions and how to avoid
having excessive response to oral
hypoglycemia drugs
 Watch for signs of hyperglycemia and
ketoacidosis
 Patients should learn not to skip planned meals

28. CARBAMAZEPINE
 Carbamazepine is an antiepileptic
anticonvulsant, drug which, reduces urine
volume in DI of pituitary origin.
 It has been shown to stimulate ADH
secretion. However it is not valuable in the
treatment of DI.

29. MOA
 Carbamazepine has a stabilizing influence
on neuronal membrane.
 It can inhibit voltage dependents Na+
channel.
 Its ability to facilitate Na+ extrusion from
nerve cells and to prevent intracellular
accumulation of this cation during repetitive
stimulation.

30. INDICATIONS
 Partial and generalized epileptic seizures
 Preventing pain of trigeminal neuralgia

31. DOSES
 On the first day of epilepsy treatment a total
dose of 200 mg is administered for
trigeminal neuralgia, the dose is 100 mg.
 CONTRAINDICATION :
 Abnormalities in liver function

32. SIDE EFFECTS
 Sedation
 Dizziness
 Vertigo
 Diplopia and ataxia

33.  Hypersensitivity reactions
 Water retention and hyponatremia
 Vomiting , diarrhea
 Acute intoxication causes coma,
convulsions

34. CLOFIBRATE
 Clofibrate is a hypolipidemic drug, it has
been found to enhance the secretion of
ADH from pituitary and exerts a beneficial
effect in DI.
 This action may causes water attention
when used as hypolipoliorunemic.

35. INDICATIONS
 Myocardial infarction
 Neurogenic diabetes insipidus
 DOSES
 0.5-1 g bd

36. CONTRAINDICATIONS
 Liver and kidney disorder
 Pregnant women
 Lactating women

37. SIDE EFFECTS
 Increased appetite
 Weight gain
 Diarrhea
 Pain in abdomen
 Skin rashes
 Neuralgia
 Cardiac dysrthmia

38. NURSING RESPONSIBILITIES
 Patient should be advised to take nicotinic
acid with meals or plenty of fluids or lessen
symptoms of GI irritation such as
heartburn.
 Be sure that patients who are going to
begin drug therapy understand that they
must continue other non-drug measurers
that help to reduce the risk of

39. THANKING YOU