This document discusses different types of antidiuretic drugs used to treat diabetes insipidus by reducing urine volume. It describes antidiuretic hormone, thiazide diuretics, and other miscellaneous drugs like chlorpropamide, carbamazepine, and clofibrate. For each drug, it provides information on mechanisms of action, indications, dosages, side effects and nursing responsibilities. The document was prepared by an assistant professor from a university in Ethiopia as an overview of antidiuretic medications.

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