Diuretics
Pharmacology
Katzung
Abnormalities in fluid volume and electrolyte composition are common and important clinical disorders. Drugs that block specific transport functions of the renal tubules are valuable clinical tools in the treatment of these disorders. Although various agents that increase urine volume (diuretics) have been described since antiquity, it was not until 1937 that carbonic anhydrase inhibitors were first described and not until 1957 that a much more useful and powerful diuretic agent (chlorothiazide) became available. Technically, a “diuretic” is an agent that increases urine volume, whereas a “natriuretic” causes an increase in renal sodium excretion and an “aquaretic” increases excretion of solute-free water. Because natriuretics almost always also increase water excretion, they are usually called diuretics. Osmotic diuretics and antidiuretic hormone antagonists (see Agents That Alter Water Excretion) are aquaretics that are not directly natriuretic.
Diuretics
Pharmacology
Katzung
Abnormalities in fluid volume and electrolyte composition are common and important clinical disorders. Drugs that block specific transport functions of the renal tubules are valuable clinical tools in the treatment of these disorders. Although various agents that increase urine volume (diuretics) have been described since antiquity, it was not until 1937 that carbonic anhydrase inhibitors were first described and not until 1957 that a much more useful and powerful diuretic agent (chlorothiazide) became available. Technically, a “diuretic” is an agent that increases urine volume, whereas a “natriuretic” causes an increase in renal sodium excretion and an “aquaretic” increases excretion of solute-free water. Because natriuretics almost always also increase water excretion, they are usually called diuretics. Osmotic diuretics and antidiuretic hormone antagonists (see Agents That Alter Water Excretion) are aquaretics that are not directly natriuretic.
Vasodilators and antihypertensive agents-Dr.Jibachha Sah,M.V.Sc,LecturerDr. Jibachha Sah
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
Diuretics - Diuretics are chemical agents which increase the excretion of urine by kidneys. They lead to the secretion of excess water and that accumulate in tissues and urine, results in decrease in body fluids especially the extracellular fluid. The increased excretion of water and electrolytes by the kidneys is dependent in three different processes viz., glomerular filtration, tubular reabsorption active and passive and tubular secretion. Diuretics are classified in mainly three types: 1.High ceiling diuretics -Loop diuretics acts mainly at thick ascending limb of the loop of Henle. These diuretics produce peak diuresis which is much greater than other diuretics. Loop diuretics inhibit reabsorption of Na+, Cl- and K+ ions by inhibiting Na+/K+/2Cl- symport of the thick ascending limb of loop of Henle. By inhibiting Na+/K+/2Cl- symport, these agents also inhibit reabsorption of Ca++ and Mg++.
E.g. Furosemide , bumetanide, torasemide.
2. Medium efficacy diuretics-(a)Thiazide -Thiazide diuretics act on the early distal convoluted tubule and inhibit the sodium-chloride symporter leading to a retention of water in the urine, as water normally follows penetrating solutes. The short-term anti-hypertensive action is based on the fact that thiazides decrease preload, decreasing blood pressure. E.g. Chlorothiazide, Hydrochlorothiazide, Benzothiazide
(b)Thiazide like diuretics- These diuretics are behave like thiazide diuretics. E.g. Chlorthialidone, Indapamide, Xipamide, Metolazone ).
3. Weak diuretics-
(a)Carbonic anhydrase inhibitor- Carbonic anhydrase inhibitor acts on proximal convoluted tubule.
Carbonic anhydrase inhibitors are a medication used in the management and treatment of glaucoma, idiopathic intracranial hypertension, altitude sickness, congestive heart failure, and epilepsy, among other diseases.
E.g. acetazolamide
(b) Potassium sparing - These are diuretics which do not promote the secretion of potassium into the urine; thus, potassium is retained and not lost as much as with other diuretics. Potassium sparing diuretics act on cortical collecting tubule. These type of diuretics inhibit sodium reabsorption in late distal tubule and indirectly spare potassium excretion. E.g. Spironolactone, Eplerenone, Triamterene, Amiloride, (c)Osmotic -Osmotic diuretic is a type of diuretic that inhibits reabsorption of water and sodium (Na). They are pharmacologically inert substances that are given intravenously. They increase the osmolarity of blood and renal filtrate. In the nephron, osmotic diuretics act at the portions of the nephron that are water-permeable like proximal convoluted tubule, descending limb of loop of Henle, collecting tubuel.
E.g. Mannitol, Glycerol, Isosorbide).
Uses of diuretics - Acute pulmonary oedema,
Congestive cardiac failure,
Forced diuresis in barbiturate poisoning, Hypertension and CCF, Idiopathic hypercalciuria,
Nephrogenic diabetes incipidus, Certain kidney disorders, acute kidney failure.
Diuretic and Urinary alkalizes-Dr.Jibachha Sah,M.V.ScDr. Jibachha Sah
Dr.Jibachha Sah,M.V.Sc (Veterinary pharmacology),Lecture,College of Veterinary science,NPI,Bhojard,Chitwan,Nepal.This is part of lecture note on veterinary pharmacologyAUTONOMIC AND SYSTEMIC PHARMACOLOGY, Sixth Semester, B.V.Sc & A.H 6th semester.
Dr.Jibachha sah,Email: jibachhashah@gmail.com,Mobile:00977-9845024121
Vasodilators and antihypertensive agents-Dr.Jibachha Sah,M.V.Sc,LecturerDr. Jibachha Sah
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
Diuretics - Diuretics are chemical agents which increase the excretion of urine by kidneys. They lead to the secretion of excess water and that accumulate in tissues and urine, results in decrease in body fluids especially the extracellular fluid. The increased excretion of water and electrolytes by the kidneys is dependent in three different processes viz., glomerular filtration, tubular reabsorption active and passive and tubular secretion. Diuretics are classified in mainly three types: 1.High ceiling diuretics -Loop diuretics acts mainly at thick ascending limb of the loop of Henle. These diuretics produce peak diuresis which is much greater than other diuretics. Loop diuretics inhibit reabsorption of Na+, Cl- and K+ ions by inhibiting Na+/K+/2Cl- symport of the thick ascending limb of loop of Henle. By inhibiting Na+/K+/2Cl- symport, these agents also inhibit reabsorption of Ca++ and Mg++.
E.g. Furosemide , bumetanide, torasemide.
2. Medium efficacy diuretics-(a)Thiazide -Thiazide diuretics act on the early distal convoluted tubule and inhibit the sodium-chloride symporter leading to a retention of water in the urine, as water normally follows penetrating solutes. The short-term anti-hypertensive action is based on the fact that thiazides decrease preload, decreasing blood pressure. E.g. Chlorothiazide, Hydrochlorothiazide, Benzothiazide
(b)Thiazide like diuretics- These diuretics are behave like thiazide diuretics. E.g. Chlorthialidone, Indapamide, Xipamide, Metolazone ).
3. Weak diuretics-
(a)Carbonic anhydrase inhibitor- Carbonic anhydrase inhibitor acts on proximal convoluted tubule.
Carbonic anhydrase inhibitors are a medication used in the management and treatment of glaucoma, idiopathic intracranial hypertension, altitude sickness, congestive heart failure, and epilepsy, among other diseases.
E.g. acetazolamide
(b) Potassium sparing - These are diuretics which do not promote the secretion of potassium into the urine; thus, potassium is retained and not lost as much as with other diuretics. Potassium sparing diuretics act on cortical collecting tubule. These type of diuretics inhibit sodium reabsorption in late distal tubule and indirectly spare potassium excretion. E.g. Spironolactone, Eplerenone, Triamterene, Amiloride, (c)Osmotic -Osmotic diuretic is a type of diuretic that inhibits reabsorption of water and sodium (Na). They are pharmacologically inert substances that are given intravenously. They increase the osmolarity of blood and renal filtrate. In the nephron, osmotic diuretics act at the portions of the nephron that are water-permeable like proximal convoluted tubule, descending limb of loop of Henle, collecting tubuel.
E.g. Mannitol, Glycerol, Isosorbide).
Uses of diuretics - Acute pulmonary oedema,
Congestive cardiac failure,
Forced diuresis in barbiturate poisoning, Hypertension and CCF, Idiopathic hypercalciuria,
Nephrogenic diabetes incipidus, Certain kidney disorders, acute kidney failure.
Diuretic and Urinary alkalizes-Dr.Jibachha Sah,M.V.ScDr. Jibachha Sah
Dr.Jibachha Sah,M.V.Sc (Veterinary pharmacology),Lecture,College of Veterinary science,NPI,Bhojard,Chitwan,Nepal.This is part of lecture note on veterinary pharmacologyAUTONOMIC AND SYSTEMIC PHARMACOLOGY, Sixth Semester, B.V.Sc & A.H 6th semester.
Dr.Jibachha sah,Email: jibachhashah@gmail.com,Mobile:00977-9845024121
Drugs used in urinary inconsistancy or scanty of urine, that promote urine formation and increases urine output are explained in the ppt by Dr. Mrunal Akre
Any substance that promotes the production of urine
All diuretics increase the excretion of water from bodies
Alternatively, an antidiuretic such as vasopressin, or antidiuretic hormone.
Diuretics are used to treat heart failure, liver cirrhosis, hypertension, water poisoning, and certain kidney diseases
Pharmacology of drugs acting on Renal System.pdfAFFIFA HUSSAIN
Diuretics also known as water pills increases the excretion of water and electrolytes (Na+) in
urine.
Natriuresis – large amount of sodium excreted in urine due to the action of kidneys.
Promoted by – ventricular and atrial natriuretic as well as calcitonin.
Inhibited by chemicals such as aldosterone. The drugs which increases sodium excretion are
known as natriuretic.
Diuresis – increased or excessive production of urine. The drugs which enhances the excretion
of water without loss of electrolyte is called as aquaretic.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
4. 1. Salidiuretics
(thiazides and their analogues)
They increase equivalently Na+
and Cl-
excretion (1:1) in distal renal tubules and
this increases diuresis. They lead to
excretion of 5 to 10% from filtrated Na+
ions
and have moderate diuretic action. They
can be classified as sulfonamides with free
–NH2 group, without antimicrobial activity.
10. Thiazides have a weak antihypertensive
effect because they reduce arterial wall sensitivity
to NA (noradrenaline) and AT (Angiotensin).
They potentiate significantly the effect
of other antihypertensive drugs.
Thiazides increase plasma renin levels.
Reduction of plasma Sodium and
osmolarity leads to “paradoxal”
antidiuretic effect in diabetes insipidus.
11. Adverse reactions (ARs) of saluretics:
Hypokalemia and enhancing therapeutic and
toxic effects of CGs, hypochloremic alkalosis,
GI disorders, skin rashes and photosensibi-
lization, muscle weakness and fatigue, hypo-
natremia, hypoglycemia, increased plasma level
of uric acids, hypercholesterolemia, impotence.
Thiazides decrease GF (glomerul filtration).
They reduce plasma volume in pregnant
women and decrease fetal oxygenation (PRC: D).
15. Furosemide has p.o. bioavailability 65%
and t1/2 30–60 min. It acts on the ascending
limb of Henley's loop by increasing
urine excretion of Na+
, Cl-
, Mg2+
and
Ca2+
. Its diuretic effect is achieved in
20–30 min after p.o. administration
and lasts 4–6 h. Its effect after i.v.
administration begins in 3–5 min and
lasts 2 h. In low doses (5 to 10 mg p.o.)
furosemide has antihypertensive effect.
It does not disrupt GF.
16.
17. Furosemide – indications:
Oedemas of different origin, acute ischemic
renal failure (in high DD, together
with mannitol), anuria and eclampsia, forced
diuresis in acute intoxications, hypertension,
resistant cardiac failure.
Furosemide enhances the action
of antihypertensive drugs and
non-depolarazing neuromuscular blockers.
18. Furosemide – ARs:
Hypokaliemia, skin rashes, hyperglycemia,
increased plasma levels of uric acid.
In fast i.v. administration – transient
hearing disturbances with temporary
deafness and orthostatic collapse.
Ototoxic risk is increased in co-medicaton
with aminoglycosides, cephalosporines,
polymyxins, sulfonamides or quinolones.
19. 3. Carbonic anhydrase inhibitors
Acetazolamide inhibits carbonic
anhydrase (CA) mainly in proximal tubules.
H2O + CO2
CA
H2CO3 H2CO3
–
+ H+
20. Acetazolamide has weak diuretic action.
It significantly enhances urine K+
excretion.
The loss of HCO3
–
anions decreases blood
alkaline reserve (for 48–72 h) and causes
metabolic acidosis. In this state the drug
becomes ineffective.
Acetazolamide blocks not only renal CA, but
also CA in the ciliary body in the eye
(reducing production of eye liquid) and in the
brain (facilitates GABA synthesis).
25. Spironolactone is a steroid compound,
which is a competitive aldosterone antagonist.
It increases Na+
excretion and decreases K+
and urea excretion. Its diuretic action is
weak and is achieved slowly.
Spironolactone is effective in oedemas,
caused by increased production of
aldosterone ascites in liver cirrhosis and
oedemas in congestive heart failure.
26. Spironolactone in low doses (25 mg/24 h)
potentiates the effect of ACE inhibitors. It
saves K+
and Mg2+
ions and has antiarrhyth-
mic effect. It also prevents the development of
myocardial fibrosis, caused by aldosterone
and in this way contributes to enhancing
myocardial contractility.
27. Diuretidin®
(triamterene/hydrochlorothiazide)
is indicated in oedemas cardiac, renal,
liver or other origin and for the
treatment of hypertension with
other antihypertensive drugs.
Moduretic®
(amiloride/hydrochlorothiazide)
has the same indications too.
29. After oral administration Mannitol is not
absorbed and has laxative effect. After i.v.
administration it is not metabolized, it
filtrates in the glomerulus and not reabsorbed
in renal tubules, causing increased osmotic
pressure and excretion of isoosmotic equivalent
of water. It increases blood flow in 30%.
30. Мannitol does not influence renin synthesis.
It does not cross tissue barriers (BBB neither),
does not penetrate to the eye and brain and
in osmotic way reduces intraocular and intra-
cranial pressure.
It is included in the treatment of brain oedema,
initial stages of acute renal failure, chronic
renal failure, glaucoma, intoxications with
drugs, excreted in the urine.