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DIURETICS
PRESENTED BY
Priyanka Priyadrsani Nayak
M.Pharmacy.
DIURETICS
DEFINITION :
 These are drugs which cause a net loss of Na+ and
water in urine
There are several categories of diuretics. All diuretics
increases the excretion of water from body.
CLASSIFICATION
Diuretics are Classified as:
1. High ceiling /Loop diuretics…
2. Thiazides.
3.Carbonic anhydrase inhibitors.
4.Potassium –sparing diuretics.
5.Osmatic diuretics.
6.Low ceiling diuretics.
DIURETICS CLASSIFICATION
1.HIGH EFFICACY DIURETICS:
(Inhibitors of Na+,K+,2Cl- cotransport)
(a) Sulphamoyl deravatives:
Furosemide.
Bumetanide.
Torasemide.
(b) Phenoxyacetic acid derivative:
Ethacrynic acid.
MEDIUM EFFICACY DIURETICS
2.Medium efficacy diuretics :
( Inhibitors of Na+,Cl- symport)
(a) Benzothiadiazines(THIAZIDES):
Hydrochloro thiazide.
Benzthiazide.
Hydroflumethe thiazide.
Ciopamide.
(b) Thiazide: Chlorthalidone.
Metolazone.
Xipamide.
Indapamide.
WEAK OR ADJUNCTIVE DIURETICS
3.Weak or adjunctive diuretics:
(a) Carbonic anhydrase inhibitors:
Acetazolamide.
(b) Potassium –sparing diuretics:
(i)Aldosterone antagonist:
Spironolacton
Eplerenone.
(ii)Inhibitors of renal epithial Na+ channel:
Trimterene.
Amiloride.
(c) Osmotic diuretics:
Mannitol.
Isosorbide.
Glycerol.
(d) Xanthines:
Theophlline.
ANTI- DIURETICS
1.Anti diuretic homone(ADH) and its analogues:
Vasopressin.
Desmopressin.
Lypressin.
Terlipressin.
2.Diuretics:
Thiazides.
Amiloride.
3. Miscellineous:
Chlorpropamide.
Carbamazepine.
MECHANISM OF DIURETICS
MECHANISM OF ACTION
MECHANISM OF ACTION OF LOOP
DIURETICS
INDICATIONS AND SIDE EFFECTS
MECHANISM OF THIAZIDE DIURETICS
POTASSIUM- SPARING DIURETICS
OSMOTIC DIURETICS
PHARMACOLOGICAL
ACTIONS
OF
DIURETICS
HIGH CEILING/LOOP DIURETICS
 High ceiling diuretics may cause a substantial
decrease upto 20%of the filtered load of Nacl and
water.
 Loop diuretics such as FUROSEMIDE inhibits the
body’s ability to reabsorb sodium at the ascending
loop in NEPHRON.
THIAZIDES
 Thiazide diuretics such as Hydrochlorothiazide act on
the distal convoluted tubule and inhibits the sodium-
chloride symporter leading to retention of water in the
urine.
 Frequent urination is due to the increased loss of
water.
 The long term anti –hypertensive action is based on
the thiazides which decrease preload and blood
pressure.
CARBONIC ANHYDRASE INHIBITORS
 Carbonic anhydrase inhibitors inhibits the enzyme
carbonic anhydrase which is found in proximal
convoluted tubule.
 This results in several effects including biocarbonate
retention in the urine.
 Potassium retention in urine.
 Decreased sodium absorption.
Eg: Acetazolamide.
Methazolamine.
POTASSIUM-SPARING DIURETICS
 These are diuretics which do not promote the
secretion of potassium into the urine.
 Potassium is retained and not lost as much as with
other diuretics.
 The term potassium sparing refers to an effects
rather than a mechanism or location.
Eg: Aldosterone antagonists
Spironolactone
 Which is a competitive antagonist of aldosterone.
 Aldosterone adds sodium channels in the cells of
collecting duct and late distal tubule of the Nephron.
 Spirnolactone prevents aldosterone from entering
the cells, and preventing sodium reabsorption.
Eg: Eplerenone.
Potassium canrenonate.
 Epithelial sodium channel blockers
Eg: Amiloride.
Triamterence.
OSMOTIC DIURETICS
The compounds as Mannitol are filtered in the
glomerulus, but cannot be reabsorbed.
 Their presence lead to an increases in the osmolarity
of the filtrate.
 To maintain osmotic balance ,water is retained in the
urine.
 Glucose like mannitol behave as an osmotic diuretic.
 Glucosuria causes a loss of hypotonic water & Na+,
leading to a hypertonic state with signs of volume
depletion.
 Such as Hypotention,Tachycardia.
LOW CEILING DIURETICS
 The low celing diuretics are used to indicate an
diuretic has a rapid flatting dose effect curve.
 It refers to a pharmacological profile ,not a chemical
structure.
MEDICINAL USES
 Diuretics are used to treat
1. Heart failures.
2.Liver cirrhosis.
3.Hypertension.
4.Certain kidney diseases
USES AND SIDE EFFECTS OF DIURETICS
REFERENCES
Essential of medical pharmacology by KD
Tripathi,7th edition.
Pharmacology by H.P Rang and M.A Dale.
Pharmacology and Pharmacotherapeutics
R.S.Satoskar and S.D.Bhandarkar.
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Diuretics...

  • 2. DIURETICS DEFINITION :  These are drugs which cause a net loss of Na+ and water in urine There are several categories of diuretics. All diuretics increases the excretion of water from body.
  • 3.
  • 4. CLASSIFICATION Diuretics are Classified as: 1. High ceiling /Loop diuretics… 2. Thiazides. 3.Carbonic anhydrase inhibitors. 4.Potassium –sparing diuretics. 5.Osmatic diuretics. 6.Low ceiling diuretics.
  • 5. DIURETICS CLASSIFICATION 1.HIGH EFFICACY DIURETICS: (Inhibitors of Na+,K+,2Cl- cotransport) (a) Sulphamoyl deravatives: Furosemide. Bumetanide. Torasemide. (b) Phenoxyacetic acid derivative: Ethacrynic acid.
  • 6. MEDIUM EFFICACY DIURETICS 2.Medium efficacy diuretics : ( Inhibitors of Na+,Cl- symport) (a) Benzothiadiazines(THIAZIDES): Hydrochloro thiazide. Benzthiazide. Hydroflumethe thiazide. Ciopamide. (b) Thiazide: Chlorthalidone. Metolazone. Xipamide. Indapamide.
  • 7. WEAK OR ADJUNCTIVE DIURETICS 3.Weak or adjunctive diuretics: (a) Carbonic anhydrase inhibitors: Acetazolamide. (b) Potassium –sparing diuretics: (i)Aldosterone antagonist: Spironolacton Eplerenone. (ii)Inhibitors of renal epithial Na+ channel: Trimterene. Amiloride.
  • 9. ANTI- DIURETICS 1.Anti diuretic homone(ADH) and its analogues: Vasopressin. Desmopressin. Lypressin. Terlipressin. 2.Diuretics: Thiazides. Amiloride. 3. Miscellineous: Chlorpropamide. Carbamazepine.
  • 12. MECHANISM OF ACTION OF LOOP DIURETICS
  • 13.
  • 15.
  • 17.
  • 21. HIGH CEILING/LOOP DIURETICS  High ceiling diuretics may cause a substantial decrease upto 20%of the filtered load of Nacl and water.  Loop diuretics such as FUROSEMIDE inhibits the body’s ability to reabsorb sodium at the ascending loop in NEPHRON.
  • 22. THIAZIDES  Thiazide diuretics such as Hydrochlorothiazide act on the distal convoluted tubule and inhibits the sodium- chloride symporter leading to retention of water in the urine.  Frequent urination is due to the increased loss of water.  The long term anti –hypertensive action is based on the thiazides which decrease preload and blood pressure.
  • 23. CARBONIC ANHYDRASE INHIBITORS  Carbonic anhydrase inhibitors inhibits the enzyme carbonic anhydrase which is found in proximal convoluted tubule.  This results in several effects including biocarbonate retention in the urine.  Potassium retention in urine.  Decreased sodium absorption. Eg: Acetazolamide. Methazolamine.
  • 24. POTASSIUM-SPARING DIURETICS  These are diuretics which do not promote the secretion of potassium into the urine.  Potassium is retained and not lost as much as with other diuretics.  The term potassium sparing refers to an effects rather than a mechanism or location. Eg: Aldosterone antagonists Spironolactone
  • 25.  Which is a competitive antagonist of aldosterone.  Aldosterone adds sodium channels in the cells of collecting duct and late distal tubule of the Nephron.  Spirnolactone prevents aldosterone from entering the cells, and preventing sodium reabsorption. Eg: Eplerenone. Potassium canrenonate.  Epithelial sodium channel blockers Eg: Amiloride. Triamterence.
  • 26. OSMOTIC DIURETICS The compounds as Mannitol are filtered in the glomerulus, but cannot be reabsorbed.  Their presence lead to an increases in the osmolarity of the filtrate.  To maintain osmotic balance ,water is retained in the urine.  Glucose like mannitol behave as an osmotic diuretic.  Glucosuria causes a loss of hypotonic water & Na+, leading to a hypertonic state with signs of volume depletion.  Such as Hypotention,Tachycardia.
  • 27. LOW CEILING DIURETICS  The low celing diuretics are used to indicate an diuretic has a rapid flatting dose effect curve.  It refers to a pharmacological profile ,not a chemical structure.
  • 28. MEDICINAL USES  Diuretics are used to treat 1. Heart failures. 2.Liver cirrhosis. 3.Hypertension. 4.Certain kidney diseases
  • 29. USES AND SIDE EFFECTS OF DIURETICS
  • 30. REFERENCES Essential of medical pharmacology by KD Tripathi,7th edition. Pharmacology by H.P Rang and M.A Dale. Pharmacology and Pharmacotherapeutics R.S.Satoskar and S.D.Bhandarkar.