2. DIURETICS SONG Hui

3. OUTLINE BACKGROUND CLASSIFICATION OF DIURETICS REVIEW AND QUESTIONS

4. BACKGROUND The essential of urine. How urine formation. Which ion play an important role in this procedure. Ald, ADH The action sites of diuretics. Look at the diagram

5. CLASSIFICATION High effect diuretics: Lasix Mediate effect: Thiazide diuretics Mild (Low)effect: K + sparing diuretics Osmotic diuretics: Mannitol Others

6. High effect diuretics High ceiling (loop) diuretics Agent furosemide (lasix) Action site thick ascending loop (AL) Mechanism 1. Cl K-Na-2Cl

7. High effect diuretics 2. PGE P.E. Cl Na Renal Blood Flow (RBF) P.K. Onset in 5 min by i.v. 30 min by p.o. t1/2=2hr last for 4-6 hr ADR Ototoxicity (etacrynic acid>lasix>bumetanide)

8. Mediate effect diuretics Thiazides Agent Hydrochlorothiazide (HCT) Action site Distal convoluted tubule (DCT) Mechanism Na-K-2Cl, CA, PDE

9. Mediate effect diuretics ADR Hypokalemia ---be careful when use with digitalis. Hyperuricemia--- compete with uric acid Hyperglycemia--- insulin Hypercalcemia--- Ca

10. Low effect diuretics K + sparing diuretics Agent Antisterone, Triamterene & amiloride Action site DCT & CT (Collecting Tubule) Mechanism 1. Ald-R 2. Na channel Na K

11. Low effect diuretics ADR Hyperkalemia, sex hormone like effects ( antisterone ) Others Carbonic anhydrase inhibitors ( acetazolamide ) H 2 O + CO 2 H + HCO 3 -------- inside cell Na ----- outside cell CA

12. Osmotic diuretics Agents (characters) Mannitol, Glucose Action site PCT, AL; Vessels, gastrointestinal tract Mechanism 1. Hyperosmolarity 2. Blood volume RBF

13. Osmotic diuretics P.E. H 2 O ADR BV CHF Dehydration Hypernatremia

14. CLINIC USES of DIURETICS Edema CHF ARF Hypertension Poisoning Hypercalciuria Hypercalciumia Glaucoma Diabetes insipidus

15. ADR of Diuretics Pla. KPla. UricA Pla.Caototoxicit y others H.D (Lasix) _ + _ + BV _ M.D (HCT) _ + + _LDL + L.D (antisterone) + + _ _Sex H effects In common Hyponatremia, electrolyte imbalances

16. Review & questions The classes of diuretics. The mechanisms of each. The Common ADR of diuretics The common P.E of diuretics The clinic uses of diuretics. Why DM patients have a lot of urine?