‫فارما –المحاضرة األولى‬

‫مستوى ثالث‬
‫ علي الرجوي‬/‫الدكتور‬

Diuretics
The volume and composition of urine are determined by :
1. Glomular filtration
2. Tubular reabsorption
The proximal convoluted tubule
The loop of henle
The distal convoluted and collecting tubules
3. Tubular secretion
Secretion of H ions
Secretion of ammonia
Secretion of potassium
Secretion of certain drugs.
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 Site of action of diuretics

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 Hormones that regulate water
excretion
• Antidiuretic hormone.
• Adrenal cortical hormones.
• Thyroid hormone.
• Anterior pituitary hormone.

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 thiazide and thiazide-like
diuretics
o Inhibitors of Na + CL symport.
o Hypokalemia
o Hyponatremia
o Hypomagnesia
o Hypercalcaemia
o Hperglycaemia
o Hyperuricaemia
o Antidiuretic effect.

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 Therapeutic uses
• Oedema (CHF, NS)
• Hypertension
• Diabetes insipidus
• Idiopathic hypercalciuria.

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 Precautions & toxicity
• Renal insufficiency.
• Digitalis toxicity adrenocorticosteroid intake.
• Diabetes mellitus
• Gout
• Hyperlipidaemia.

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 Loop diuretics
• Inhibitors of Na –K -2Cl symport.
• High efficacy
• Hypokalemia
• Increase renal blood flow.

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 Therapeutic uses
• Acute pulmonary oedema
• Hypertensive crisis.
• Acute renal oedema
• Hypercalcaemia.

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 Side effects
• Hypokalemia
• Hypovolaemia
• Hyperglycaemia
• Ototoxicity.

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 Potassium sparing diuretics
• Spironolactone (aldosterone
antagonists),triamterene and amiloride.
• Hperkalemia should not used with ACEI
• Carenone is the active metabolite of
spironolactone.

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 Therapeutic uses
• Refractory oedema
• Primary hyperaldosteronism.
• 2nd hyperaldosteronism.

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 Carbonic anhydrase inhibitors
Acetazolamide, methazolamide
• They reduce absorption of bicarbonate
producing alkaline urine.
• Metabolic acidosis.
• Reduce IOP.
• Antiepileptic action.
• Treat acute mountain sickness.

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 Osmotic diuretics
• Mannitol , urea, glycerin and glucose.
• Increase osmolarity of the tubular fluid.
• Used in IOP and ICP.
• Non absorbable solute pulls water into urine
and increases urine volume.

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 Toxicity of osmotic diuretics
• Extracellular volume expansion which may
complicate HF and produce pulmonary
edema.
• Dehydration and hypernatremia.

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 Acidifying diuretics
ammonium chloride
• Hperchloraemic acidosis.
• Acidification of urine.
• Treatment of alkalosis.

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 Antidiuretics
• Antidiuretic hormone.
• Drugs that release ADH & constrict ARA.
• Thiazide & chlorpropamide.

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 ADH antagonists
• Lithium carbonate.
• Demeclocycline.

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