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Diuretics_2_of_2.ppt - DIURETICS (2 of 2) Dr R. P. Nerurkar...

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DIURETICS(2 of 2)Dr R. P. NerurkarDept. of PharmacologyT. N. Medical College &BYL Nair Ch. Hospital, MumbaiDECEMBER 7, 2005
Learning ObjectivesAt the end of my 2 lectures you should be able to1)List 5 majortypesof diuretics and their mechanismand site of action2)List the majorapplications and toxicitiesof them3)Describe themeasures that reduce K+ lossduringnatriuresis4)List theRx of hypercalcimia and hypercalciuria5)managerefractory edemacases6)List Rx ofnephrogenic diabetes insipidus
Overview of 1stlectureDefinitionPhysiology of Urine formation and drugs modifying itClassification and Mechanism of actionPharmacology of Loop diuretics and CA inhibitorsGroup discussion and Exercises onPrescription writing,Patient oriented problem solvingIdentification of drugs actingADR and drug interactions
Thiazides -Sites of Action
Thiazide Diuretics -ActionsActs on early part of distal tubulesInhibit Na+-Cl-symporter and reabsorptionIncrease NaCl excretion (5-10% Medium efficacy)Na exchanges with K+in the DTK+lossHypokalemiaNot effective in very low GFR of < 30ml/min, mayreduce GFR furtherMetolazoneadditional action on PT, effective at lowGFR, can be tried in refractory edema
Thiazide Diuretics -OtheractionsHypotensive actionreduce Ca++excretionmay ppthypercalcemia in patients of hyperparathyroidism,bone malignancywith metastasisIncrease Mg++ excretionHypochloremic alkalosisHyperuricemiaHyperglycemia (inhibit insulin release ?)Hyperlipidimia (Cholesterol and TG)
ThiazidesPreparationsDrug NameDose (oral)Duration (hr)Chlorothiazide(1957)500-20006-12Hydrochlorothiazide25-1008-12Benzthiazide25-10012-18Hydroflumethiazide25-10012Chlorthalidone50-10048Metolazone5-2018Xipamide, Clopamide20-4012-24Indapamide(No CAI)2.5-524-36
Thiazides -Uses1)Hypertension(Hydrochlorothiazide, Indapamide)2)Edema: Cardiac, Hepatic RenalLess efficacious than loop diureticUseful for maintainence therapy3)Hypercalciuria and renal Ca stones4)Diabetes Insipidus (DI)(Nephrogenic responds better)Paradoxical use,MOA - ? Reduce GFR, ? More complete reabsorption in PTConvenient, Cheaper than Desmopressin in Neurogenic DIAmiloride is the DOC for Lithium induced nephrogenic DI5)Metolazone useful even when GFR is as low as 15ml/min

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Term
Fall
Professor
NoProfessor
Tags
Diuretic, Thiazide, Spironolactone

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