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What are the functions of the kidney?
1. Waste excretion
2. Electrolyte balance
3. Regulation of extracellular fluid volume
4. Acid base balance
5. Drug and hormone metabolism
6. Blood pressure regulation
7. Calcium/phosphate balance regulation
What is the general action of most diuretics?
Increase the excretion of Na+ and water
Decrease the reabsorption of Na+ and Cl- from the filtrate
Increased water loss is secondary to increased excretion of NaCl
What are diuretics used to treat?
Hypertension
Glaucoma
Salt/water overload associated with:
Nephrotic syndrome
Heart failure
What is the therapeutic goal of diuretics?
Increase excretion of salt and water.
What transport mechanisms are used in the nephron?
Active transport
Diffusion
Ion channels
Counter transporters (antiport)
Cotransporters (symport)
Exchange systems and their place in the nephron
Na+/H+ exchanger---------Proximal Tubule
Na+/K+ ATPase-----------Whole Nephron
Na+/K+/2Cl- cotransporter---Loop of Henle
Na+/Cl- cotransporter--------Distal tubule
What are the 4 kinds of diuretics?
Loop
Thiazide
Potassium sparing
Carbonic anhydrase
Give an overview of loop diuretics
Mechanism
: Bind to Cl- part of Na+/K+/Cl- transporter, inhibiting it.
Result
: increase Na+ excretion
increase Mg2+ excretion
increase Ca2+ excretion
increase K+ excretion
decrease uric acid excretion
Side effects
: Hypokalaemia
Metabolic alkalosis
Prerenal uremia
Tinnitus
Uses
: Treatment of salt and water overload associated with
pulmonary oedema
heart failure
renal failure
nephrotic syndrome
Give an overview of thiazide diuretics
Mechanism
: bind to the Cl- part of the Na+/Cl- cotransport system in the distal tubule, to inhibit it.
Result
: increase Na+ excretion
increase Mg2+ excretion
increase K+ excretion
decrease Ca2+ excretion
Side effects
: Hypokalaemia
Hyperglycaemia
Metabolic alkalosis
Prerenal uremia
Uses
: Hypertension
Mild heart failure
Give an overview of potassium sparing diuretics
Not used primarily as diuretics, rather they are used in conjunction with loop or thiazide diuretics to minimise risk of hypokalaemia.
Spironolactone is an aldosterone antagonist, inhibits Na+ retention and K+ secretion.
Amiloride blocks sodium channels to inhibit Na+ reabsorption.
Side effect
: Hyperkalaemia
Give a summary of Carbonic anhydrase inhibitors
No longer used as diuretics
Used in glaucoma to decrease intraocular pressure.
Inhibit the carbonic anhydrase to increase excretion of Na+, K+ and bicarbonate.
Side effects
: Metabolic acidosis and Alkaline urine
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Author
Anonymous
ID
17116
Card Set
Diuretics
Description
Diuretics
Updated
2010-05-01T22:17:47Z
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