Diuretic Osmotic agents药物.pptVIP

Chapter 24Diuretic Osmotic agents Diuretic Agents Definition Diuretic agents are acting on the renal tubules, increase excretion of electrolytes water, increase the amount of urine. Clinical applications: edema hypertension, Others: Renal failure, renal stones, hypercalcaemia. Over 99% of glomerular filtrate is reabsorbed by tubules GFR is about 180L/day urine output is about 1L/day Drugs which work on the glomerular filtration get less diuretic effects. Tubular function: I. Reabsorption components of plasma are reabsorbed almost completely: e.g. sodium and glucose Waste products are partially reabsorbed: e.g. 45% of urea is reabsorbed. II. Secretion. Hydrogen, potassium ions, organic ions 1. Proximal tubules: 60%-65% of the filtered sodium ions and water are reabsorbed in this segment by the pump of Na+-K+-ATPase and Na+, H+ exchanger. Carbonic anhydrase inhibitor acetazolamide has effect on proximal tubules. 2. Loop of henle: The descending limb is permeable to water The ascending limb is impermeable to water 3. Thick ascending limb: 30-35% of filtered sodium is reabsorbed in the thick ascending limb Cl- promotes the absorption of Ca2+ and Mg2+ 4. Distal tubule: 10% of filtered sodium is reabsorbed. Ca2+ absorption, regulated by parathyoid hormone 5. Collecting tubules: 2% of filtered sodium is reabsorbed by Na+-K+ exchange. Regulated by aldosterone. Aldosterone antagonists, e.g. spironolactone, interfere with this process. Diuretic Agents Classification of diuretics High efficacy diuretics (Loop diuretics) Moderate efficacy diuretics (thiazides) Low efficacy diuretics Diuretic Agents High efficacy diuretics (Loop diuretics) Furosemide (呋塞米) Bumetanide (布美他尼) Torasemide (托拉塞米) Etacrynic acid (依他尼酸) Furosemide (呋塞米) Pharmacological effects Inhibition of Na+-K+-2Cl― co-transport system in the thick ascending limb of the loop of henle ↓dilute and concentrate functions of kidney, excrete large isotonic urine. Large amo