药理学课件第22章 利尿药和脱水药-2014版.ppt

第22章 利尿药和脱水药 Diuretics and Dehydrate agents;本次课要求掌握的主要内容;利尿药是直接作用于肾脏，增加Na+、Cl-等电解质和水的排出，使尿量增多的药物。;利尿药是直接作用于小管上皮细胞、增加尿液形成率的物质。 ;利尿药是促进机体钠和水的净丢失、增加尿量的药物。 ;其实，并非增加尿量的药物都是利尿药。如强心苷增加心衰病人的心排量，也使尿量增加，但其不作为利尿药。;利尿药增加尿量和排钠，用于高血压、心衰、肾衰、肾病综合征和肝硬化等病变时调节体液的量和/或成份。;(1)各种水肿：心性、肝性、肾性。 (2)高血压：根据病情，选用不同类别利尿药。 (3)其他：尿崩症、肾结石等。 ;1.高效利尿药 high efficacy (ceiling) diuretics 袢利尿药 Loop diuretics 钠钾氯同向转运抑制剂 Inhibitor of Na+-K+-2Cl- symport;2.中效利尿药 moderate efficacy diuretics 抑制Na+-Cl- ???向转运(symport)，;3.低效利尿药 Low efficacy diuretics ①醛固酮拮抗剂(aldosterone antagonist)： 螺内酯(spironolactone)、 依普利酮 (Eplerenon);④碳酸酐酶抑制剂 (inhibitors of carbonic anhydrase)： 乙酰唑胺（醋唑磺胺）;13/70;The volume of plasma filtered by the kidney is termed the glomerular filte rate (GFR) and is equal to approximately 180 L/day for a person weighing 70 kg. ;;肾小管和集合管的重吸收;NaHCO3 reabsorption in proximal tubule. （近曲小管）A, antiporter; S, symporter; CH, ion channel. (The actual reaction catalyzed by carbonic anhydrase is OH-?+ CO2→HCO3-; however, H2O →OH-?+ H+, and HCO3-?+ H+?→H2CO3, so the net reaction is H2O + CO2→ H2CO3) Numbers in parentheses indicate stoichiometry. BL and LM indicate basolateral and luminal membranes, respectively. ;;NaCl reabsorption in distal convoluted tubule;Na+ reabsorption in late distal tubule and collecting duct. Cl- reabsorption (not shown) occurs both paracellularly and transcellularly, and the precise mechanism of Cl- transport appears to be species-specific. A, antiporter; CH, ion channel; CA, carbonic anhydrase. Numbers in parentheses indicate stoichiometry. Designated voltages are the potential differences across the indicated membrane or cell. BL and LM indicate basolateral and luminal membranes, respectively. ;AIP, aldosterone-induced proteins; ALDO, aldosterone; MR, mineralocorticoid receptor; CH, ion channel; ①activation of membrane-bound Na+channels; ②redistribution of Na+ channels from cytosol to membrane; ③de novo synthesis of Na+ channels; ④activation of mem