利尿药（Diuretics）.docVIP

利尿药（Diuretics） The twenty-first chapter diuretics and dehydrating drugs The first section offers a diuretic Definition: a drug that acts on the kidneys, increases electrolytes and water excretion, and increases urine output. First, physiological basis of diuretic action The formation of urine includes glomerular filtration, reabsorption and secretion of renal tubules and collecting ducts. (1) glomerular filtration (two) reabsorption of renal tubules and collecting ducts 1. proximal convoluted tubules: 65 – 70%Na+ reabsorption 2. mtal: 30 - 35% Na+ was absorbed, and then the lower water absorption, NaCl resorption dependent luminal membrane K+-Na+-2Cl- transport system. 3. distal convoluted tubules and collecting ducts: 5 - 10%Na+ reabsorption. The proximal convoluted tubule proximal to the luminal membrane K+-Na+2Cl- mediates the reabsorption of 10%Na+ in the urine. Therefore, the drugs that inhibit the absorption of Na+ in this segment can produce moderate diuretic effect. At the same time, there is Na+-Ca2+ exchange in this section. Two. Classification, functional site and mechanism of diuretics commonly used (1) highly effective diuretics (loop diuretics) Drug: furosemide, miconazole acid (diuretic acid), Broometa Ni Amy furosemide (Furosemide, furosemide) [pharmacological effects] 1. diuretic effect: fast, strong and short. The site of action: the medullary loop, the ascending branch, the medulla and the cortex The mechanism of action: Inhibition of medullary loop of the ascending branch diameter Na+-2Cl-- K+ cotransporter (together with the Cl- competition in the vector of Cl- binding site), Na+, Cl- absorption down, thus affecting the renal concentration and dilution function. Increasing K+ excretion - Na+ excretion increases and promotes K+-Na+ exchange. At the same time, diuresis causes the decrease of body fluid, increases of renin and aldosterone secretion, and excretion of K+. Easy to cause hypokalemia and low salt syndrome. 2. dilated vessels: (1) dilati