一般选用噻嗪类利尿药.ppt

 Diuretics and Dehydrant Agents Jin Wang Institute of Pharmacology School of Medicine Shandong University wangj@sdu.edu.cn Section1 Diuretics Definition Diuretics are a family of drugs that act on kidney and promote the excretion of urine (including water and electrolyte). (mainly used in edema) The physiological basis of diuretics ⅠExcretion function of kidney ⅡUrinary physiology of kidney and the sites of diuretics ⅠExcretion function of kidney Excretion of inorganic ion Excretion of organic ion Excretion of water ⅠExcretion function of kidney 1. Excretion of inorganic ion Convection Via ion channels Simple diffusion Facilitated diffusion Active transport (primary) Active transport (secondary) Symporter Antiporter ⅠExcretion function of kidney 2. Excretion of organic ion Secondary active transport Anionic transport system Cationic transport system Pay attention: competition ⅠExcretion function of kidney 3. Excretion of water Water channel – aquaporins (AQPs) Noble prize in chemistry 2003 Reabsorption of renal tubule and collecting tube Proximal tubules Henle’s loop Distal convoluted tubules Collecting tubules Proximal Tubule Na+/ K+ ATPase: maintains gradient Na+ flows down via channel Na+_ H+ exchange: carbonic anhydrase (CA) AQP1/7: Water follows passively 65%~70% of Na+ and water reabsorption Cl- 、 Ca2+ 、 K+ 、 Mg2+ reabsorption TAL: thick ascending limb 1. No AQPs: impermeable to water 2. Transports Na+ by Na+ - K+ - 2Cl- symporter 25-35% of Na+ reabsorbed Reabsorption of Ca2+ , Mg2+ and Cl- Distal Convoluted Tubule 5~10% of Na+ reabsorbed (1) Na+-Cl- symporter (2) Ca2+-channel (3) Na+-Ca2+ exchange : parathyroid hormone (PTH)  (4) No AQPs: impermeable to water Collecting Duct Water permeability: main site Controlled by ADH Via AQPs(2,3,4) Driven by medulla osmotic gradient 2-5% of Na+ reabsorbed : Via Na+ channels Regulated by ADS K+ secretion : major s