药理学_利尿药.pptVIP

Major points Physiological and pharmacological basis of diuretics Pharmacology of diuretics Diuretics and dehydrant agents Diuretics: increase urine flow, increase Na+ excretion accompanying Cl- Dehydrant agents(Osmotic diuretics): freely filtered at the glomerulus, limited reabsorption by the renal tubule, relative inert pharmacologically. Effects of aldosterone Activation of Na+ channels Redistribution of Na+ channel from cytosol to membrane Synthesis of Na+ channels Redistribution of Na+/K+ ATPase channel from cytosol to membrane Synthesis of Na+ /K+ ATPase channels Increase of mitochondrial production of ATP * * 利 尿 药 Diuretics Proximal tubule Collecting tubule Distal tubule Thick acsending limb Tubule transport system and sites of action of diuretics Cortex Outer medulla Glomerulus Proximal tubule Lumen urine Interstitium blood ATP Na+ Na+ HCO3- H+ Na+ Cl- K+ H+ HCO3- H2CO3 HCO3- + H2CO3 H2O + CO2 CO2 + H2O CA CA CA carbonic anhydrase Diuretics Thick acsending limb cell Lumen urine Interstitium blood ATP Na+ K+ Cl- K+ K+ 2Cl- Na+ Ca2+ Mg2+ K+ + - 10mV Basolateral Cl- channels ROMK Recycling Diuretics Distal convoluted tubule Lumen urine Interstitium blood ATP Na+ K+ Cl- Cl- Na+ K+ Basolateral Cl- channels Diuretics Ca2+ Late distal tubule and Collecting duct Lumen urine Interstitial space ATP R Na+ ADH K+ K+ Na+(depolarization) K+ ROMK Principal cell H2O Water channel molecules Na+ channel inhibitors Lumen urine Interstitiial space ATP Na+ K+ R Aldosterone Nucleus mRNA AIP Na+ Mitochondria Aldosterone antagonists AIP Alosterone -induced proteins Effects of aldosterone on late distal tubule and collecting duct and diuretics mechanism of aldosterone antagonists