利尿药医疗主题知识宣教讲义.ppt

利尿药医疗主题知识宣教;学习目标;Introduction;肾脏排泄;溶质跨膜转运的七种基本机制;ATP介导的转运：原发主动转运 Na+-K+-ATPase (sodium pump) Ca2+-ATPase (calcium pump) H+-ATPase (hydrogen pump) 同向转运体(symporter, cotransporter) Na+-K+-2Cl- Na+-Cl- 反向转运体(antiporter, countertransporter) Na+/H+ exchanger Na+/Ca2+ exchanger 离子通道 Na+ channel;水转运 ;肾小管上皮细胞转运的通用机制;有机离子排泄;尿液形成;① 近曲小管;HCO3-的重吸收依赖于碳酸酐酶。 Cl–的重吸收（两种观点）： 近曲小管末端，由于HCO3-大部分重吸收，Na+/H+继续交换促使Cl-/碱交换，导致NaCl重吸收。 H2O伴随NaHCO3重吸收后，使管腔中Cl–浓度升高，通过旁细胞途径扩散进 组织间液。;② 髓袢;③ 远曲小管;④ 集合管;④ 集合管 ;Major Segments of the Nephron and Their Functions.;利尿药分类;Diuretics were first classified according to their dose-response relationship as ceiling quality. High ceiling diuretics: the loop diuretics cause a substantial diuresis-----up to 20% of the filtered load of NaCl and water. This is huge when compared to normal renal sodium reabsorption which leaves only ~0.4% of filtered sodium in the urine. increase saluresis over a broad dose range, and therefore are the diuretics of choice in patients with advanced renal failure. Low ceiling diuretics: thiazides, antikaliuretics, etc. The dose-response curve is flat, which means that their saluretic effect is limited ( 5%). thiazides are believed to be ineffective when the glomerular filtration rate (GFR) is less than 30 ml/min.;现代利尿药的发展;碳酸酐酶抑制药(carbonic anhydrase inhibitors) ;药代动力学;药效学;临床应用;不良反应;禁忌症;袢利尿药(loop diuretics);药代动力学;药效学;临床应用;不良反应;噻嗪类(Thiazide);分类;常用的中效能噻嗪类或非噻嗪类利尿药剂量和药理特性比较;药代动力学;药效学;临床应用;不良反应;保钾利尿药(Potassium-sparing Diuretics) ;药代动力学;药效学;临床应用;不良反应;促进水排泄的药物;渗透性利尿药(Osmotic Diuretics);药代动力学;药效学;临床应用;不良反应;抗利尿激素拮抗剂(ADH Antagonists);Diuretic Combinations;Ⅴ. Summary: Sites of Diuretic Action;各类利尿药（包括脱水药）的特点比较;Changes in urinary electrolyte patterns in response to diuretic drugs;利尿的中药和食物;;Adverse effect;Review and Key Points;Thank You !