21第二十一章利尿药和脱水药.pptVIP

Diuretics and Dehydrants objective 掌握 呋塞米、氢氯噻嗪、螺内酯、氨苯蝶啶的药理作用、主要不良反应及药物的相互作用。 熟悉 利尿药的概念与分类，泌尿生理及药物作用部位,脱水药的概念。甘露醇的作用、应用及不良反应。。 了解 其它利尿药、脱水药的作用特点。 § 1 Diuretics 【definition】 acting on kidney→ excretion of water and electrolyte ↑ →urine volume ↑ Clinical use for edema and unedema diseases. Glomerular filtration Commonly GFR 125ml/min 原尿 125ml×60 ×24 = 180 L/d 终尿 1.8 L/d 99% reabsorption ↑GFR 10% 原尿198L/d; 终尿 1.98L/d ↓reabsorption 1% 原尿180L/d; 终尿 3.6L/d 1. proximal tubules (近曲小管 ) Reabsorption by : H+ - Na+ exchange 2. loop of Henle (髓袢) reabsorption of Na+ ≈35% Na+-K+-2Cl- cotransporter ★ furosemide ㈠ 髓袢升支粗段皮质部、髓质部 Na+- K+-2Cl- cotransporter → NaCl reabsorption↓ → the dilution and concentration all↓→ urine volume ↑; ★ ↑renal PGs synthesis →blood stream ↑. 3. distal tubules (远曲小管) reabsorbs Na+≈10% (filtrated Na+) By Na+ -Cl- cotransporter; impermeable to water; Ca2+ reabsorption (parathyroid hormone甲状旁腺素, PTH regulation) Thiazides (噻嗪类) acting on the initial part of distal tubule ( 远曲小管近端） Inhibit Na+-Cl- cotransporter ?NaCl reabsorption ? ? the dilute function↓; ? Ca2+reabsorption ; tubular lumen [Na+ ] ? ? Na+-K+ exchange ? ? Hypokalemia(低血钾) 4. Collecting tube reabsorbs Na+ 2% ~5% (filtrated Na+) by Na + - K + exchange regulated by aldosterone（醛固酮）; reabsorption of water----urine concentration by ADH (vasopressin) regulation. Triamterene 氨苯蝶啶 Spironolactone 螺内酯 Usual drugs 一. high efficacy diuretics furosemide （呋噻米、速尿） ethacrynic acid （依他尼酸、利尿酸） bumetanide （布美他尼） 【 characteristics】 1. Rapidly, strong, shortly; 2. ? renal blood flow ; 3. electrolyte disorders may occur; Na+ 、Cl- 、K+ 、Ca2+ excretion↑ Reasons of K+ e