Scribd
Upload
43 views32 pages

Diuretics 1

This document discusses diuretics and their mechanisms and sites of action. It begins by reviewing sodium and water reabsorption along the nephron. It then discusses various classes of diuretics - osmotic diuretics like mannitol which work in the proximal tubules and loop of Henle by increasing osmotic pressure; carbonic anhydrase inhibitors like acetazolamide which work in the proximal tubules by inhibiting bicarbonate reabsorption; loop diuretics which work in the thick ascending limb of the loop of Henle by inhibiting sodium reabsorption; thiazide diuretics which work in the early distal tubule; and potassium-sparing diuretics which work in

Uploaded by

Nurul Arsy M
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
43 views32 pages

Diuretics 1

This document discusses diuretics and their mechanisms and sites of action. It begins by reviewing sodium and water reabsorption along the nephron. It then discusses various classes of diuretics - osmotic diuretics like mannitol which work in the proximal tubules and loop of Henle by increasing osmotic pressure; carbonic anhydrase inhibitors like acetazolamide which work in the proximal tubules by inhibiting bicarbonate reabsorption; loop diuretics which work in the thick ascending limb of the loop of Henle by inhibiting sodium reabsorption; thiazide diuretics which work in the early distal tubule; and potassium-sparing diuretics which work in

Uploaded by

Nurul Arsy M
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 32

dr.

Setiawati

You need to know these things:


Mechanism

of action
Clinical indications
Toxicity/adverse reactions

Review the pathways of Na+ and


water reabsorption along the
human nephron

Kidney: 1.3 million nephron each


Glomeruli:
Receive 25% of cardiac output
Filtration rate: 100-120 ml/minute
Tubules:
Reabsorption of 99% of glomerular
filtrate only + 1 ml/min. excreted as
urin
Secretion

Tubular
Fluid

Blood

Proximal tubuls:
Reabsorption of 65% Na+
Permeable to water isotonic urine

Loop of Henle
Thick decending limb: most active water
reabsorption
Thick ascending limb:
Reabsorption of Na+,

Distal tubules :
Na+ reabsorption

Water permeability controlled by


antidiuretic hormone (ADH)
2-3% of filtered Na+ reabsorbed here via
Na+ channels that are regulated by
aldosterone
Major site of K+ secretion

Diuretik: suatu subtansi yang dapat


menambah kecepatan pembentukan urin
Diuresis : ada 2 pengertian
- adanya penambahan volume urin yang
diproduksi
- jumlah pengeluaran zat-zat terlarut
dan air

Mobilization of edema mengubah


keseimbangan cairan sehingga volume
cairan ekstrasel kembali menjadi normal
Antihypertensive therapy pilihan pertama
Therapy of congestive heart failure
Prophylaxis of renal failure

Diuretik Osmotik ( manitol, isosorbid, urea,


gliserin
Diuretik golongan Sulfonamid
- CA-inhibitor( asetazolamid,
diklorofenamid)
- Loop Diuretik ( paling kuat )
- Thiazid
Diuretik Hemat Kalium
Anti Diuretik Hormon ( ADH )

Diuretics

Site of Action

Mechanism

Osmotic Diuretic

1. Proximal tubules
2. Loop of Henle
3. Collecting duct

Inhibition of water and Na+


reabsorption

Carbonic
Anhydrase
Inhibitor (CA-I)

Proximal tubules

Inhibition of bicarbonate
reabsorption

Loop Diuretic

Loop of Henle
(thick ascending limb)

Inhibition of Na+, K+, Clcotransport

Thiazide

Early distal tubule

Inhibition of Na+, Cl- cotransport

Potassium sparing
diuretics

Late distal tubule


Collecting duct

Inhibition of Na+ reabsorption


and K+ secretion

13

Site of Action of
Diuretics

14

Agents : Mannitol, sorbitol,urea, glycerine,


isosorbide
Site of action : mainly the proximal tubules
Properties of osmotic diuretics:

Freely filtrated by glomerulus


Negligible tubular reabsorption
Chemically inert
Usually non metabolized

15

OD is filtrated and increases osmotic


pressure in tubular lumen
Hence, increases excretion of water and
electrolytes
Almost all of electrolyte are excreted:
Na+, K+, Ca++, Mg++, HCO3-, phosphate

16

Mannitol and urea:


Not absorbed from GI tract intravenous

Glycerine and isosorbide:


Can be administered orally

Metabolism:
glycerine 80% metabolized
mannitol 20%
Urea, isosorbide: not metabolized

Excretion: renal

18

Oliguria berat : awal 200 mg/kgBB selama


3-5 menit mel infus
Profilaksis GGA pada operasi : 50-100 g
Menurunkan TIK, TIO pada glaukoma : 1,5-2
g/kgBB sbg larutan 15-20% melalui infus
selama 30-60 mnt

Penyakit ginjal dengan anuria


Kongesti atau udem paru berat
Dehidrasi berat
Perdarahan intrakranial kec cito kraniotomi
Infus manitol harus segera dihentikan bila
terdapat : tanda2 g3n fungsi ginjal yang
progresif, payah jantung, kongesti paru

Pada tindakan bedah saraf : 1-1,5 g/kgBB iv


Potensi sebagai diuretik lebih lemah dari
manitol

Diberikan per oral sebelum suatu tindakan


optalmologi untuk menurunkan TIO
Dosis : 1-1,5 g/kgBB
Efek maksimal terlihat setelah 1 jam
pemberian dan menghilang dalam 5 jam

Diberikan secara oral untuk indikasi yang


sama dengan gliserin
Efek sama dengan gliserin
Menimbulkan diuresis yang lebih besar dari
gliserin tanpa menimbulkan hiperglikemia
Dosis : 1-3 g/kgBB sebanyak 2-4 kali sehari

Adverse Effects
Innitial increase of plasma volume
potentially dangerous in heart failure
and lung edema
Hypo Na+ headache, nausea,
vomitus
Hypovolemia
Hypersensitivity reaction
Vein thrombosis, pain if extravasation (urea)

Hyperglycemia, glycosuria (glycerine)


24

Renal failure and anuria

Lung edema

Dehydration

Intracranial hemorrhage, except before


craniotomy

25

Carbonic Anhydrase adalah enzim yang


mengkatalisis reaksi CO2 + H2O H2CO3
Enzim ini terdapat di dalam sel korteks
ginjal, pankreas, mukosa lambung, mata,
eritrosit dan SSP tetapi tidak terdapat
dalam plasma
Dalam tubuh, H2CO3 berada dalam
keseimbangan dengan ion H+ dan HCO3yang sangan penting dalam sistem buffer
darah

26

Kidney:

Inhibition of Bicarbonate (HCO3-) reabsorption


Reduces Na-H-exchange NaHCO3 is excreted
along w/ H2O

Eye:

Inhibits formation of aqueous humor


decreases intra ocular pressure

CNS: anti convulsive effects


due to pH decrease
direct effect

28

Asetazolamid mudah diserap melalui


saluran cerna
Kadar maksimal dalam darah dicapai dalam
2 jam dan ekskresi melalui ginjal sudah
sempurna dalam 24 jam

Glaucoma penurunan TIO : 250-1000


mg/hari
Epilepsi: limited usage
Acute mountain sickness : 250 mg 2 kali
sehari
Familial periodic paralysis : 250-750 mg/hari
dalam 2-3 do
Urinary alkalinization: preventing uric acid
and cystine stones
Metabolic alkalosis

30

Sirosis hepatis disorientasi mental ok


>>amoniak di dalam hati
Kehamilan teratogenik

Acetazolamide (Diamox):
Tablet 125 and 250 mg
Doses: 250-1000 mg/day

Dichlorphenamide: tablet 50 mg (1-4 times


daily)
Metazolamide: tablet 25 and 50 mg (1-4
times daily)

32

You might also like