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【正文】 , dependent on dose。 individual differentia。 b. Inhibition of Na+K+2Cl― cotransport system in the thick ascending limb of the loop of henle,↓dilute and concentrate functions of kidney, excrete larger isotonic urine. Diuretic Agents They can cause 3040% of filtered sodium to be excreted, according to their natriuretic capacity, loop diuretics are highly efficacious. Large amounts of Na+, Cl― , K+ and divalent cations (Ca2+, Mg2+) are excreted and Cl― loss is more than Na+ in urine. Diuretic Agents c. Decrease renal vascular resistance。 increase renal blood flow and cause redistribution of blood flow within the renal cortex. d. Increase renin release, prostacyclin may play an important role in mediating the renin release response to loop diuretics. Diuretic Agents e. Improve pulmonary congestion and reduce left ventricular filling pressures by increasing systemic venous capacitance. f. Inhibit electrolyte transport in inner ear, alterate the electrolyte position of endolympha, this may contribute to drug induced ototoxity. Diuretic Agents ③ Uses a. Serious edema edema of nephrotic syndrome, nephrosis。 ascites of liver cirrhosis or edema patients who do not respond to salt restrictions or thiazides。 chronic congestive heart failure to minimize venous and pulmonary congestion. Diuretic Agents b. Acute pulmonary edema brain edema c. Prevent and treat acute or chronic renal failure furosemide can increase the rates of urine flow and enhance K+ excretion in acute renal failure Diuretic Agents d. Promote excretion of toxic substances e. Others Treat hypertension crisis Treat acute hypercalcaemia Treat hyperkalemia Diuretic Agents ④ Side effects a. Water and Electrolyte disturbance hypovalume, hypokalemia, hyponatremia, hypomagnesemia, hypochloremic metabolic alkalosis. During diuretic therapy, hypokalemia is the most mon. Also monly secondary to severe liver disease or congestive cardiac failure. Diuretic Agents b. Ototoxicity Hearing loss or deafness, they can be potentiated by another ototoxic drugs (. aminoglycosides). c. Hyperuricemia and induced gout caused by hypovolemiaassociated enhancement of uric acid reabsorption in the proximal tubule.
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