利尿劑英文ppt課件-資料下載頁
2024-12-08 03:29本頁面
【正文】 nt the K+ secretion 41 42 lumen apical membrane interstitial fluid Collecting tubule Basolateral membrane AIP: aldosteroneinduced protein。 SP: spironolactone。 ALD: aldosterone Triamterene amiloride spironolactone aldosterone 42 Spironolactone ? Pharmacological effects ? less than 23% of the filtered sodium is excreted ? effective only in the increasing status of aldosterone and ineffective for total adrenoprival animal ? the higher the level of endogenous aldosterone, the greater the effects of spironolactone on urinary excretion 43 Relative changes in the position of urine induced by potassiumsparing diuretics 44 Spironolactone ? Clinical Uses ? Edema of primary hyperaldosteronism and refractory edema associated with secondary aldosteronism (cardiac failure, hepatic cirrhosis , nephrotic syndrome, and severe ascites ) ? in bination with other diuretics to reduce sodium reabsorption and prevent potassium loss in the tubule ? inhibits renal excretion of digoxin, the dosages of digoxin need to be reduced if both drugs bined use 45 Triamterene and amiloride ? Pharmacological effects ? directly block sodium ion channels in the late distal tubules and clollecing duct, inhibit Na+ reabsorption and promote its excretion ? do not block the aldosterone receptor ? still effective for total adrenoprival animal ? The major use is in bination with other diuretics 46 47 lumen apical membrane interstitial fluid Collecting tubule Basolateral membrane AIP: aldosteroneinduced protein。 SP: spironolactone。 ALD: aldosterone Triamterene amiloride spironolactone aldosterone 47 48 48 Carbonic anhydrase Osmotic diuretics (mannitol, sorbitol, glucose, urea) 49 Osmotic diuretics ? Mechanism of action ? increase the osmotic pressure of blood and renal filtrate ?The agents are filtered by the glomerulus, but are not reabsorbed or secreted by the renal tubules ? work by expanding plasma volume, therefore increasing blood flow to the kidney ? prevent the reabsorption of water at the segment of proximal tubule and desending limb of loop of Henle 50 Osmotic diuretics ? Pharmacodynamics and Indications ? Dehydration ? reduction of intracranial and intraocular pressure ? Brain edema, glaua ? Dilate renal vascular, increase renal blood flow within the renal medulla, increase urine volume ? Prevent acute renal failure ? Eliminate toxic substances from GI tract or promote removal of renal toxins 51 Osmotic diuretics ? Side effects ? Hyperkalemia ? contraindicated in ?patients with hyperkalemia ?patients at increased risk of developing hyperkalemia ?patients with renal failure ?patients receiving other K+sparing diuretics or taking angiotensinconverting enzyme inhibitors, or taking supplements K+ 52
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