利尿藥和脫水藥ll-資料下載頁
2024-10-02 06:19本頁面
【正文】 He has long known that he is hypertensive but never had symptoms, so he refused to take antihypertensive medications. ? During the last month, he has noted increasing ankle edema, reduced exercise tolerance, and difficulty sleeping lying down, but he reports no episodes of chest pain or disfort. He now has pitting edema to the knees and is acutely unfortable lying down. ? Vital signs include blood pressure of 190/140 mmHg, pulse 120/ min, and respirations 20/min. Chest auscultation reveals loud rhonchi, but an electrocardiogram is negative except for evidence of left ventricular hypertrophy(左心室肥厚 ). ? He is given a diuretic intravenously and admitted to intensive care. ? What diuretic would be most appropriate for this man’s case of acute pulmonary edema associated with heart failure? What are the possible toxicities of this therapy? 第二十八頁，共三十頁。 小 結 各類利尿藥的利尿作用部位及利尿作用機制 呋塞米、氫氯噻嗪的藥理作用、臨床應用及主要不良反響 第二十九頁，共三十頁。 內容總結 利尿藥及脫水藥 Diuretics and Dehydrant Agents。定義 :作用于腎臟 ,增加電解質及水排泄 ,使尿量增多的藥物。管腔膜上的Na+K+2Cl同向共轉運子。沖洗腎小管 ,防止腎小管萎縮和壞死。亦與耳蝸毛細胞損害有關 ,忌與氨基糖苷。利尿 →血容量 ↓→胞外液濃縮 →尿酸經(jīng)近曲小管的重吸收 ↑。〔 2〕機制：抑制遠曲小管近段 Na+Cl共轉運子，抑制 NaCl和水的重吸收。 CASE STUDY 第三十頁，共三十頁。
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