【正文】 的髓質段和皮質段的 Na+K+2Cl共同轉運系統(tǒng)，抑制其對 Cl的主動再吸收及 Na+的被動再吸收。 ? 主要作用于近曲小管的利尿藥：碳酸酐酶抑制劑醋唑磺胺，弱效，排出 HCO3的堿性尿。利尿藥在治療水腫，高血壓，心力衰竭時的意義。復習泌尿生理過程，說明各段腎小管的再吸收及分泌功能。Chapter 26 Diuretic Osmotic agents 南開大學醫(yī)學院 張京玲 Chapter 26 目的 了解各類利尿藥的作用部位，掌握呋塞米（速尿），氫氯噻嗪類，螺內酯，氨苯喋啶（三氨喋啶），甘露醇等的作用，應用，不良反應。 Chapter 26 內容 ? 利尿藥的定義。聯(lián)系說明各類利尿藥排電解質的情況。利尿藥按作用部位的分類。 Chapter 26 內容 ? 主要作用于髓袢升支的利尿藥： 呋塞米，布美他尼 的利尿作用，特點，強效，速效。抑制腎臟的濃縮和稀釋功能。不良反應。 ? 主要作用于髓袢升支皮質段的利尿藥：噻嗪類藥物：以 氫氯噻嗪 為例說明這類藥物利尿作用的特點，中效。降壓作用。不良反應。附氯噻酮。抑制遠曲小管和集合管的 Na+ K+交換，排 Na+留 K+。氨苯喋啶直接抑制 Na+的再吸收。不良反應。 ? 中草藥：簡述澤瀉，茯苓，豬苓，車前的利尿效果。 甘露醇 與山梨醇的脫水作用及滲透性利尿作用。高滲葡萄糖的脫水作用。 individual differentia。 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。 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.