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【正文】 f them can be inhibited by nonsteroidal antiinflammtory drugs under certain conditions. Diuretic Agents They are most useful in states of mineralocorticoid excess, due either to primary hypersecretion or to secondarey aldosteronism. In the setting of enhanced mineralocorticoid secretion and continuing delivery of Na+ to distal nephron sites, renal K+ wasting occurs. Diuretic Agents This is due to K+ secondary by the collecting tubule. K+sparing diuretics of either type may be used in this setting to blunt the K+ secretory response and prevent depletion of the intracellular K+ stores. Diuretic Agents Toxicity ① Hyperkalemia ② Hyperchloremic metabolic acidosis ③ Gyneastia ④ Acute renal failure ⑤ Kidney stones Diuretic Agents Contraindications ① Susceptible hyperkalemia patients ② Patients with chronic renal insufficiency ③ Patients with liver disease Diuretic Agents VII. Clinical uses of diuretics 1. Cardiac edema 2. Renal edema 3. Cirrhotic edema 4. Acute hydrocephalus and pulmonary edema Osmotic Agents VIII. Osmotic agents 1. 20% mannitol (甘露醇 ) 2. 25% sorbitol (山梨醇 ) 3. 50% glucose (葡萄糖 ) Osmotic Agents They limit water reabsorption primarily in those segments of the nephron that are freely permeable to water: the proximal tubule and the descending limb of the loop of Henle. The presence of mannitol prevents the normal absorption of water by increased osmotic force. Osmotic Agents As a result, urine volume increases in conjunction with mannitol excretion. The conitant increase in urine flow rates decreases the contact time between fluid and the tubular epithelium, reducing Na+ reabsorption. Osmotic Agents Clinical indications ① Increase urine volume, prevent anuria (acute renal failure) ② Reduction of intracranial and intraocular pressure ③ Promote prompt removal of renal toxins (occasionally used) Osmotic Agents Toxicity ① Extracellular volume expansion and hyponatremia, prior to the diuresis ② Dehydration and hypernatremia, when excessive use of the drug without adequate water replacement 謝謝觀看 /歡迎下載 BY FAITH I MEAN A VISION OF GOOD ONE CHERISHES AND THE ENTHUSIASM THAT PUSHES ONE TO SEEK ITS FULFILLMENT REGARDLESS OF OBSTACLES. BY FAITH I BY FAITH
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