PRESENTATION ON: - DIURETICS
PRESENTATION BY-RAHUL VASHISHTHA
PRESENTED TO- MR. KOMAL MEHROTRA
COURSE – M.PHARM (PHARMACOLOGY)
INTRODUCTION:-DIURETICS
Diuretics, also called water pills, are medications designed to
increase the amount of water and salt expelled from the body as
urine.
Most work by making your kidneys release more sodium into your
urine.
The sodium then takes water with it from your blood. That decreases
the amount of fluid flowing through your blood vessels, which
reduces pressure on your vessel walls.
TYPES:-
1. High ceiling/loop diuretic-
High ceiling diuretics may cause a substantial diuresis – up to 20%.
Loop diuretics, such as furosemide, inhibit the body's ability to
reabsorb sodium at the ascending loop in the nephron, which leads to
an excretion of water in the urine.
Other examples of high ceiling loop diuretics include ethacrynic
acid and torasemide.
2. Thiazides-
These type of diuretics such as hydrochlorothiazide act on the distal
convoluted tubule and inhibit the sodium-chloride symporter .
Leading to a retention of water in the urine.
Frequent urination is due to the increased loss of water that has not
been retained from the body.
3. Carbonic anhydrase inhibitors-
Carbonic anhydrase inhibitors inhibit the enzyme carbonic
anhydrase which is found in the proximal convoluted tubule.
This results in several effects including bicarbonate
accumulation in the urine and decreased sodium absorption.
Drugs in this class include acetazolamide and methazolamide.
4. Potassium-sparing diuretics-
These are diuretics which do not promote the secretion
of potassium into the urine.
Thus, potassium is retained and not lost as much as with other
diuretics.
Aldosterone antagonists- Spironolactone, which is
a competitive antagonist of aldosterone.
Spironolactone prevents aldosterone from entering the principal
cells, preventing sodium reabsorption.
5. Calcium-sparing diuretics-
The term "calcium-sparing diuretic" is sometimes used to identify
agents that result in a relatively low rate of excretion of calcium.
The reduced concentration of calcium in the urine can lead to an
increased rate of calcium in serum.
The thiazides and potassium-sparing diuretics are considered to be
calcium-sparing diuretics.
6. Osmotic diuretics-
Osmotic diuretics (e.g. mannitol) are substances that increase
osmolarity but have limited tubular epithelial cell permeability.
It was previously believed that the primary mechanism of osmotic
diuretics such as mannitol is that they are filtered in the glomerulus,
but cannot be reabsorbed.
Thus their presence leads to an increase in the osmolarity of the
filtrate and to maintain osmotic balance, water is retained in the urine.
7. Low ceiling diuretics-
The term "low ceiling diuretic" is used to indicate a diuretic has a
rapidly flattening dose effect curve (in contrast to "high ceiling“).
Certain classes of diuretic are in this category, such as the thiazides.
E.g-Chlorthalidone.
Hydrochlorothiazide
MECHANISM:-
Medical uses:-
In medicine, diuretics are used to treat -
Heart failure.
Hypertension, water poisoning, and certain kidney diseases.
Liver cirrhosis.
Tissue swelling (edema).
Some diuretics, such as acetazolamide, help to make
the urine more alkaline and are helpful in increasing excretion of
substances such as aspirin in cases of overdose or poisoning.
Adverse effects:-
The main adverse effects of diuretics are -
Hypovolemia
hypokalemia
hyperkalemia
metabolic alkalosis
metabolic acidosis
Hyperuricemia
low sodium levels
Headaches
Dehydration
Muscle cramps
Drug interactions:-
Antidepressants such as fluoxetine and venlafaxine.
Digoxin.
Other drugs for high blood pressure.
Heart disease.
REFERENCES:-
Drug Monitor – Diuretics Archived January 17, 2008, at
the Wayback Machine.
https://www.mayoclinic.org/diseases-conditions/high-
blood-pressure/in-depth/diuretics/art-20048129.
https://en.wikipedia.org/wiki/Diuretic.
