Uh today uh i’ll be discussing about diuretics first you should know what is a diameter these are the agents they increase your outflow the urine volume they’re going to increase and its ph also as well as the ionic composition of the urine and blood you all know nephron is the most important part of the kidney the triglyceride your information it occurs in three
Step one is glamorous filtration rate that is usually 180 liter per day tubular reabsorption your 98 whatever filter through the glamorous all will get re-absorbed and whichever remaining two percent that will start excreted to the urine through the tubular secretion process okay how will increase urine output means either by increasing glamorous filtration
Rate and decreasing tubular reabsorption why we need these diuretics means to maintain urine volume in case of renal failure to mobilize edema fluid like if there is an enema to leave the whatever fluid content in the relay that whatever fluid content in the medium in case of heart failure liver failure floating centromere and also to control high bp also we’re
Using these diuretics coming to the classification we have i have is efficacy diuretics these are also called loop diuretics sodium potassium two chloride coat transport their mechanism is this and in that we have sulphamil derivative and next we have medium efficacy diabetics we have high ceiling high mechanism is sodium chloride simple they will do means they
Limit these two ions i have a case here high ceiling negatives they limit the absorption of these three ions benzodiazepines hydrochlorothiazide benzene hydro diuretics we have carbonic and hydrogen centimeters acidosis potassium spilling the index we have aldosterone anterior spinal electrode etc osmotic diuretics this is the last class we have magnetol
Glycerol so this classification is important for anesthesia nursing bpd all the students you may expect denmark question also because along with the hypertension questions like these thousands uh any diuretics they may ask for timer questions sometimes so classification is a little bit important and usually hypertension this diuretics one of the mainly thyroid
Derivatives are the first choice drug so then you can get denmark question you should know the classification of hypertension and here like usually you’ll expect the final question high seeding diuretic high efficacy and high ceiling diabetic these are also called loop diuretics and like like this limit and get question and ties as we get to make it question
Even carbonic anhydrase animated potassium spain there it is also you may get a final question classification is not that important but sometimes they may ask but in hypertension these diabetics are the first challenge drugs so we should do in detail these diabetics first you should know how the euro formation occur then we will go for a different drugs if you
Know this diagram well we can able to write all the drugs mechanism is given here try to understand see you know this is about once captured so when uh any fluid enter into the glamorous it will get filter your blue first it enters the proximal converted tool here i’m just telling which is important for your exam point of view like i’m not going detail about
The physiology of your information only to write answers to the equations whatever is required that much see here what are the ions will get reabsorbence one is bicarbonate here they have not shown two more ions one is sodium next diagram i’ll show you that and potassium this nephron is the descending loop of henle here this there are no drugs to it the next
Part is the ascending loop of only here three ions will get reabsorbed there is a co transport one sodium potassium sorry sodium potassium two chloride co transport with this sodium potassium and two chloride ions will get real so the next part we have is the distant convoluted tubule here also there is one simple mechanism that is sodium chloride simple here
Only sodium and chloride will get absorbed but in ascending global finland sodium potassium and chloride will get absorbed and like if here calcium absorption will also takes place in this distal convective tubule in presence of parathyroid hormone okay pth and next part we have is the last part that is collecting dirt here there is a re absorption of so i’ll
Show you here sodium and to compensate that hydrogen or potassium will excrete usually okay here the two unknowns we have one is aldosterone that increase the reabsorption of sodium and excretion of potassium it’s already given here and we have one more hormone effect is there here that is antidiuretic hormone if anti-diuretic hormone level is more means here
Water will get reabsorbed more and urine will be very concentrated if there is a deficiency of antibiotic hormonal adx then you’ll get a more dilute urine okay so next diagram i’ll show you with in simple way this blue line indicates reabsorption and the red line is for the secretion coming to the proximal cumulative tubule here they are not shown bicarbonate
Bicarbonate will also be clear so sodium potassium and bicopy these are three halves we get we have so coming to the ascending logo friendly we have a reabsorption of sodium potassium and chloride and in distal converted tubule we have re absorption of chloride and sodium and in collecting that we have the absorption of sodium to compensate that hydrogen and
Potassium will get excreted and if anti-ra that will occur in presence of aldosterone hormone sodium reabsorption anti-dynamic hormone is more water will get reabsorbed more concentrated urine will be excreted if anterior carbon is less will get very dilute urine okay next we have see that i told about the how your information occurs we have drugs drugs which
Acts on the proximal convoluted tool we have a carbonic anhydrase inhibitor like they limit the enzyme carbonic anhydrase the next the drug which act on acidic loop of any we have loop diabetics these are also called high efficacy diabetes they inhibit this sodium potassium two chloride co transport the sodium potassium and chloride will not get reabsorbed here
In proximal convoluted tool then with the carbonic and hydrogen reserve so bicarbonate sodium and potassium will not get reabsorbed and distilled converted to when we have drugs this is the inhibit sodium chloride co transport so sodium and chloride will not get reabsorbed and here we have a arduostume and onions that is spironolactone amyloid all they’ll do
That work so they inhibit the reabsorption of sodium and they increase the reabsorption of potassium and we have a flash and these are also called potassium spelling diabetics like like in other cases there is a inhibition sorry hypokalem the chance of hypokalemia will be moved so they leave a combination of these potassium spelling directly they increase the
Reabsorption of production that can be compensated okay we’ll go each class high ceiling diuretics diuretics is the furosemide and fructose even among patients with poor renal function are not responding to other they inhibit sodium potash i think it’s not complicated now in ascending global finally which co-transport is present sodium potassium to chlorate
Co transport these loop diuretics we’re going to indicate so this inhibits the reabsorption of sodium potassium and chloride ions okay the absorption of sodium potassium chloride is decreased because this pump is inhibited coatran’s food is inhibited also helps in excretion of magnesium calcium recommended all those areas side effects ototoxic ear infection it
Causes hypokalemia hypocalcemia calcium reabsorption also they inhibit magnesium magnesium chloride hypovolemic blood volumes also less hyperuricemia so these drugs are secreted in proximal conduct so they compete with uric acid secretion hypersensitive reaction contains sulfur this is how hyper uracil will occur i’ll show you this so in proximal convoluted to
Secrete a variety of organic gases from the blood strip into the lumen see like whatever we have loop diameters they compete with the uric acid to secrete into a proximal convoluted tubule so that will increase the uric acid level their uric acid it will get absorbed and that will increase the urine hyperuricemia okay useless enema heart value liver cirrhosis
Increase water blood pressure syndrome pregnancy medical their failure so the these causes hypo can they decrease the russian liver so in case of hyperkalemia can use same hypoglycemia that causes hypercalcemia you can use okay this is just an information next class of drugs we have is the thyroid diuretics this side of action is distal conductor tubule they mean
Sodium chloride co transport so animation of sodium chloride will be inhibited okay i’ll show you once again see this is the site of iron and with the absorption of sodium and providence okay inhibitory absorption sodium and chloride causes loss of potassium also will not get excreted through the eating by increasing the calcium reabsorption so here there is
No hypo calcium instead we have hypercalcemia due to increased hormone low toxicity and compared to diabetics hyperglycemia will be the hyperlipidemia hyper ulcemia will be again here also uric acid level will be high hypertension refractory edema does not respond to other treatment then you can look for these drugs along with the low diagram nephrolithiosis
And stones in that case due to idiopathic hyper calcium calcium will start getting through them because these tracks they eliminate the urinary excretion of calcium they increase the absorption of calcium so that’s when you’re losing hypocalcemia right because they increase calcium reabsorption so they can able to increase the calcium level nephrogenic diabetes
Inceptors increase flow of urine so there are two types of diabetes enzymes diabetes enzymes urine volume will be high i mean urine output will be high in this case the one is the neurogenic and refrigerant you need to go in detail diabetes incidence means you can use this and continue with the next bpd thank you so you
Transcribed from video
pharmacology 2nd bsc diuretics 2 By Oxford Medical college