Kuliah Diuretik UWK
-
Upload
surya-nirmala-dewi -
Category
Documents
-
view
233 -
download
0
Transcript of Kuliah Diuretik UWK
-
7/27/2019 Kuliah Diuretik UWK
1/23
Budhi Setiawan
Pharmacology
Wijaya Kusuma University
-
7/27/2019 Kuliah Diuretik UWK
2/23
-
7/27/2019 Kuliah Diuretik UWK
3/23
Overview Caution:
Hyponatremia and pulmonary congestion ECF volume -> PULMONARY EDEMA
Contraindicated: ANURIAdue to renal disease They can complicateCongestive Heart Failure!
Mannitol (IV) Clinical Use:
Prevent or tx Oliguric phase ofAcute Renal Failure Prevent anuria from Hemolysis, Rhabdomiolysis Intracranial pressure inCerebral Edema IOP Promote urinary excretion oftoxic substances
-
7/27/2019 Kuliah Diuretik UWK
4/23
Urea (IV) Clinical Use:
Intracranial pressure inCerebral Edema IOP
Glycerin (Oral) Clinical Use: Glaucoma
Metabolized to glucose => HYPERglycemia Isosorbide (Oral)
Clinical Use: IOP and acute glaucoma attack after intraocular surgery
-
7/27/2019 Kuliah Diuretik UWK
5/23
Overview MOA (PCT)
Inhibits reabsorption of:
Na+, bicarb, water, and indirectly K+. Refer to notes for exact mechanism
Clinical Uses:
1. Glaucoma
2. Urinary Alkalinization
3. Tx for MetabolicAlkalosis4. High altitude sickness
-
7/27/2019 Kuliah Diuretik UWK
6/23
Acetazolamide Methazolamide Dorzolamide (only used for Glaucoma)
Brinzolamide (only used for Glaucoma)
Toxicity
1. Metabolic Acidosis
2.
Renal Stones Ca Salt3. Renal Potassium Wasting
4. Drowsiness and Paresthesia
-
7/27/2019 Kuliah Diuretik UWK
7/23
Overview MOA (ALH)
Inhibit the Na/K/Cl cotransport of the luminalmembrane
Ascending limb of the LOOP of Henle. Clinical Use:
1. Pulmonary edema2. EdemaCirrhosis3. Nephrotic Syndrome4. CHF5. Hypertension6. Hypercalcemia induced by Malignancy
-
7/27/2019 Kuliah Diuretik UWK
8/23
SE: RISK of ARRHYTHMIAS
[electrolyte] : Na, K, Cl, Ca, and Mg Ototoxicity
Inhibition of electrolyte transport in ENDOLYMPH Hypokalemic Metabolic Alkalosis Allergic Reaction
-
7/27/2019 Kuliah Diuretik UWK
9/23
Rx Interactions Aminoglycosides Digoxin - risk ofarrhythmias NSAIDS
InhibitsPG-mediated in RBF=> diuretic effects Quinidine Potentially fatal Torsades de pointes
Hypokalemia => risk of arrhythmias
-
7/27/2019 Kuliah Diuretik UWK
10/23
Furosemide (Lasix) MOA:
Dilate Veins => Venous Capacitance Clinical Use:PULMONARY EDEMA
Torsemide Bumetanide (diuretic action 4-6 hrs) Ethacrynic Acid
MOST Ototoxic!But NOT aSulfa
-
7/27/2019 Kuliah Diuretik UWK
11/23
Overview MOA(DCT)
Blocks Cl site of the Na/Clcotransporter (LM) The kidneys ability to [urine] during hydropenia isNOT altered.
Clinical Use1. Hypertension2. CHF3. Hepatic cirrhosis4. Nephrotic Syndrome assoc. edema
-
7/27/2019 Kuliah Diuretik UWK
12/23
Chlorothiazide Hydrochlorothiazide Bendroflumethiazide Indapamide
Longest t1/2 = last up to 72 hours
Hydroflumethiazide Trichlormethiazide Methyclothiazide
-
7/27/2019 Kuliah Diuretik UWK
13/23
Overview SE: Like effects on electrolytes as loop diuretics
NotOtotoxic Caution:
Quinidine Potentially fatal Torsades de pointes Gout= plasma [uric acid]
Metolazone Chlorthalidone
Long t1/2 = 24-72 hrs
-
7/27/2019 Kuliah Diuretik UWK
14/23
Na+ Channel Blockers (DCT & CD) Triamterene Amiloride
Aldosterone Receptor Agonist Spironolactone
SE:
Hyperkalemia(ACEI & ARB side effect) Gynecomastia, impotence, hirsutism, menstrual,
irregularities, libido
-
7/27/2019 Kuliah Diuretik UWK
15/23
Agonist : ADH & Desmopressin Antagonist : Demeclocycline & Lithium
cAMP causes the insertion of additional waterchannel into the luminal membrane
Antagonists inhibit the action of ADH
Agonist for diabetes insipidus tx
Antagonists for SIADH tx
-
7/27/2019 Kuliah Diuretik UWK
16/23
Agonist : Hyponatremia & Hypertension Demeclocycline : Bone & Teeth Abnormality
Lithium : Nephrogenic Diabetes Insipidus
-
7/27/2019 Kuliah Diuretik UWK
17/23
-
7/27/2019 Kuliah Diuretik UWK
18/23
-
7/27/2019 Kuliah Diuretik UWK
19/23
Drugs Used in Congestive Heart Failure
Positive Inotropic Vasodilators Miscellaneous
Drugs Drugs
Cardiac
Glycosides
PDE
Inhibitors
Beta
Agonists
Nitroprusside
NitratesHydralazine
Loop Diuretics
ACE Inhibitors
Beta Blockers
SpironolactoneThiazide
-
7/27/2019 Kuliah Diuretik UWK
20/23
Digoxin, Digitoxin, Ouabain Inhibition Na+/K+ ATPase
Alters Na+/Ca2+ exchanger
Increase intracellular Ca2+
is stored SR Increase contractile force
Clinical use Congestive Heart Failure
It doesnt prolong life
Dosing regiment must be careful and monitored
Atrial fibrillation
-
7/27/2019 Kuliah Diuretik UWK
21/23
Reduction in digoxin clearance : Quinidine,Amiodarone, Verapamil, etc
Reduce Potassium Serum : Loop diuretics,Thiazides Induce toxicity
Digitalis induced vomiting may depletemagnesium serum facilitate toxicity
Digitalis Toxicity are arrhythmias, nausea,
vomiting and diarrhea Toxicity TX Correction K+/Mg+ serum,
Antiarrhythmia drugs, Digoxin Antibodies
-
7/27/2019 Kuliah Diuretik UWK
22/23
DIURETICS Furosemide Pulmonary Congestion & Edema
Thiazides Mild Chronic Failure
Spironolactone Long Term Benefit in Chronic CHF
ACE INHIBITORS Reduce Mortality & Morbidity in CHF
First Line Drugs in CHF
ARBs probably have similar effect
BETA 1 SELECTIVE ADRENOCEPTOR AGONIST Dobutamine & Dopamine are useful for acute CHF
They are not appropriate for chronic failure
-
7/27/2019 Kuliah Diuretik UWK
23/23
Beta Adrenoceptor Antagonists They have been shown in long term studies to reduce
progression chronic CHF
They are not value in acute CHF
Phosphodiesterase Inhibitors Amrinone & Milrinone increase cAMP by inhibiting its
breakdown Ca2+ intracellular increase
They also cause vasodilatation
They should not be used in chronic CHF
Vasodilators Nitroprusside & Nitroglycerin is often used for acute CHF
Hydralazine & Isosorbide dinitrate for chronic CHF