Dr.Rathnakar U P MD.DIH.

PGDHM
Dept of Pharmacology
KMC, Mangalore
 Introduction
Renal function
•Excrete waste
product of
metabolism,drugs
•Maintain water
electrolyte balance
 Diuretics:
• Diuretics are the
drugs that promote
the excretion of Na +

and water from the

body by an action on
the kidney.
NEPHRON
Classification
 DIURETICS
• High efficacy diuretics
[Loop diuretics ] (High ceiling
diuretics):
• Medium efficacy diuretics
[Thiazide diuretics]
• Weak diuretics
7. Potassium sparing diuretics
10.Carbonic anhydrase
inhibitors
12.Osmotic diuretics:
• Furosemide, Bumetanide,
Torsemide
• Hydrochlorthiazide,
Metolazone
• Aldosterone receptor
antagonist: Spironolactone,
Triamterene, amiloride
• Acetazolamide
• Mannitol, glycerol
 MOA
• Inhibition of Na-K-2Cl
• High Efficacy co-transporter of
ascending loop of Henle
• Medium Efficacy • Inhibit Na+-Cl- symport
in the DCT
• Low Efficacy
5. Tiamterene, • Inhibit Na+ channel in
Amiloride DT & CT
[Potassium sparing]
7. Spironolactone • Aldosterone antagonist
8. CA inhibitors • Inhibit CA in PT

• Osmotically @ PCT
10.Osmotic
 Adverse effects: High and Medium Efficacy

• Hypokalaemia
• Nausea, vomiting, diarrhoea, Head ache,
Giddiness
• Allergic
• Metabolic
Hyperurecemia
Hyperglycemia
Hypercalcemia[Thiazides]
Hypocalcemia[Furosemide]
 Uses

High efficacy Medium efficacy[Thiazides]

• Edema: • Edema
Any cause • Hypertension
Heart failure,
Cirrhosis, Renal
Acute
pulmonary
edema
Cerebral edema
 HTN
 Potassium Sparing [weak]
Tiamterene & Amiloride Spironolactone
• Uses • Uses
Used along with Edema-Cirrhosis,
Thiazides to nephrotic
reduce potassium
Heart failure
loss
• Adverse effects
• Adverse effects
Nausea, Vomiting, • Drowsiness,
Hirsutism,
diarrhoea
Hyperkalemia
 CA Inhibitors-
Acetazolamide[weak]
• Uses • Adverse effects
• Weak Common
Glaucoma Acidosis,
Mountain sickness hypokalemia
To alkalinise urine Drowsiness
Epilepsy Hepatic coma
 Osmotic diuretics-Mannitol,
Glycerol
• Uses • Adverse effects
I.V Head ache
Raise intracranial Nausea
tension Vomiting
Acute glaucoma Allergic reactions
Should not be
given in Heart
failure, pulmonary
edema etc.
 Summary
• Diuretics reduce water reabsorption and increase
urine volume
• Loop diuretics such as furosemide (frusemide)
inhibit the NaK2Cl cotransporter in the loop of
Henle
• Thiazide diuretics inhibit the NaCl cotransporter in
the distal tubule
• Amiloride inhibits the epithelial Na channel in the
collecting duct
• Spironolactone is an aldosterone antagonist
• Mannitol is an osmotic diuretic
• Acetazolamide inhibits carbonic anhydrase inhibitor
• Loop diuretics and Thiazide diuretics increase
potassium excretion,
• Amiloride and spironolactone reduce potassium
excretion
• Used in edema
 Antidiuretic hormone
(ADH)/Vasopressin
• Synthesized in the hypothalamus

• Secreted from the posterior lobe of

pituitary gland

• Rise in plasma osmolarity; contraction

of extracellular fluid volume.
 Therapeutic uses
• Lypressin
• Telipressin
• Desmopressin –given
intranasally/orally/im
- Diabetes insipidus due to damage to
posterior pituitary
- Nocturnal enuresis in patients with
normal pituitary function –
intranasal/oral at bed time