Renal Drugs - Dr. Ureta
Renal Drugs - Dr. Ureta
Renal Drugs - Dr. Ureta
2. Premenstrual edema
result of imbalances in hormones such as estrogen excess
which facilitates loss of fluid in ECF
3. Hepatic Ascites
A. Blood flow in portal system often obstructed in cirrhosis
elevates BP
Colloid osmotic pressure of blood is decreased as result of
impaired plasma CHON synthesis by a diseased liver
elevated BP + low osmolarity of blood fluid escape
from portal system abdomen
B. Secondary aldosteronism due to decreased ability of liver to
inactivate steroid hormone
4. Kidney disease
damaged by disease, glomerular membranes allow plasma
CHONs to enter ultrafiltrate
protein loss edema
I. CARBONIC ANHYDRASE INHIBITORS (CAIs)
low plasma volume increased aldosterone increased
retention of Na+ & fluid aggravates edema Mercurial Diuretics
Prototype – Acetazolamide
Water & Diuretic Salts Mechanism of action
Water & various electrolytes/non-electrolytes act as diuretic o inhibits carbonic anhydrase catalyzes dehydration of
agents when- in excess carbonic acid, H2CO3 , required for bicarbonate
Water – true physiologic diuretic reabsorption
blockade of carbonic anhydrase activity induces
High water intake permits excretion of drugs
a sodium bicarbonate diuresis, reducing body
Sodium salts
bicarbonate levels
Restriction of salt intake – tx of edema
Therapeutic uses:
NaCl used primarily to tx deficits in ECF volume
o Glaucoma
Decreases production of aqueous humor reduces
Drugs Used in Renal Disorders
elevated intraocular pressure; most common use of
Drugs that modify SALT excretion
Carbonic anhydrase inhibitors
o PCT Carbonic Anhydrase Inhibitors
o Urinary alkalinization
o TAL Loop Diuretics
increasing urinary pH – enhances renal excretion of
o DCT Thiazides
cystine and other weak acids - 2-3 day effect
o CD K+ Sparing Diuretics
o Acute mountain sickness
Drugs that modify WATER EXCRETION used as prophylaxis - rapid ascent above 10,000 ft
o ADH Agonists – given nightly before ascent – cerebral and
o ADH Antagonists pulmonary edema
Drugs that modify BOTH salt and water excretion o Metabolic alkalosis
o Osmotic Diuretics alkalosis due to excessive use of diuretics in heart
failure
DIURETICS o Epilepsy
Drugs inducing a state of increased urine flow both grand mal & petit mal- reduces severity &
Most diuretics act directly on the kidney with few magnitude of seizures- in conjunction with
exceptions on tubular antiepileptic medications to enhance action
All diuretics except spironolactone exert their effects from o Hydrocephalus
the luminal side of the nephron reduces the rate of CSF formation and decreases
It is necessary for diuretics to get into the tubule fluid in cerebral spinal fluid pH
order to be effective
Pharmacokinetics Preparations Available
o well absorbed orally or topically o Bumetanide
o for glaucoma – applied topically 2-4x daily oral: 0.5,1,2 mg tablets
Adverse effects parenteral: 0.5 mg/2ml ampule for IV/IM
o hyperchloremic metabolic acidosis - due to reduction of oral dosage - 0.5-2 mg/daily dose
body bicarbonate stores o Ethacrynic acid
o potassium depletion, drowsiness and paresthesia; Hssn oral: 25, 50 mg tablets
reaction parenteral: 50 mg IV inj
Preparations Available oral dosage - 50-200 mg/daily dose
o Oral o Furosemide
Acetazolamide (Diamox) tablet 250 mg 1-4x/d oral: 20,40,80 mg tablets; 10 mg/ml sol
Dichlorphenamide 50 mg 1-3x/d; parenteral: 10 mg/ml for IM or IV inj; total daily
Methazolamide 50-100 mg 2-3x/d dose – 20-80 mg
o Topical o Torsemide – total daily dose – 5-20 mg
Dorzolamide ophthalmic drops 2%
Brinzolamide ophthalmic drops B. Muzolomine
New loop diuretic
II. LOOP DIURETICS Longer half-life = 10-20 hours
high ceiling diuretics Effective in treatment of Advanced Renal Failure
major action on Thick Ascending Limb of Loop of Henle Withdrawn because of sever neurologic effects