Episode
Chapter Fifteen: Clinical Use of Diuretics, part 1
- Podcast
- Channel Your Enthusiasm
- Published
- May 13, 2024
- Duration seconds
- 7256
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Summary
Outline Chapter 15 — Clinical Use of Diuretics - Among most commonly used drugs - Block NaCl reabsorption at different sites along the nephron - The ability to induce negative balance has made them useful in multiple diseases - Edematous states - Hypertension - Mechanism of action - Three major classes - Loop - NaK2Cl - Up to 25% of filtered sodium excreted - Thiazide - NCC - Up to 3-5% of filtered sodium excreted - Potassium sparing - ENaC - Up to 1-2% of filtered sodium excreted - Each segment has a unique sodium channel to allow tubular sodium to flow down a concentration gradient into the cell - Table 15-1 is interesting - Most of the sodium 55-655 is reabsorbed in the proximal tubule - Proximal diuretics would be highly effective if it wasn’t for the loop and other distal sites of Na absorption - Loop Diuretics - Furosemide - Bumetanide - Torsemide - Ethacrynic acid - NaK2Cl activated when all four sites are occupied - Loop diuretic fits into the chloride slot - In addition to blocking Na reabsorption results in parallel decrease in calcium resorption - Increase in stones and nephro albinos is especially premature infants which can increase calcium excretion 10-fold - Thiazide - Even though they are less potent than loops they are great for hypertension - “Not a problem in uncomplicated hypertension where marked fluid loss is neither necessary nor desirable” - Some chlorothiazide and metolazone also inhibit carbonic anhydrase in the proximal tubule - Increase Calcium absorption. Mentions that potassium sparing diuretics do this also - Potassium sparing diuretics - Amiloride - Spironolactone - Triamterene - Act at principal cells in the cortical collecting tubule, - Block aldosterone sensitive Na channels. - Discusses the difference between amiloride and triamteren…