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    Add as FriendLoop diuretics for undergraduates by Dr Shakeel

    by: Dr.Shakeel

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    1 : SHAKEEL Dr Shakeel Ahmad Mir Nambalhar,Budgam Kashmir India C/O: Department of Pharmacology Govt Medical College Srinagar,kashmir ( These slides are intended for MBBS students.See notes for slide details SHAKEEL
    2 : SHAKEEL Slides designed by: Danish Shakeel 7th Standard student Kendriya Vidyalaya No 2 Air Force Station Srinagar kashmir (
    3 : SHAKEEL Dedicated to My beloved students of Govt Medical College Srinagar,kashmir
    4 : SHAKEEL Renal Pharmacology SHAKEEL
    7 : SHAKEEL Agents used Furosemide Bumetanide Torsemide Axosemide Piretanide Tripamide Ethacrynic Acid SHAKEEL
    8 : SHAKEEL Chemistry Sulphonamide and carboxylic acid derivatives except ethacrynic acid (phenoxy acetic acid derivative) SHAKEEL
    9 : SHAKEEL Chemistry SHAKEEL
    10 : SHAKEEL Site of action Ascending Limb of Henles Loop (major action) PCT(minor action) SHAKEEL
    11 : SHAKEEL Inhibitors of CA ® Acetozolamide Site I Site II Site III Site IV Inhibitors of Na+-K+-2Cl symport (Loop diuretics) ® Furosemide, Bumetanide Inhibitors of Na+-Cl- symport Thiazide diuretics Hydochlorothiazide Aldosterone antagonist (K+-sparing diuretic) ® Spironolactone Inhibitor of Na+channel (K+-sparing diuretic) ® Triamterene, Amiloride
    12 : SHAKEEL Action Mechanism Attach to Cl- binding site of Na+/K+/2Cl- cotransporter and block its function.This leads to inhibition of electrolyte reabsorption in this segment. SHAKEEL
    13 : SHAKEEL
    14 : SHAKEEL RENAL EFFECTS increase in the urinary excretion of Na+ and Cl- profoundly increase in the excretion of Ca2+ and Mg2+. urinary excretion of HCO3 - and phosphate increase the urinary excretion of K+ and titratable acid. Acutely, loop diuretics increase the excretion of uric acid, whereas chronic administration of these drugs results in reduced excretion of uric acid increase total RBF Redistribution of renal blood flow SHAKEEL
    15 : SHAKEEL EXTRA RENAL EFFECTS increase the capacitance of the vascular bed May decrease intracranial pressure by reducing CSF production inhibit electrolyte transport in many tissues. SHAKEEL
    16 : SHAKEEL Pharmacokinetics Route of administration : Oral and IV Absorption : Rapidly from GIT Distribution : Strongly protein bound Onset of action : 1 hr (oral), 30 min (IV) Duration of action : 2-3 hrs Excretion : Urine
    17 : SHAKEEL Adverse effects Related to renal action(COMMON) Hypovolemica hypotension Hypokalemia (K+ depletion) Hypomagnesemia Hyperuricemia (precipitates gout) Metabolic alkalosis (due to excess H+ loss) Unrelated to renal action(RARE) Ototoxicity (tinnitus, deafness) Hyperglycemia (rarely precipitating diabetes) Hyperlipidemia, Hypersensitivity (skin rash) Bone marrow depressiondepression Loop diuretics Contraindication Severe Na+ and volume depletion Hypersensitivity to sulfonamide Gout
    18 : SHAKEEL Drug Interactions (1) aminoglycosides (synergism of ototoxicity caused by both drugs) (2) anticoagulants (increased anticoagulant activity) (3) digitalis glycosides (increased digitalis-induced arrhythmias) (4) lithium (increased plasma levels of lithium) (5) sulfonylureas (hyperglycemia) (6) cisplatin (increased risk of diuretic-induced ototoxicity) (7) NSAIDs (blunted diuretic response), (8) probenecid (blunted diuretic response) (9) thiazide diuretics (synergism of diuretic activity of both drugs leading to profound diuresis), (10) amphotericin B (iintensification of electrolyte imbalance). SHAKEEL
    19 : SHAKEEL THERAPEUTIC USES Treatment of acute pulmonary edema CCF Treatment of hypertension The edema of nephrotic syndrome ,ascites etc. Halide overdose Treatment hypercalcemia Hyperkalemia AKI(ac kidney injury) SHAKEEL
    20 : SHAKEEL Potential uses SHAKEEL

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