Module 1: Fluid Therapy and Diuretics

1. osmotic diuretics

2. carbonic anhydrase

3. benzothiadiazides / thiazides

4. aldosterone antagonist

5. xanthine / aminouracils

6. potassium - retaining agent

7. aquaretics

8. dopamine (d1) receptor agonist

DIURETICS

1. osmotic diuretics

   1. Mannitol

   2. Sorbitol’ inositol

   3. Glycerin

   4. Isosorbide

2. carbonic anhydrase

   1. Acetazolamide

   2. Dichlorphenamide

   3. Methazolamide

   4. Ethoxzolamide

3. benzothiadiazides / thiazides

   1. Chlorothiazide

   2. Polythiazide

   3. Cyclothiazide

   4. Hydrochlorothiazide

4. aldosterone antagonist

   1. Spironolactone

   2. Eplerenone

   3. Heparin

   4. Canrenone

   5. Potassium canrenoate

5. xanthine / aminouracils

   1. Theophylline / Aminophylline

   2. Theobromine (cocoa)

   3. Caffeine (coffee)

   4. Chlorazamil Hydrochloride

6. potassium - retaining agent

   1. Triamterene

   2. Amiloride

7. loop of henle diuretics

   1. Furosemide

   2. Ethacrymic acid

   3. Burmetamide (Bumetanide)

   4. Torsemide

8. aquaretics

   1. Vasopressin (arginine vasopressin)

   2. Lixivaptan

   3. Tolvaptan

   4. Conivaptan

9. neural endopeptidase inhibitors (nep)

   1. Ecadotril

10. dopamine (d1) receptor agonist

    1. Fenoldopam

DIURETICS

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increases osmotic pressure within the lumen of proximal tubule

MOA of OSMOTIC DIURETICS

1. Tx of nephritis (inflammation of nephron)

2. Tx of renal failure

3. Regulation of CSF

4. Regulation of intra-ocular fluid

5. Induction of polyuria to eliminate toxin

6. Tx of urolithiasis (stones in Urinary tract)

7. Tx of cystitis (inflammation of urinary bladder)

USES of OSMOTIC DIURETICS

Inhibition of the reabsorption by the tubular cells, leading to retention to bicarbonate in the tubular lumen

MOA of CARBONIC ANHYDRASE INHIBITOR

1. Tx of chronic glaucoma

2. Tx of udder edema

3. Reduce Intra-ocular pressure

4. Adjunct to Tx of epilepsy

5. Acute mountain (high-altitude) sickness

USES of CARBONIC ANHYDRASE INHIBITOR

4. .

Decrease sodium reabsorption and therefore decrease fluid reabsorption

MOA of BENZOTHIADIAZIDES / THIAZIDES

1. Tx of edema associated with congestive heart failure

2. Tx of edema with renal, cardiac and hepatic origin

3. Tx of nephrogenic diabetes insipidus

USES of BENZOTHIADIAZIDES / THIAZIDES

1. Central diabetes insipidus

2. Nephrogenic diabetes insipidus

Types of Diabetes Insipidus

• pituitary

• Thiazides diuretics

in central diabetes insipidus

• (ADH / Vasopressin)

• __________ gland doesn’t produce ADH

• Tx is _________________

• ADH

• Thiazides diuretics

• diet, low protein, low salt, high filtrate

in nephrogenic diabetes insipidus

• produces _____ but when it reaches the kidney it doesn’t function.

• Tx is ______________

• Direct the tx in their _________, (wag pahirapan yung kidney sa filtration) → ___________, _____________, ____________

block the effect of aldosterone, preventing the reabsorption of sodium, which encourages water loss.

MOA of ALDOSTERONE ANTAGONIST

1. True competitive antagonist of aldosterone

2. Has some estrogen like activity

3. Tx of hypokalemia

4. Tx of edema associated with renal, liver, and cardiac failure

5. Tx severe ascites

uses of ALDOSTERONE ANTAGONIST: Spironolactone

1. Prevents release of aldosterone

uses of ALDOSTERONE ANTAGONIST: Heparin

1. Inhibit aldosterone receptors

2. Prevent excessive excretion of potassium

uses of ALDOSTERONE ANTAGONIST: Spironolactone, eplerenone

promote renal vascular vasodilation

MOA of XANTHINE / AMINOURACILS

1. Increase heart function

2. Increase pressure

3. Increase filtration

4. Increase water release

USES of XANTHINE / AMINOURACILS

prevent sodium reabsorption in the collecting tubule

MOA of POTASSIUM – RETAINING AGENT

1. Tx of edema ass, with CHF

2. Tx of edema with liver cirrhosis

3. Tx of edema with nephrotic symptoms

USES of POTASSIUM – RETAINING AGENT

Inhibit sodium, potassium, chloride transport in Loop of Henle

MOA of LOOP OF HENLE DIURETICS

1. Tx of edema

2. Tx of pulmonary congestion

3. Tx of ascites

4. Tx of hydrothorax

5. Contraindicated in anuria, NSAID, aminoglycoside

6. Have ototoxic effect (ear sound, hearing, lead to tinnitus (ringing in the ears))

7. Tx of renal failure

8. Exercise-induce pulmonary hemorrhage (EIPH) in horse treatment of chronic heart failure

USES of LOOP OF HENLE DIURETICS

inhibit V2 receptors which mediate antidiuretic hormone (ADH)

MOA of AQUARETICS

1. edema associated with liver cirrhosis

2. heart failure

3. nephrogenic syndrome and inappropriate secretion of ADH

USES of AQUARETICS

1. NEP degraded atrial natriuretic factor (ANF)

USES of NEURAL ENDOPEPTIDASE INHIBITORS (NEP)

right atrium, sodium excretion, diuresis

ANF is from the muscle of the ____________ and release in response to blood volume overload leading to __________________ and ________

1. increase renal blood flow

2. increase filtration

3. induce natriuresis

USES of DOPAMINE (D1) RECEPTORS AGONIST