DIURETIK

PENGARUH OBAT DIURETIK

DIURETIKdr. Rohmania SetiariniDrugs that accelerate the rate of urine formation

In the nephron, where sodium goes, water follows20% to 25% of all sodium is reabsorbed into the bloodstream in the ascending loop of Henle5% to 10% in the distal convoluted tubules3% in collecting ductsIf water is not absorbed, it is excreted as urineResult: removal of sodium and water

DiureticsDiuretics

Diuretic DrugsClassificationsCarbonic anhydrase inhibitorsLoop diureticsPotassium-sparing diureticsThiazide diureticsOsmotic diuretics

Tempat kerja obat diuretik

Perubahan elektrolit urin dan pH tubuh karena pemberian obat diuretikGroup NaClNaHCO3K+Body pHCarbonic anhydrase inhibitor+++++-Loop agent++++0++Thiazides+++++Loop agent+thiazides+++++++++K+ sparing agent++--Inhibitor karbonik anhidraseKarbonik anhidraseenzim mengkatalisis reaksi CO2+H2OH2CO3Asetazolamid, diklorfenamid, methazolamid

DiureticsCarbonic Anhydrase Inhibitors (CAI)Mechanism of ActionThe enzyme carbonic anhydrase helps to make H+ ions available for exchange with sodium and water in the proximal tubules

CAIs block the action of carbonic anhydrase, thus preventing the exchange of H+ ions with sodium and waterreduces H+ ion concentration in renal tubules

Result: increased excretion of bicarbonate, sodium, water, & K+ Resorption of water is decreased and urine volume is increased

Indikasi :GlaukomaAlkalinisasi urinAlkalosis metabolikMountain sicknessToksisitas :Hiperkloremik metabolik asidosisBatu renalHilangnya potasiumKontraindikasi :HiperammonemiaHepatik ensefalopatiLoop diuretikMenghambat reabsorpsi NaCl di TALFurosemid, bumetanid, asam etakrinat, torsemid

Loop Diuretics Mechanism of ActionAct directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorptionIncrease renal prostaglandins, resulting in the dilation of blood vessels and reduced peripheral vascular resistance

Indikasi :HiperkalemiaGGAOverdosis anionToksisitas :Hipokalemia OtotoksisitasHiperurisemiaHipomagnesemiaAlergi Thiazid Menghambat reabsorpsi NaCl di DCTHidroklorotiazid, klorotiazid, politiazid, triklormetiazid, bendroflumrtiazid

Indikasi :HipertensiGagal jantungNefrolitiasisNefrogenik diabetes insipidus

Toksisitas :Hipokalemia & hiperurikemiaHiperlipidemiaHiponatremiaReaksi alergi Potassium-sparing diureticMenurunkan reabsorpsi Na di kolekting tubulSpironolakton, triamteren, eplerenon, amilorid

Potassium-Sparing Diuretics Mechanism of ActionInterfere with sodium-potassium exchange in collecting ducts and convoluted tubules

Competitively bind to aldosterone receptorsBlock the resorption of sodium and water

Prevent potassium from being pumped into the tubule, thus preventing its secretion

Competitively block the aldosterone receptors and inhibit its action

Sodium and water are excreted

Indikasi :hiperaldosteronismToksisitas :HiperkalemiaGinekomastiaGGABatu ginjalDiuretik osmotikEfek osmotikManitol Indikasi :Meningkatkan volum urinMenurunkan TIO&TIK

Toksisitas :Ekspansi volum ekstraselulerDehidrasi, hiperkalemia, hipernatremiaTypes and Names of DiureticsOsmotic agentsMannitolProximal tubuleDescending loopCollecting ductCarbonic anydrase inhib.AcetazolamideProximal tubuleThiazidesHydrochlorothiazideDistal convoluted tubuleLoop diureticEthacrynic acidFurosemideLoop of HenleType Example Sites of ActionK+ - sparingSpironolactoneAmilorideCollecting tubuleNephron sites of action of diuretics

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