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59-291 Section 3, Lecture 2 Diuretics: -increase in Na + excretion (naturesis)

59-291 Section 3, Lecture 2 Diuretics: -increase in Na + excretion (naturesis) Thiazide and Related diuretics -decreased PVR due to decreases muscle contraction -an economical and effective treatment -protect against osteoporosis Loop diuretics

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59-291 Section 3, Lecture 2 Diuretics: -increase in Na + excretion (naturesis)

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  1. 59-291 Section 3, Lecture 2 Diuretics: -increase in Na+ excretion (naturesis) Thiazide and Related diuretics -decreased PVR due to decreases muscle contraction -an economical and effective treatment -protect against osteoporosis Loop diuretics -used in patients with poor kidney function where thiazide derivatives will not be effective

  2. vasodilators a-antagonists b-antagonists Angiotensin II receptor antagonists b-antagonists CNS-directed sympatholytics b-antagonists ACE inhibitors Angiotensin II receptor antagonists diuretics

  3. Potassium-Sparing Diuretics • -mild diuretic and antihypertensive effect • Minimize renal-K+ loss thus preventing hypokalemia • If the patient can’t tolerate these drugs then use thiazide and take KCl tablets

  4. Sympatholytics

  5. vasodilators a-antagonists b-antagonists Angiotensin II receptor antagonists b-antagonists CNS-directed sympatholytics b-antagonists ACE inhibitors Angiotensin II receptor antagonists diuretics

  6. Angiotensin Inhibitors

  7. Angiotensin inhibitors • ACE inhibitors • Angiotensin receptor inhibitors Renin secretion induced by: 1-Symp. Outflow 2-reduction in BP and wall tension in renal arterioles 3-reduced NaCl reabsorbtion AT1 AT1 G-proteins – IP3

  8. Increase fetal morbidity and mortality, especially during 2nd and 3th trimesters Renal failure in patients with bilateral renal artery stenosis ACE inhibitors Adverse effects

  9. Vasodilators • Organic nitrites and nitrates • Amyl nitrites; (nitrites), administered by inhalation • Nitroglycerin (glyceryl trinitrate); sublingual, oral or transdermal administration • Calcium channel blockers • Amlodipine, felodipine • Diltiazem, verapamil

  10. Tolerance Aldehyde dehydrogenase releases NO from nitroglycerin, and this process is accompanied with formation of superoxide anion free radical (O2-) that in turn, deactivate aldehyde dehydrogenase -to avoid periodically interrupt the administration of the drugs Pills –sublingual Sustained release- patches, skin ointments, IV Adverse effects- headaches, hypotension, dizziness, reflex tachycardia, use -blocker in combination

  11. Ca2+- channel blockers (CCBs) Suppress cardiac activity and relax smooth muscles-in combination increase coronary blood flow Side effects: fatigue, headache, dizziness, flushing, peripheral edema Occasionally cause gingival hyperplasia

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