DIURETIK

dr. Rohmania Setiarini

Diuretics
Drugs that accelerate the rate of urine formation
In the nephron, where sodium goes, water follows
20% to 25% of all sodium is reabsorbed into the
bloodstream in the ascending loop of Henle
5% to 10% in the distal convoluted tubules
3% in collecting ducts
If water is not absorbed, it is excreted as urine
Result: removal of sodium and water

Diuretics

Diuretic Drugs
Classifications

Carbonic anhydrase inhibitors

Loop diuretics
Potassium-sparing diuretics
Thiazide diuretics
Osmotic diuretics

Tempat kerja obat diuretik

Perubahan elektrolit urin dan pH tubuh

karena pemberian obat diuretik
Group

NaCl

NaHCO3

K+

Body pH

Carbonic
anhydrase
inhibitor

+++

Loop agent

++++

Thiazides

++

Loop
agent+thiazides

+++++

++

K+ sparing
agent

Inhibitor karbonik anhidrase

Karbonik anhidraseenzim
mengkatalisis reaksi
CO2+H2OH2CO3
Asetazolamid, diklorfenamid,
methazolamid

Diuretics
Carbonic Anhydrase Inhibitors (CAI)
Mechanism of Action

The 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 water
reduces 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 :
Glaukoma
Alkalinisasi urin
Alkalosis metabolik
Mountain sickness

Toksisitas :
Hiperkloremik
metabolik asidosis
Batu renal
Hilangnya potasium

Kontraindikasi :
Hiperammonemia
Hepatik ensefalopati

Loop diuretik
Menghambat reabsorpsi NaCl di TAL
Furosemid, bumetanid, asam etakrinat,
torsemid

Loop Diuretics
Mechanism of Action

Act directly on the ascending limb of the loop of

Henle to inhibit chloride and sodium resorption
Increase renal prostaglandins, resulting in the
dilation of blood vessels and reduced peripheral
vascular resistance

Indikasi :
Hiperkalemia
GGA
Overdosis anion

Toksisitas :
Hipokalemia
Ototoksisitas
Hiperurisemia
Hipomagnesemia
Alergi

Thiazid
Menghambat reabsorpsi NaCl di DCT
Hidroklorotiazid, klorotiazid, politiazid,
triklormetiazid, bendroflumrtiazid

Indikasi :
Hipertensi
Gagal jantung
Nefrolitiasis
Nefrogenik diabetes
insipidus

Toksisitas :
Hipokalemia &
hiperurikemia
Hiperlipidemia
Hiponatremia
Reaksi alergi

Potassium-sparing diuretic
Menurunkan reabsorpsi Na di kolekting
tubul
Spironolakton, triamteren, eplerenon,
amilorid

Potassium-Sparing Diuretics
Mechanism of Action

Interfere with sodium-potassium exchange in collecting ducts and

convoluted tubules
Competitively bind to aldosterone receptors
Block 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 :
hiperaldosteronism

Toksisitas :
Hiperkalemia
Ginekomastia
GGA
Batu ginjal

Diuretik osmotik
Efek osmotik
Manitol

Indikasi :
Meningkatkan volum
urin
Menurunkan
TIO&TIK

Toksisitas :
Ekspansi volum
ekstraseluler
Dehidrasi,
hiperkalemia,
hipernatremia

Types and Names of Diuretics

Type

Example

Sites of Action

Osmotic agents

Mannitol

Proximal tubule
Descending loop
Collecting duct

Carbonic
anydrase inhib.

Acetazolamide

Proximal tubule

Thiazides

Hydrochlorothiaz
ide

Distal convoluted
tubule

Loop diuretic

Ethacrynic acid
Furosemide

Loop of Henle

K+ - sparing

Spironolactone
Amiloride

Collecting tubule

Nephron sites of action of diuretics

SEMOGA BERMANFAAT