Dr.

Padmanabha T S
DEPT OF PHARMACOLOGY
AIMS, B.G.NAGAR.
 Drugs: ETHACRYNIC ACID & FUROSEMIDE

Mechanism : Na+/K+/2Cl- transporter inhibition

intracellular K+ in TAL
back diffusion of K+
positive potential
reabsorption of Ca2+ & Mg2+
diuresis

Indications : acute pulmonary oedema, heart failure,

acute renal failure, anion overdose, hypertension,
refractory oedema, hypercalcemic states.
 Vasodilating property: PG
NSAIDs: diminish / cancells anti HTN
 Side effects:
Sulfonamide hypersensitivity
Hypokalemia & alkalosis
HYPOCALCEMIA
Hypomagnesemia
Hyperuricemia
OTOTOXICITY (ethacrynic > furosemide)

Drug interactions:
Aminoglycosides
Lithium
Digoxin
NSAIDs
Cotrimoxazole
 Cross allergenicity with:

Carbonic anhydrase inhibitors

All loop diuretis except ethacrynic acid
Thiazides
Sulfa antibiotics
Celecoxib.

Latin : SULFO, SULFA

Greek: THIO
 Drugs : HYDROCHLOROTHIAZIDE ,
INDAPAMIDE METOLAZONE

Mechanism : Na+/Cl- transporter inhibition

luminal Na+, Cl- in DCT
diuresis

Indications :
Hypertension , CHF
Nephrolithiasis
Nephrogenic diabetic insipidus
 Side effects:
Sulfonamide hypersensitivity
Hypokalemia & alkalosis
HYPERCALCEMIA
Hyperuricemia
Hyperglycemia
Hyperlipidemia

Drug interaction & cautions:

Digoxin :
Avoided in patients with diabetes mellitus.
 insulin release (ATP dependent K+ channel
opener similar to minoxidil, diaxoxide)

Even beta blocker : insulin release

ATP dependent K+ channel opener:

vasodilation property

What drugs are preferred in diabetic patient

with hypertension???
 ALDOSTERONE ANTAGONISTS:
Spironolactone
Eplerenone

SPIRONOLACTONE : uses & side effects

Uses: hyperaldosteronic site, adjunct to K+ sparing

diuretics, antiandrogenic uses, CHF.
S/E: hyperkalemia , acidosis, ANTIANDROGEN.

NA+ CHANAEL BLOCKER:

AMILORIDE & TRIAMTRENE
Uses : adjunct to K+ sparing diuretics, lithium induced DI
S/E: hyperkalemia , acidosis
 MANNITOL(I.V) inhibits water reabsorption
through out the tubule
It increases urine volume

Uses:
IOP in glaucoma.
ICP
Oliguric states.(rhabdomyolysis)

Side effects: acute hypovolemia.

 Drugs : ACETAZOLAMIDE & DORZOLAMIDE.

Mechanism: Carbonic anhydrase inhibition.

H+ formation inside PCT cell.
Na+/H+ antiport
Na+ & HCO3- in the lumen.
diuresis.

Uses:
Glaucoma, acute mountain sickness, metabolic alkalosis.

Side effects:
Bicarbonaturia , ACIDOSIS, HYPOKALEMIA,
HYPERCHLOREMIA, paresthesis, renal stones, sulfonamide
hypersensitivity.
 Altitude
Patm & PAo2
Hypoxia
Hyperventillation
Pco2
Resp alkalosis
Vasoconstriction
Pc
Edema
Drug MOA Urinary Blood pH
electrolytes
Acetazolamide CA inhibitor Na+ Acidosis
K+
HCO3-
Ethacrynic acid, Inhibition of Na+ Alkalosis
Furosemide, Na+K+2Cl- K+
Torsemide cotransporter in Ca2+
TAL Mg2+
Cl-
Hydrochlorothiaz Inhibition of Na+ Alkalosis
ide , Indapamide Na+Cl- K+
Metolazone cotransporter in Cl-
DCT Ca2+

Amiloride & Blocks Na+ Na+(small) Acidosis

Triamtrene, channels, K+
Spironolactone Blocks
Eplerenone aldosterone
receptors in
collecting tubule.
References:
Kaplans pharmacology
K.D. Tripathi