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Diuretics

(See also Caffeine, Theobromine, Theophylline, Eufillin, Ammonia.
chloride.)
Diuretics, or diuretics, are called substances,
causing an increase in excretion of urine and a decrease
fluid content in the tissues and serous cavities of the body.
Previously, diuretics were used mainly for diseases,
accompanied by fluid retention in the body, especially with
chronic circulatory failure, nephrotic syndrome,
cirrhosis of the liver. Currently, they are also widely used in
hypertension, glaucoma and other diseases.
The therapeutic effect of diuretics is not always due to
increased diuresis, however, the diuretic effect is their
main pharmacological sign.
Diuretic-induced increase in urination is associated with their
specific action on the kidneys, consisting primarily in
inhibition of reabsorption of sodium ions in the renal tubules, which
accompanied by a decrease in water reabsorption.
Modern diuretics are divided mainly into 3 groups: c) salure-
tics, b) potassium-sparing and c) osmotic diuretics. To saluretics
thiazide and thiazide-like drugs (dichlothiazide,
cyclomethiazide, oxodoline, etc.), sulfamoylanthranilic derivatives
and dichlorophenoxyacetic acids (furosemide, ethacrylic acid and
etc.), carbonic anhydrase inhibitors (diacarb) (there are other classes of
fication of diuretic agents).
The drugs of this group have different strengths and
diuretic effect, which depends mainly on their
physico-chemical properties and effects on different parts of the nephron.
Thiazides (benzothiadiazine derivatives) act mainly
on the cortical segment of the nephron loop and cause enhanced excretion
sodium and potassium ions. The characteristic side effect of the diuretics of this
group is hypokalemia, accompanied by weakness, dizziness
burning, headache, nausea, ECG changes.
The duration of diuretic action is significantly different in
different drugs. So, the effect after a single dose of dichlothiazide
lasts several hours, and after taking oxodoline - up to 3 days.
Thiazides are widely used in the treatment of chronic cardiac
insufficiency. By increasing diuresis, they reduce the volume of circulating
plasma and, accordingly, venous return of blood to the heart and the load on
myocardium, reduce congestion in the lungs.
Thiazides are also widely prescribed for hypertension. Them
antihypertensive effect is partially associated with the removal of salts and water
from the body and a decrease in the volume of circulating plasma. Moreover,
they have a direct antispasmodic effect on the walls
vessels. It is established that under the influence of benzothiadiazine derivatives
metabolic processes in the cell membranes of arterioles change, in particular
the extraction of sodium ions from them, which leads to a decrease
swelling and decreased peripheral vascular resistance. Maybe,
that in this case, not an absolute decrease in the content of Na B + in
walls of blood vessels, and a change in the ratio between its intra- and extracellular
accurate content.
Under the influence of thiazides, the reactivity of the vascular system changes
pressor reactions to vasoconstrictors decrease (adrenaline
etc.) and the depressive reaction to ganglioblocking is amplified
facilities.
The most powerful saluretics are the so-called loop
diuretics, which include furosemide, bufenoks, ethacrine
acid. They operate throughout the upstream loop
nephron (Henle loop) and dramatically inhibit the reabsorption of chlorine ions and
sodium. They also enhance the excretion of potassium ions. Wide-spread saluretics
are used in the treatment of chronic heart failure and
hypertension. Due to the strong and fast advancing
their effect was also prescribed in the treatment of acute cardiac
insufficiency. However, it should be borne in mind that they caused
electrolyte shifts can lead to the development of arrhythmias, while profuse
diuresis can cause a decrease in cardiac output and arterial
hypotension. In this regard, in acute heart failure,
especially with myocardial infarction, they prefer to use peripheral
vasodilators
When using thiazides for the treatment of hypertension
it should be borne in mind that they stimulate the renin-angiotensin system
and aldosterone production, leading to a gradual weakening of diure-
toxic and hypotensive effect. For antihypertensive therapy
it is advisable to use drugs slower and longer
actions, since they have a weaker effect on the renin-angiotensin system
mu and their hypotensive effect lasts longer.
To reduce the stimulation of the renin-angiotensin system,
it is necessary to combine thiazides with Ab-blockers (see Anaprilin).
To reduce the side effects associated with hypokalemia,
use combined preparations containing thiazide and
potassium-sparing diuretics (see Triamteren, Amiloride).
The main representative of diuretics - carbonic anhydrase inhibitors
is diacarb. It reduces the reabsorption of sodium bicarbonate and secretion.
hydrogen ions in the proximal tubules and increases excretion
with urine of bicarbonates and phosphates. Due to the short and
relatively weak diuretic effect in recent years its
relatively rarely used as an independent diuretic
facilities. Sometimes it is used in combination with other diuretics.
to prevent alkalosis.
Carbonic anhydrase inhibitors reduce the secretion of aqueous humor
eyes; they are widely used to reduce intraocular pressure in
glaucoma.
Sometimes they are prescribed as additional funds for treatment
epilepsy, especially small forms.
Potassium-sparing diuretics increase the release of sodium ions and
at the same time reduce the release of potassium ions. They operate in the field
distal tubules in places where sodium and potassium ions exchange;
have a less potent diuretic effect than saluretics, but not
cause hypokalemia. As anti-maliuretic agents they can
primarily used in combination with saluretics, while
the diuretic effect is enhanced and the development of hypo
potassium. At the same time, with prolonged independent use
potassium-sparing drugs should consider the possibility of side
phenomena associated with hyperkalemia, especially in patients with renal
insufficiency.
The main representatives of this group of drugs - spironolactone
and triamteren, as well as amiloride - differ in the mechanism of action.
Spironolactone is an aldosterone antagonist, and its therapeutic
activity the higher, the greater the level of aldosterone in liquids
organism.
Triamteren and amiloride are not antagonists of aldosterone,
under the influence of these drugs, cell permeability decreases
membranes of the epithelium of the distal tubules for sodium ions.
As for osmotic diuretics, they increase the osmotic
pressure in the glomeruli and tubules and inhibit reabsorption
water mainly in the proximal tubules.
The most active osmotic diuretics (mannitol, etc.)
used to cause forced diuresis in acute
poisoning (barbituritis, salicylates, etc.), acute renal
failure, as well as acute heart failure in
patients with reduced renal filtration. As dehydration
They are prescribed for brain edema.
Previously used mercury diuretics
due to high toxicity and the introduction into practice of newer
highly effective non-mercury diuretics are excluded from the list
medicines.

Subgroup Diuretic agents include subgroups: