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Diuretics

(See also Caffeine, Theobromine, Theophylline, Euphyllin, Ammonium
chloride.)
Diuretics, or diuretics, are called substances,
Causing an increase in the excretion of urine from the body and a decrease
The content of fluid in the tissues and serous cavities of the body.
Previously, diuretics were used mainly for diseases,
Accompanied by fluid retention in the body, especially when
Chronic circulatory failure, nephrotic syndrome,
Cirrhosis of the liver. At present, they are also widely used
Hypertensive disease, glaucoma and other diseases.
The therapeutic effect of diuretics is not always due to
Increased diuresis, nevertheless, the diuretic effect is their
The main pharmacological sign.
The increase in urination caused by diuretics is due to their
Specific effect on the kidneys, consisting, first of all, in
Inhibition of the reabsorption of sodium ions in the renal tubules, which
Is accompanied by a decrease in water reabsorption.
Modern diuretics are divided mainly into 3 groups: c) salure-
Ticks, b) potassium-sparing and c) osmotic diuretics. To saluretics
Include thiazide and thiazide-like drugs (dichlorothiazide,
Cyclomethiazide, oxodoline, etc.), derivatives of sulfamoylanthranil
And dichlorophenoxyacetic acids (furosemide, ethacrynic acid and
Etc.), inhibitors of carbonic anhydrase (diacarb) (there are other classic-
Fication of diuretics).
Preparations of this group have different strengths and
Diuretic effect, which depends mainly on their
Physicochemical properties and effects on different areas of the nephron.
Thiazides (benzothiadiazine derivatives) act mainly
On the cortical segment of the nephron loop and cause increased excretion
Ions of sodium and potassium. A characteristic side effect of diuretics of this
Group is hypokalemia, accompanied by weakness, dizziness,
Headache, nausea, ECG changes.
The duration of diuretic action is significantly different in
Different preparations. So, the effect after a single dose of dichlorothiazide
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, respectively, venous return of blood to the heart and stress on the
Myocardium, reduce congestion in the lungs.
Thiazides are widely prescribed also in hypertensive disease. Their
The antihypertensive effect is partially associated with the excretion of salts and water
From the body and a decrease in the volume of circulating plasma. Besides,
They have a direct spasmolytic effect on the walls
Vessels. It was found that under the influence of benzothiadiazine derivatives
Metabolic processes in the cell membranes of arterioles, in particular,
Removal of sodium ions from them, which leads to a decrease in the
Swelling and decreased peripheral vascular resistance. Maybe,
That in this case the absolute decrease in the Na B + content in
Walls of blood vessels, and the 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 vasoconstrictive substances decrease (epinephrine
And others) and the depressor reaction to ganglion blocking
facilities.
The most powerful saluretics are the so-called loop
Diuretics, which include furosemide, bufenox, etacrine
acid. They operate all over the ascending loop section
Nephron (Henle loops) and sharply inhibit the reabsorption of chloride ions and
Sodium. They also enhance the release of potassium ions. Saluretics are wide-
Are used in the treatment of chronic heart failure and
Hypertensive disease. In connection with the strong and rapidly advancing
Their effect was also prescribed in the treatment of acute cardiac
Insufficiency. However, it must be borne in mind that the
Electrolyte shifts can lead to the development of arrhythmias, and abundant
Diuresis can cause a decrease in cardiac output and arterial
Hypotension. In this regard, with acute heart failure,
Especially with myocardial infarction, prefer to use peripheral
Vasodilators.
When using thiazides for the treatment of essential hypertension
It should be borne in mind that they stimulate the renin-angiotensin system
And aldosterone production, leading to a gradual weakening of diuret-
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 worth combining thiazides with Ab-adrenoblockers (see Anaprilin).
To reduce the side effects associated with hypokalemia,
Combined preparations containing thiazide and
Potassium-sparing diuretics (see Triamteren, Amilorid).
The main representative of diuretics - inhibitors of carbonic anhydrase
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. In connection with a short and
Relatively weak diuretic effect in recent years
Relatively rarely used as an independent diuretic
facilities. Sometimes it is used in combination with other diuretics
To prevent alkalosis.
Inhibitors of carbonic anhydrase reduce the secretion of watery moisture
eyes; They are widely used to reduce intraocular pressure
Glaucoma.
Sometimes they are prescribed as additional agents in the treatment
Epilepsy, especially small forms.
Potassium-sparing diuretics increase the release of sodium ions and
Decrease at the same time the release of potassium ions. They operate in the field of
Distal tubules in places where sodium and potassium ions are exchanged;
Have a less strong diuretic effect than saluretics, but not
Cause hypokalemia. As anticatalytic drugs can they
Primarily used in combination with saluretics, while
The diuretic effect increases and the development of hypo-
Of potassium. At the same time with prolonged independent use
Potassium-saving drugs should take into account the possibility of
Phenomena associated with hyperkalemia, especially in patients with renal
Insufficiency.
The main representatives of this group of drugs are spironolactone
And triamterene, as well as amiloride - differ in the mechanism of action.
Spironolactone is an aldosterone antagonist, and its therapeutic
The higher the activity, the more the level of aldosterone in liquids
Organism.
Triamterene and amiloride are not antagonists of aldosterone,
Under the influence of these drugs, the permeability of cellular
Shells of the epithelium of distal tubules for sodium ions.
As for osmotic diuretics, they increase osmolality,
Pressure in the glomeruli and tubules and prevent reabsorption
Water mainly in the proximal tubules.
The most active osmotic diuretics (mannitol, etc.)
Used to cause forced diuresis in acute
Poisonings (barbiturates, salicylates, etc.), acute renal
Deficiency, as well as in acute heart failure in
Patients with reduced renal filtration. As dehydration-
They are prescribed for edema of the brain.
Previously used mercury diuretics, Kmercuzal, promeran in
Of high toxicity and the introduction of newer
Highly effective non-nutritional diuretics are excluded from the nomenclature
Medicines.

The subgroup of diuretics includes subgroups: