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Diuretics

(See also Caffeine, Theobromine, Theophylline, Euphyllinum, Ammonium
chloride.)
Diuretics, or diuretics, are called substances
causing an increase in urine excretion and a decrease in
fluid content in the tissues and serous cavities of the body.
Previously, diuretics were used mainly in diseases
accompanied by fluid retention in the body, especially when
chronic circulatory failure, nephrotic syndrome,
cirrhosis of the liver. Currently, they are also widely used when
hypertension, glaucoma and other diseases.
The therapeutic effect of diuretics is not always conditioned.
increased diuresis, however, the diuretic effect is their
main pharmacological trait.
Increased urination caused by diuretics is associated with their
specific action on the kidneys, consisting primarily in
slowing down the reabsorption of sodium ions in the renal tubules that
accompanied by a decrease in water reabsorption.
Modern diuretics are mainly divided into 3 groups: c) salure-
tics, b) potassium-sparing and c) osmotic diuretics. To saluretics
include thiazide and thiazide-like drugs (dichlothiazide,
cyclomethiazide, oxodoline, etc.), sulfamoyl anthranilic derivatives
and dichlorophenoxyacetic acids (furosemide, ethacrynic acid and
others), carbonic anhydrase inhibitors (diacarb) (there are also other
diuretic drugs).
Drugs in this group have a different strength and duration.
diuretic effect, which depends mainly on their
physical and chemical properties and effects on different areas of the nephron.
Thiazides (benzothiadiazine derivatives) act primarily
on the cortical segment of the nephron loop and cause increased excretion
sodium and potassium ions. Characteristic side effect of diuretics this
group is hypokalemia, accompanied by weakness, dizziness
pain, headache, nausea, ECG changes.
The duration of the diuretic action is significantly different in
different drugs. So, the effect after a single dose of dichlothiazide
lasts a few hours, and after taking oxodoline - up to 3 days.
Thiazides are widely used in the treatment of chronic heart
failure. 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 hypertensive disease. Their
antihypertensive effect is partly due to the excretion of salts and water
from the body and a decrease in circulating plasma volume. Besides,
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
extraction of sodium ions from them, which leads to a decrease in
swelling and reduced peripheral vascular resistance. Maybe,
that in this case plays a role not an absolute decrease in the content of Na B + in
vascular walls, 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 vasoconstrictor substances (adrenaline
and others) and the depressor response to ganglioblokiruyuschie increases
facilities.
The most powerful saluretics are the so-called loopbacks.
diuretics, which include furosemide, bufenox, ethacrynic
acid. They operate throughout the ascending loop.
nephron (loop of Henle) and sharply inhibit the reabsorption of chlorine ions and
sodium. They also enhance the excretion of potassium ions. Saluretics wide
ko are used in the treatment of chronic heart failure and
hypertensive disease. Due to the strong and fast coming
they began to be prescribed the effect also in the treatment of acute cardiac
failure. However, it is necessary to take into account that they cause
electrolyte shifts can lead to the development of arrhythmias, and copious
diuresis can cause a decrease in cardiac output and arterial
hypotension. In this regard, in acute heart failure,
especially with myocardial infarction, prefer to use peripheral
chesky vazodilatator.
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 diuretic
tic 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 possible to combine thiazides with Ab -blockers (see Anaprilin).
To reduce the side effects associated with hypokalemia,
use the 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 bicarbonates and phosphates. Due to the short and
relatively weak diuretic effect of late
relatively rarely used as an independent diuretic
facilities. Sometimes it is used in combination with other diuretics.
to prevent alkalosis.
Carboanhydrase inhibitors reduce the secretion of aqueous humor
eyes; they are widely used to reduce intraocular pressure at
glaucoma
Sometimes they are prescribed as additional agents in the treatment of
epilepsy, especially small forms.
Potassium-sparing diuretics increase the release of sodium ions and
reduce with the release of potassium ions. They operate in
distal tubules in places where sodium and potassium ions are exchanged;
have a less strong diuretic effect than saluretics, but not
cause hypokalemia. As protivokaliyureticheskie means they can
primarily used in combination with saluretics, while
the diuretic effect is enhanced and the development of hypo-
kalemia. At the same time, with long-term independent use
potassium-sparing drugs should consider the possibility of adverse
phenomena associated with hyperkalemia, especially in patients with renal
insufficiency.
The main representatives of this group of drugs - spironolactone
and triamterene, as well as amiloride - differ in the mechanism of action.
Spironolactone is an aldosterone antagonist, and its therapeutic
the activity is higher, the greater the level of aldosterone in liquids
organism.
Triamterene and amiloride are not aldosterone antagonists,
under the influence of these drugs decreases the permeability of cellular
epithelial membranes of the distal tubules for sodium ions.
As for osmotic diuretics, they increase osmotic
cescal pressure in the glomeruli and tubules and inhibit reabsorption
water mainly in the proximal tubule.
The most active osmotic diuretics (mannitol, etc.)
used to cause forced diuresis in acute
poisonings (barbituurites, salicylates, etc.), acute renal
failure, as well as in acute heart failure in
patients with reduced renal filtration. As a dehydration
Onnyh means they are prescribed for swelling of the brain.
Previously used mercury diuretics
due to high toxicity and the introduction of newer ones
high-performance non-mercury diuretics are excluded from the nomenclature
medicines.