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Pharmacology, Na+ Reabsorbtion, Spare the K+. So, it can be given in…
Pharmacology
Diuretics
Thiazide
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Action: Increased excretion of Na+ and Cl-, decreased urinary Ca2+ excretion, Reduced peripheral vascular resistance (Start with decreased CO. After continued therapy, blood volume return to normal but antihypertension effect remains).
Uses: Hypertension, Heart Failure (along with Loop Diuretics), Hypercalciuria, Diabetes Insipidus.
Adverse Effect: Hypokalemia, Hypomagnesemia, Hyponatremia, Hyperuricemia, Hypovolemia, Hypercalcemia, Hyperglycemia (Due to impaired release of insulin related to hypokalemia)
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Loop Diuretics
Highest efficacy, Strong diuretics bcs the ascending limb accounts for rebsorbtion of 25-30% of filtered NaCl and downstream sides are unable to compensate the increased Na+
Commonly used: furosemide. Bumetanide and torsemide uses is increasing due to better bioavailability and more potent than furosemide
MoA: Inhibit the cotranspor Na+/K+/2Cl- in ascending Loop of Henle -> Reabsorbtion of those ions decrease in medulla.
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Action: Diuresis, Increase urinary Ca2+ excretion (Bcs Ca2+ reabsorbed in the distal convoluted tubule), Venodilation and reduced left ventricular fillinf pressures via enhanced PGE synthesis.
Uses: Edema, Hypercalcemia, Hyperkalemia
Effect: Acute hypovolemia, Hypokalemia, Hypomagnesemia, Ototoxicity, Inducing vertigo
Potassium-Sparing
Aldosterone Antagonist
MoA: prevents translocation of the receptor complex into the nucleus of the target cell -> Lack of intracellular proteins that stimulate Na+/K+ exchange in collecting tubules
Uses: edema associated with secondary hyperaldosteronism, hypokalemia, HF,, resistant hypertension.
Adverse Effects: Hyperkalemia, Gynecomastia
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ACE Inhibitor
MoA: Inhibit converting Angiotensin I to Angiotensin II, Inhibit degradation of bradykinin
Effect:
- Low SNS output
- Vasodilation of vessel
- Na+ and H2O Retention Reduce (bcs decrease in angiotensin II and aldosteron)
- High Level of Bradykinin
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Use: HFrEF, Hypertension
Contraindication: Pregnancy
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Spare the K+. So, it can be given in patient with Hypokalemia
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to decrease heart rate and inhibit release of renin to decrease remodelling, hyperthrophy, and cell death