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DASAR PENGGUNAAN :

PENINGKATAN TEKANAN INTRA OKULER / GLAUKOMA

HIPOPROTEINEMIA HEART FAILLUR TRAUMATIC RENAL FAILLUR TOXIN EXCRETION DRUG OVER DOSE HYPERTENSI OEDEMA PULMONUM CALCIURIA

Diuretic Class(site and mechanism of action)

Osmotic DiureticsFreely filterable, non-reabsorbable osmotic agents like mannitol, glycerol, and urea act primarily on the proximal tubule to reduce the reabsorption of H2O and

solutes including NaCl.

Loop DiureticsFurosemide, Bumetanide, Torsemide, and Ethacrynic Acid inhibit the Na+/ K+/ 2Cl- cotransport system in the thick ascending limb of Henle's loop (ALH).

Thiazide Chlorothiazide, hydrochlorothiazide, etc. inhibit NaCl cotransport in early distal convoluted tubule (DCT).

K+-Sparing Diuretics Spironolactone competitively blocks the actions of aldosterone on the cortical collecting ducts (CCDs)Amiloride and Triamterene inhibit the Na+/K+ pump by reducing Na+ entry across the luminal membrane of the CCDs.

. Carbonic Anhydrase Inhibitors Acetazolamide, Methazolamide, and Dichlorphenamide inhibit CA in luminal membrane of proximal tubule, reducing proximal HCO3-reabsorption

Mechanism of action:

Inhibits Na+ & Cl- reabsorption in the loop of Henle & proximal & distal tubules of nephron:

*markedly increases excretion of Cl-, Na+, & water *also increases excretion of K+, Mg++, Ca++, ammonium, H+,

bicarbonate, & phosphate

Side Effects/Adverse Effects: Dose-related

hypokalemia, dehydration,

postural hypotension, hypochloremic alkalosis,

azotemia

Mechanism of action:

Interferes with reabsorption of Na+ & Cl- in the distal convoluted tubule of the nephron, thus:

*increases Na+ excretion, causing increased urine output *also increases excretion of K+, Mg++, Ca++, ammonium, H+,

bicarbonate, & phosphate *decreases calcium & uric acid excretion

Side Effects:

Frequent - hypokalemia, dizziness, muscle weakness, dry mouth, thirst,

Interactions: the same as Lasix, due to effects on lytes