利尿药和脱水药3

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1、DiureticsandDehydrants利尿药和脱水药Chapter211objective掌握呋塞米、氢氯噻嗪、螺内酯、氨苯蝶啶的药理作用、主要不良反应及药物的相互作用。熟悉利尿药的概念与分类，泌尿生理及药物作用部位,脱水药的概念。甘露醇的作用、应用及不良反应。。了解其它利尿药、脱水药的作用特点。2High-ceilingdiureticsorloopdiureticFursosemide呋塞米,bumetanide布美他尼,Torasemide特拉塞米,etacrynicacid依他尼酸THIAZIDESchl

2、orothiazide氯噻嗪,hydrochlorothiazide氢氯噻嗪,cyclopenthiazide环戊甲噻嗪,bendrofluazide苄氟噻嗪Potassium-sparingdiuretic(保钾类利尿药）Spironolactone螺内酯,triamterene氨苯蝶啶,Amilorine阿米洛利CarbonicanhydraseinhibitorsAcetazolamide乙酰唑胺3§1Diuretics【definition】actingonkidney→excretionofwaterande

3、lectrolyte↑→urinevolume↑Clinicaluseforedemaandunedemadiseases.4肠系膜上神经节交感神经节腹腔神经节主动脉丛肾丛肠系膜下神经节5肾髓质、肾皮质、肾单位6【Renalphysiology】kidneyNephron肾单位肾小球肾小管近曲小管髓袢远曲小管collectingtube集合管glomerularfiltration180L/dfinalurine1.8L/d99%reabsorption7血液流经肾小球滤过而形成原尿。凡能增加肾血流量及有效滤过压的药物

4、当可利尿。如氨茶碱，通过增加心肌收缩性，增加肾血流量及肾小球滤过率而利尿。但其利尿作用很弱。89GlomerularfiltrationCommonlyGFR125ml/min原尿125ml×60×24=180L/d终尿1.8L/d99%reabsorption↑GFR10%原尿198L/d;终尿1.98L/d↓reabsorption1%原尿180L/d;终尿3.6L/d101.proximaltubules(近曲小管)Reabsorptionby:H+-Na+exchangeCO2+H2OCAH++HCO3-Dia

5、mox乙酰唑胺㈠H+-Na+exchange↓Na+reabsorption↓→urine↑lowefficacy112.loopofHenle(髓袢)reabsorptionofNa+≈35%Na+-K+-2Cl-cotransporterfurosemide㈠稀释浓缩12★furosemide㈠髓袢升支粗段皮质部、髓质部Na+-K+-2Cl-cotransporter→NaClreabsorption↓→thedilutionandconcentrationall↓→urinevolume↑;★↑renalPGss

6、ynthesis→bloodstream↑.1.Highefficacydiuretics;2.Na+,K+,Cl-,Ca2+,Mg2+excretionincrease.Notice133.distaltubules(远曲小管)reabsorbsNa+≈10%(filtratedNa+)ByNa+-Cl-cotransporter;impermeabletowater;Ca2+reabsorption(parathyroidhormone甲状旁腺素,PTHregulation)14Thiazides(噻嗪类)acti

7、ngontheinitialpartofdistaltubule(远曲小管近端）InhibitNa+-Cl-cotransporterNaClreabsorptionthedilutefunction↓;Ca2+reabsorption;tubularlumen[Na+]Na+-K+exchangeHypokalemia(低血钾)moderateefficacydiuretics154.CollectingtubereabsorbsNa+2%~5%(filtratedNa+)byNa+-K+exchan

8、geregulatedbyaldosterone（醛固酮）;reabsorptionofwater----urineconcentrationbyADH(vasopressin)regulation.16Triamterene氨苯蝶啶Spironolactone螺内酯㈠Na+-K+exchangeantagonizealdoste