REGUB16: Diuretics

Class of
Diuretics
Carbonic
Anhydrase
Inhibitors

Loop Diuretics
#MOSTPOWER
FUL

Example(s)

Acetozolamide

Frusemide
Bumetanide
Ethacrynic acid

Mechanism of Action

Inhibits Carbonic Anhydrase,

which is an enzyme that
catalyzes:
CO2 + H2O H+ + HCO3Inhibition of Carbonic Anhydrase
therefore decreases the ability of
PCT to secrete H+ in exchange
for Na+, thus water wont leave,
resulting in mild diuresis. Mild
because Loop of Henle still
reabsorbed large amounts of
Na+.
-

Inhibit Na+/K+/2Cl- carrier,

which decreses reabsorption
of those ions.
Induce expression of COX-2
and increase Prostaglandins.
Increase renal blood flow.

Place of
Action in
Nephron
PCT epithelial
cells (both
luminal and
intracellular)

Therapeutic (Clinical)
use

Luminal
membrane of
ascending
limb of loop
of Henle.

Chronic open-angle
glaucoma.
Prophylaxis of acute
mountain sickness.

Acute pulmonary
Oedema.
Heart failure.
Liver failure.
Acute
hypercalcaemia.
Hyperkalaemia.
Reducing intracranial
pressure.
Acute renal failure.
Anion overdose.

Adverse Side
Effects
(None mentioned)

Hypokalaemic
metabolic
acidosis.
Hyponatraemia.
Hypomagnesem
ia.
Hypovolaemia.
Hyperuricaemia.
Renal failure.
Ototoxicity.
Allergic
reactions.

Thiazide
Diuretics and
Related Agents
#MOSTWIDELY
USED

PotassiumSparing
Diuretics

Bendroflumethiaz
ide.
Hydrochlorthiazid
e.
Chlorthalidone.
Indapamide.

Spironolactone
Eplerenone

Amiloride
Triamterene

Decrease reabsorption of
Na+ by binding to the Cl- site
of Na+/Cl- cotransporter,
inhibiting its action and
results in an increase of Na+
and Cl- concentration in
tubular fluid.
- 3 phases of action:
1) Acute: 1) Increased
excretion of Na+ and Cl-.
2) Loss of K+. 3)
Decreased urinary
Calcium excretion.
2) Sub-acute: Renal and
vascular effects.
3) Chronic: vascular
(peripheral vasodilation).
Prevent K+ secretion by directly
blocking mineralocorticoid
receptors. (Spironolactone and
Eplerenone)

Luminal
membrane of
DCT.

Collecting
ducts.

Indirect inhibition of Na+ influx

through ion channels.

Osmotic
Diuretics

Mannitol
Urea

Modifying the content of the

filtrate by increasing the
osmolarity. To maintain

(N/A)

Hypertension.
Mild/moderate
congestive heart
failure.
Prevention of
recurrent kidney
stone formation in
idiopathic
hypercalciuria.
Nephrogenic
diabetes insipidus.

Hypertension.
Primary/secondary
hyperaldosteronism.
(spironolactone)
Heart failure.
(spironolactone and
Eplerenone)
Albuminuria in
diabetics.
(Eplerenone).
Post myocardial
infarction.
(Eplerenone).
Reducing intracranial
pressure.
Acute renal failure.

Hyponatraemia.
Hypokalaemia.
Hyperuricaemia.
Hypercalcaemia
.
Impaired
glucose
tolerance.
Hyperlipidaemia
.
Allergic
reactions.

Hyperkalaemia
Hypercholeraem
ic metabolic
acidosis.

Spironolactone:
- Gynaecomastia.
- Impotence.
- Menstrual
irregularities.
- Kidney stones.

(None mentioned)

osmolarity, water is retained in

urine.

Galucoma.
Toxicity.
ECF expansion.
Dehydration.