0 évaluation0% ont trouvé ce document utile (0 vote)
81 vues12 pages
Potassium-sparing diuretics such as amiloride, spironolactone, and triamterene reduce sodium reabsorption and potassium secretion in the kidneys. They are not very potent as diuretics on their own but are primarily used in combination with other diuretics to treat conditions like hypertension, congestive heart failure, and edema. These drugs work by interfering with sodium-potassium exchange in the kidneys and competitively binding to aldosterone receptors. They are generally well absorbed, metabolized in the liver, and excreted in urine but require cautious use during pregnancy and lactation due to potential adverse effects.
Potassium-sparing diuretics such as amiloride, spironolactone, and triamterene reduce sodium reabsorption and potassium secretion in the kidneys. They are not very potent as diuretics on their own but are primarily used in combination with other diuretics to treat conditions like hypertension, congestive heart failure, and edema. These drugs work by interfering with sodium-potassium exchange in the kidneys and competitively binding to aldosterone receptors. They are generally well absorbed, metabolized in the liver, and excreted in urine but require cautious use during pregnancy and lactation due to potential adverse effects.
Potassium-sparing diuretics such as amiloride, spironolactone, and triamterene reduce sodium reabsorption and potassium secretion in the kidneys. They are not very potent as diuretics on their own but are primarily used in combination with other diuretics to treat conditions like hypertension, congestive heart failure, and edema. These drugs work by interfering with sodium-potassium exchange in the kidneys and competitively binding to aldosterone receptors. They are generally well absorbed, metabolized in the liver, and excreted in urine but require cautious use during pregnancy and lactation due to potential adverse effects.
They are primarily used in combination with other diuretics.
Amiloride (Midamor)
Spironolactone (Aldactone)
Triamterene (Dyrenium) Interfere with sodium-potassium exchange in collecting ducts and convoluted tubules
Competitively bind to aldosterone receptors Block the reabsorption of sodium and water
Prevent potassium from being pumped into the tubule, thus preventing its secretion
Sodium and water are excreted
These drugs are generally used in combination with a thiazide or loop diuretic to treat hypertension CHF refractory edema
They are also used to induce diuresis in clinical situations associated with hyperaldosteronism:
adrenal hyperplasia in the presence of aldosterone-producing adenomas when surgery is not feasible.
these drugs are well absorbed protein bound, and widely distributed
they are metabolized in the liver and primarily excreted in urine
these diuretics cross the placenta and enter breast milk * routine use during pregnancy is not appropriate, and they should be saved for situations in which the mother has pathological reasons for use, not pregnancy manifestations or complications , and the benefit to the mother clearly outweighs the risk to the fetus. * If one of these drugs is needed during lactation, another method of feeding the baby should be used, because of the potential for adverse effects on fluid and electrolyte changes in the baby. these drugs are contraindicated for use in patients with allergy to the drug,hyperkalemia, renal disease , or anuria. are given cautiously during pregnancy and lactation. These agents can cause hyperkalemia, hyperchloremic metabolic acidosis, and arrhythmias.
Spironolactone is associated with gynecomastia and can also cause menstrual abnormalities in women.
These drugs are contraindicated in renal insufficiency, especially in diabetic patients.
They are contraindicated in the presence of other potassium-sparing diuretics and should be used with extreme caution in individuals taking an angiotensin-converting enzyme (ACE) inhibitor.
Spironolactone Act as antagonists to aldosterone, competes with aldosterone for receptor sites in DCT
Results in decreased Na + reabsorption in DCT
Promotes Na + and water loss
Decreased Na + reabsorption balanced by K + retention at this site (and H + ).
Used in combination with diuretic e.g.. frusomide Triamterene and Amiloride
Similar effect to spironolactone by reducing Na +
absorption and H + /K + secretion in DCT Independent of aldosterone Have little diuretic effect Used in conjunction with diuretics In low doses blocks entry of Na+ into tubule cells across luminal membrane Decrease availability of Na + to Na + -K + -ATPase at basal cell membrane Called Na + channel blockers
Drug Name Usual Dosage Usual Indications amiloride (Midamor) 15 -20 mg/d PO with monitoring of electrolytes All of the potassium sparing diuretics are indicated for the adjunctive treatment of edema caused by congestive heart failure, liver disease, or renal disease; hypertension; hyperkalemia; and hyperaldosteronism; Special considerations: Not for use in children Spironolactone (Aldactone) 100 200 mg/d PO for edema; 100 400 mg/d PO for hyperaldosteronism; 50 100 mg/d PO for hypertension Pediatric: 3.3 mg/kg per day PO Special considerations: Can be used in children with careful monitoring of electrolytes Triamterene (Dyrenium) 100 mg/D PO b.i.d Special considerations: Not for use in children