Professional Documents
Culture Documents
Basic Principles
Pharmacodynamic properties
characteristics that describe its biologic
effects
Greater interest clinically
Diuretics
Thiazide Diuretics
Thiazide Diuretics
Thiazide Diuretics
Mechanism of Action
Early renal (salt/water excretion) effects act
by inhibiting the Na/Cl reabsorption pump in
the DCT
wherever Na goes, water follows
Thiazide Diuretics
Thiazide Diuretics
Mechanism of Action
Chronic vascular effects (several months)
Chronically, ECF and CO return toward baseline,
while systemic vascular resistance decreases
In the subacute phase, CO and SVR coexist but in
a transition state
The cellular mechanism is still unknown
Thiazide Diuretics
Loop Diuretics
Loop Diuretics
Loop Diuretics
Loop Diuretics
Loop Diuretics
Mechanism of Action
Normal GFR
Variety of mechanisms blunts the ability to
persistently reduce ECF volume or BP
The initial diuresis is typically followed by longer
period of Na retention (neutral or positive balance)
Loop Diuretics
Mechanism of Action
Renal dysfunction
Loop diuretics effectively reduce ECF volume and
BP
The renal and antinatriuretic mechanisms are
blunted
AE: hypokalemia
Aldosterone Blockers
Aldosterone Blockers
Aldosterone Blockers
Aldosterone Blockers
Aldosterone Blockers
Aldosterone Blockers
Other Diuretics
Other Diuretics
Osmotic Diuretics
Prototype is mannitol (nonreabsorbable
solute)
Major effect is in the proximal tubule and
descending limb of Loop of Henle
Prevents normal absorption of water by
interposing a countervailing osmotic force
Beta Blockers
Beta Blockers
Mechanism of Action
Reduction of HR and CO
CNS effect
Inhibition of renin release
Reduction in venous return and plasma volume
Reduction in peripheral vascular resistance
Reduction in vasomotor tone
Improvement in vascular compliance
Resetting of baroreceptor levels
Effects on prejunctional B receptors, reduction in
Norepi release
Attenuation of pressor response to catecholamines
with exercise and stress
Beta Blockers
RAAS
Beta Blockers
Beta Blockers
Beta Blockers
Alpha blockers
vasodilation
Alpha blockers
Alpha blockers
Alpha Blockers
RAAS Blockers
ACE Inhibitors
ACE Inhibitors
ACE Inhibitors
ACE Inhibitors
Benzothiazepines Diltiazem
1,4 dihydropyridines rest
most common use for headaches
Endothelin antagonists
Anti-Hypertensive Drugs