It is a presentation exploring basics about the diuretics and their working mechanism in the body.

1. TEERTHANKER MAHAVEER COLLEGE OF PHARMACY
TMU, MORADABAD
DIURETICS
A
PRESENTATION
FOR PARTIAL
FULLFILMENT OF
MASTER OF PHARMACY
COURSE CODE :- MPL106
(PHARMACOLOGY)
PRESENTED BY:-
MOHIT PANDEY
M.PHARM 1 SEM
(PHARMACOLOGY)
PRESENTED TO:-
DR. K.K. SHARMA
PROFESSOR
PHARMACOLOGY

2. INTRODUCTION
Diuretics are substances that slow renal reabsorption of water and thereby
cause diuresis (an elevated urine flow rate), which in turn reduces blood
volume.
The kidney regulates the ionic composition and volume of urine by active
reabsorption or secretion of ions and/or passive reabsorption of water.
Diuretics are drugs that increase the volume of urine excreted.
NATRIURETICS – which increase the loss of sodium in urine.

3. FIG:- GENERAL DIAGRAM OF KIDNEY CONSISTING OF NEPHRONS

4. FUNCTION OF KIDNEY
• Functional Unit :- NEPHRON
• 1.2 MILLION NEPHRON IN ONE KIDNEY
Maintain the balance of Na+ , K+, Cl- , urea , uric acid ,bicarbonate and ammonia
in the body.
Also regulate the balance between blood–body fluid.
Glomerular Filtration Rate – 120ML/MINUTE
NORMAL URINE OUTPUT = 1.5L/DAY
Urine Output – 400-500ml/day = OLIGUREA
Urine output - 3500ml/day = POLYUREA

5. CLASSIFICATION OF DIURETICS

7. HIGH CEILING / LOOP DIURETICS
• Loop diuretics include furosemide, torsemide,
azosemide, and bumetanide
• SITE OF ACTION - thick ascending limb of the
loop of Henle.
• Where 20% -30% of filtered NaCl is reabsorbed.
• Loop diuretics acts by bind to the Na-K-2Cl
cotransport protein and inhibit its action, impairing
reabsorption of Na+
, K+, and Cl- . Leads to
hypochloremia in blood.

8. THIAZIDE DIURETICS (MEDIUM EFFICACY)
• Thiazide diuretics are Chlorothiazide,
chlorthalidone.
• SITE OF ACTION - The thiazide diuretics
act mainly in the distal convoluted tubule to
decrease the reabsorption of Na+ by inhibition
of a Na+ /Cl- cotransporter. As a result, these
drugs increase the concentration of Na+ and
Cl− in the tubular fluid.
• Therapeutic use- hypertension , C.H.F.
• Hypercalciuria- to prevent renal stone.
• A/E- electrolyte imbalance, hypotension (due
to depletion of volume)

9. CARBONIC ANHYDRASE INHIBITOR
• Acetazolamide Act by suppressing the activity
of carbonic anhydrase enzyme.
• SITE OF ACTION- PROXIMAL
CONVOLUTED TUBULE.
• THERAPEUTIC USE- used to treat glaucoma
(Lowering of intraocular tension due to decreased
formation of aqueous humour (aqueous is rich
in HCO3 ¯ )
• Carbonic anhydrase catalyzes this reaction:-
CO2 + H2O ⇋ HCO3
– + H+
• Physiological of carbonic anhydrase enzyme:-
1) The acid–base homeostasis balance (by
secreting and excreting protons)
2) The bicarbonate reabsorption process.

10. Potassium-Sparing Diuretics
• Potassium sparing diuretics primarily acts on late distal convoluted tube and
collecting duct of the nephron.
• They act by following mechanism:-
1. By antagonizing aldosterone action-Aldosterone enhances activity of
sodium–potassium pumps results in increase secretion of K+ and
reabsorption of Na+; increases reabsorption of water, which increases blood
volume and blood pressure.
E.g. Spironolactone, Eplerenone.
2. By inhibit Na+ channel responsible for Na+ reabsorption and K+ excretion.
E.g. Amiloride, triamterene.

11. ALDOSTERONE ANTAGONIST
• ALDOSTERONE acts by combining with an intracellular mineralocorticoid receptor (MR) which
induces the formation of ‘aldosterone-induced proteins’ (AIPs).
• The AIPs promote Na+ reabsorption and K+ secretion.
• Aldosterone antagonist combines with MR and inhibits the formation of AIPs in a competitive manner.
• E.g. SPIRONOLACTONE
Na+ channel inhibitor
• Na+ channel inhibitor block the luminal Na+ channels and indirectly inhibit K+ excretion,
while the net excess loss of Na+ is minor, because this is only a small fraction of the total
amount of Na+ excreted in urine.

12. OSMOTIC DIURETICS
• E.g. - Mannitol ,a nonelectrolyte of low molecular weight.
• Pharmacologically inert , can be given to raise osmolarity of plasma and
tubular fluid. Freely filtered at the glomerulus and undergoes limited
reabsorption.
• SITE OF ACTION – PCT AND LOOP OF HENLE.
• Mannitol limit tubular water and electrolyte reabsorption.
• It acts to Expands extracellular fluid volume (because it does not enter cells,
mannitol draws water from the intracellular compartment).

13. REFERENCES
• Tripathi KD. Essentials of medical pharmacology. JP Medical Ltd;
2013 Sep 30.
• Whalen K. Lippincott® illustrated reviews: pharmacology. Wolters
kluwer India Pvt Ltd; 2018 Oct 25.
• Tortora GJ, Derrickson BH. Principles of anatomy and physiology.
John Wiley & Sons; 2018 May 15.
• Bell R, Mandalia R. Diuretics and the kidney. BJA education. 2022
Jun 1;22(6):216-23.
• Roush GC, Kaur R, Ernst ME. Diuretics: a review and update.
Journal of cardiovascular pharmacology and therapeutics. 2014
Jan;19(1):5-13.