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diuretics:site 1 acting drugs with moa ans sar
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Lecture 2
Site 1: Proximal tubule
Site 1: Proximal tubule
Carbonic anhydrase inhibitors Sulphamoyl containing compounds 2 groups – heterocyclic sulphonamide
derivatives SAR:
Simple heterocyclic sulphonamide: acetazolamide – Sulphamoyl group – required for activity
Sulphamoyl nitrogen – unsubstitutedSubstitution of methyl group on acetazolamide
ring nitrogen - methazolamide
Site 1 Diuretics
Site 1 Diuretics
Developed from sulfanilamide
Moiety to which Sulphamoyl group is attached – aromatic
Derivative with high lipid/water partition coefficient and low pKa – greatest CA inhibitory activity and diuretic activity
m-disulfamoylbenzene compounds: 1,3-disulamoyl benzene lacked diuretic Activity
Substituents – diuretic activityDichlorphenamide – CA inhibition, chlouretic
activity Chloraminophenamide: less CA inhibition, poor
diuretic
Site 1 Diuretics
SAR
Site 1 Diuretics
Mechanism of Action
CA is located both intra-cellularly (type II CA) and in the luminal brush border membrane (type IV CA) of proximal convoluted tubule cells.
Both of these site I locations are major targets of the CA inhibitors.
These diuretics also inhibit intracellular CA in the intercalated cells of the connecting and cortical collecting tubules (i.e. site 4).
Mechanism of Action During the first 4 to 7 days of continuous therapy
with CA inhibitor - an increase in Na+ and HC03-
excretion:(a) Inhibition of intracellular CA in proximal tubule cells - decreases the available H+ normally exchanged for luminal fluid Na‘ - decreased proximal tubule reabsorption of Na (b) Inhibition of CA on the luminal brush border membrane of proximal tubule cells -causes a decrease in the production of carbon dioxide within the luminal fluid and a decrease in the proximal tubule uptake of carbon dioxide.
Mechanism of Action Net result - decrease in the reabsorption of HCO3
-. No massive diuresis on inhibition of the portion of
proximal tubule Na+ reabsorption under the control of CA
Other Na+ reabsorption sites downstream (especially site 2) compensate for action by reabsorbing much of the additional Na+ presented to them.
Some of the luminal fluid is reabsorbed downstream by a non CA mediated system
The actions of the CA inhibitors ultimately result in the urinary loss of only 2 to 5% of the filtered load of Na and up to 30 % of the filtered load of HCO3
-
Mechanism of Action Secondarily, the CA inhibitors enhance the urinary
excretion of a substantial amount of K+
Urinary loss of K+ increases because the proximal tubule actions of CA inhibitorspresent a greater percentage of the filtered load of
Na to site 4,increase the flow rate of luminal fluid through the
distal convoluted tubule and collecting tubule anddecrease the availability of intracellular H+ at site 4
All three changes favor enhanced exchange of luminal fluid Na+ for intracellular K at site 4.
Mechanism of Action The urinary concentration of Cl- decreases
after CA inhibitors administration CA inhibitors are primarily Natriuretic,
bicarbonaturetic, and kaliuretic agents. Resistance to diuretic action
Mechanism of action:
Site 1 Diuretics
Pharmacokinetics:Well absorbed from GIT, distributionLittle biotransformationExcretion: urineAttain high conc. in renal luminal fluid, proximal
tubule cells
Site 1 Diuretics
Adverse effects:Development of metabolic acidosis due to loss
bicarbonateHypokalemia due to renal loss of K+
20% reduction in GFR – due to increase in flow rate of luminal fluid , increase in reabsorption of additional solute
Hypersensitivity reactions: urticaria, drug fever, interstitial nephritis, etc.
Parasthesia (tingling sensation), drowsiness, fatigue, anorexia, GI disturbances, urinary calculi
Site 1 Diuretics
Exacerbate symptoms of cirrhosis of liverDevelopment of hepatic encephalopathy (due to
increased level of ammonia in systemic circulation)
Site 1 Diuretics
Uses:Glaucoma (CA – enzyme in eye)Inhibition of CA – reduce rate of formation of
aqueous humor – reduce intraocular pressure Acute mountain sicknessAdjuvant for epilepsyTo create alkaline urine – to hasten renal
excretion of noxious weak acids, to maintain urinary solubility of poor water soluble endogenous weak acids
Site 1 Diuretics
References
Wilson gisvold Foye