‫رؤساء اللجنة العلمية دفعة ‪:37B‬‬

‫ريم عبداجمليد اليوسفي(رئيسة)‬ ‫حممد عبدالرمحن القرع (رئيسا)‬

‫صفاء ابراهيم حلمي(نائبة)‬ ‫عمار امحد احلنظاني (نائبا)‬
‫رؤساء دائرة الفارما ‪:‬‬
‫نهله جنيب اخلوالني (رئيسة الدائرة)‬ ‫صهيب نبيل (رئيس الدائرة)‬
 ‫الفهرس‬

‫‪Autonomic nervous system‬‬

‫‪Autocoid‬‬
‫‪Diuretics‬‬
‫‪CVS‬‬
‫‪Respiration‬‬
‫‪GIT‬‬
‫‪Blood‬‬

‫رسالة شكر‬

‫اليك‪.....‬‬

‫يا من نقش فينا العلم‬

‫يوما ما يف املستقبل القريب؛‬

‫عندما نتذكر كل ما صنعت ألجلنا كي نصل اىل الذي وصلنا اليه يف يومنا ذاك فأن لساننا يقف عاجزا‬

‫على قول أي شيء‪ ،‬فعبارات الشكر قليلة‪ ،‬و كلمات الثناء ال تستطيع ان تفيك حقك‪ ،‬سقيتنا من حبر‬

‫علمك‪ ،‬و اغثتنا بغيث اخلربة الوافرة كنت نعم املعطي وكنا نعم الغارف و املتلقي فشكرا لك عنان‬

‫الشكر و العطاء؛‬

‫كل الشكر واالمتنان اليك دكتورنا وأستاذنا؛‬

‫الدكتور البروف ‪/‬عدنان األدهل‬

‫من ال يشكر الناس ال يشكر اهلل‪ ،‬وأنتم مجيعا تستحقون الشكر والثناء احرتقتم يف الظالم لتنريوا لنا الطريق‪ ،‬كنتم يف سباق‬

‫مع الوقت سكنتم على رفوف مالزم ومراجع الفارما فلوالكم بعد اهلل مل تكن دائرتنا لتصل اىل أفضل املراتب ولوال جهودكم‬

‫ملا كان للنجاح أي وصول وملا حتققت األهداف‪ ،‬فأنتم أساس رفعة الدائرة‪ ،‬وأساس تقدمها‪ ،‬وأنتم من حيمل شعلة النجاح‬

‫والتطور‪ ،‬فشكرا لكم واىل االمام دائما‪.‬‬

‫• أسماء األعضاء‪:‬‬
‫✓ صهيب نبيل مقبل‬
‫✓ عاصم محمد الصالحي‬
‫✓ عبد اللطيف حيدر الحمراء‬
‫✓ عبد الكريم احمد الظاهري‬
‫✓ امل محمد الشجري‬
‫✓ اية محمد الشاوش‬
‫✓ خولة يحيى خليفة‬
‫✓ رنا عبد الغني الصلوي‬
‫• أعضاء الطباعة‪:‬‬ ‫✓ ريم عبد المجيد اليوسفي‬
‫✓ سميه محمد المريسي‬
‫✓ احمد محمد النهمي‬ ‫✓ شذى عبد هللا بصيبص‬
‫✓ عبير شائف الخديري‬
‫✓ أسامة محمد الطويل‬ ‫✓ عبير عادل راوح‬
‫✓ الرا صادق الحشيبري‬
‫✓ حمزة يحيى الوشلي‬ ‫✓ مرام خالد السالمي‬
‫✓ محمد عبد الرحمن القرع‬
‫✓ نهله نجيب الخوالني‬

‫‪ ‬النقص فينا باقي‪،‬و الكمال بالمشاركة و التعاون؛‬

‫في حال وجود أي خطأ او تعديل ‪،‬يرجى ارساله الى بوت اللجنة العلمية‪:‬‬

‫‪@ScientificGroup37Bbot‬‬
 Chapter: Diuretics

 Thiazide diuretics.

 Loop diuretics.

 k+ sparring diuretics.

 Osmatic diuretics.

 Carbonic anhydrase inhibitor (CAI).

 Pharmacology Ph.Dr: Adnan AL-
Group 37_B Diuretics adhal

❖ Diuretics: - they are drugs which decrease the blood volume and increase urine
volume (increase urine excretion).
 the mechanism of action(diuretics) is based upon decreasing blood volume leads to
decrease blood pressure.
 low dose diuretic therapy is safe, inexpensive, effective in preventing stroke and MI.

Classification of diuretics: -
1. Thiazide diuretics.
2. Loop diuretics.
3. k+ sparring diuretics.
4. Osmatic diuretics.
5. Carbonic anhydrase inhibitor (CAI).

1. Thiazide diuretics: -
a) Are the most widely used and may lead to diuretic.
▪ These drugs increase the urine execration to 3-4 liters
b) Are called " low ceiling diuretic" because of increasing the dose above
normal therapeutic doses don't promote farther diuretic response.
- Thiazide group: ((chlorothiazide-hydrochlorothiazide (‫)قديم لم يعد يستخدم بكثرة‬-
hydro "Bendro" flumethiazide))
- Thiazide like group: (chlorthalidone-Indapamide-Metolazone) "new
drugs"
c) Act on early part of distal convoluted tubule.
➢ Mechanism of action (MOA): -
1) Inhibit reabsorption of Na, K, Cl, Mg, H2o.
2) Increase Na and water excretion decrease extracellular
volume decrease blood pressure.
3) Decrease urinary excretion of calcium.
4) Decrease peripheral resistance by unknow mechanism.
➢ Therapeutic uses: -
1. Chronic hypertension (main use)-the 1st drugs of choice for hypertension,
because its effect is moderate or mild.
2. Mild or moderate heart failure.
3. Edema
4. Diabetes insipidus (nephrogenic type)
5. In autosomal dominant hypocalcemia.
6. Idiopathic-calciuria.
7. Hyperkalemia.

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Pharmacology Ph.Dr: Adnan AL-
Group 37_B Diuretics adhal

➢ Side effect (S.E): -

1. Hypokalemia.
2. Hypotension.
3. Hyponatremia.
4. Hyperglycemia.
5. Hypercalcemia.
6. Hyperuricemia.
7. Hyperlipidemia.
 Contraindication: -
1. Diabetes with hypertension, because it causes hyperglycemia due to both
decrease in:
 Pancreatic release of insulin decrease K
 Tissue utilization of glucose.
2. Gout

2. loop diuretics: -

1) (Bumetanide, furosemide (Lasix), torsemide and ethacrynic acid).

2) Most uses furosemide.
3) The strongest diuretics especially Bumetanide.
4) Act on loop of Henle (thick ascending limb).
▪ These drugs increase the urine excretion to 6-7 liters and may reach to 8 liters

 MOA: -
-Inhibit reabsorption of Na, K, Cl, Mg, Ca, H2o.

 Therapeutic uses: -
1. Acute pulmonary edema (or edema of any causes-main use):
it's a medical emergency characterized by hypoxia caused by accumulation
of fluid in the lungs where the gases exchange takes place (alveoli)...
➢ This case might be orthopnea
➢ Furosemide and other loop diuretics are the 1st drug of choice in
cases of acute pulmonary edema.
➢ Pulmonary edema caused by left side heart failure or renal impair
lead to excretion overload fluids from lung.
2. Sever hypertension:
Just one single dose due to these drugs cause high electrolyte excretion.
3. Ascites:
a) Accumulation of fluid in the peritoneal cavity
b) Ascites is a complication of portal hypertension.

4. Hyperkalemia.
5. Hypercalcemia:
Because they increase Ca+ in urine.

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Pharmacology Ph.Dr: Adnan AL-
Group 37_B Diuretics adhal

 S.E:
1. Hypokalemia:
K depletion due to heavy load Na presented to the collecting tubule results
in increase exchange of tubular Na for K, leading to the possibility of
hypokalemia.

2. Hypocalcemia:
Doesn't use in case of osteoporosis.

3. Decrease of hearing capacity(ototoxicity):

Permanent hearing loss may occur with loop diuretic, particularly when
used in conjunction with other ototoxic drugs e.g., aminoglycoside
antibiotic

4. Hypotension.
5. Dehydration.
6. Metabolic alkalosis.
7. Hyponatremia, hypomagnesemia.
8. Acute hypovolemia.
9. Hyperuricemia:
Because the loop of diuretic competes with uric acid for renal secretion,
thus blocking its secretion increase uric acid Gout.

Note:
 Furosemide is contraindicated with gentamicin(antibiotics)because may
lead to sever toxicity losing of hearing.
 Loop diuretics don't use to chronic hypertension due to high electrolyte
excretion.
 Loop diuretics cause hypocalcemia.
 Thiazide cause hypercalcemia.
❖ Brather's syndrome (as if patient take loop diuretic)
❖ The defect in thick ascending limb of loop of Henel there are
increase in urine output and hypokalemia.

❖ Gitaman's syndrome (as if patient take thiazide diuretic)

❖ The defect in early part of DCT there is increase in urine output
and hypokalemia.
The treatment of both is K sparing diuretic & Spironolactone

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Pharmacology Ph.Dr: Adnan AL-
Group 37_B Diuretics adhal

3. Potassium sparing diuretics:

❖ Aldosterone antagonist: ❖ Non aldosterone antagonist:

 Spironolactone – eplerenone  Triamterene
1) Spironolactone:  Amiloride
More effective
2) Eplerenone:
It's better because it has fewer side effect, but is less effect.
3) Act on late part of distal convoluted tubule.

 MOA: -
a) Is aldosterone receptor antagonist
b) It gets rid of water and sodium but keep K.
c) Spironolactone: is direct antagonist of aldosterone.
d) Eplerenone: competitive antagonist of aldosterone of mineralocorticoid
receptor prevents aldosterone binding.

 Clinical uses: -
1. Edema (usually lower limb edema)
2. Chronic heart failure (spironolactone is the common) prevent remodeling
that occurs as compensation for the progressive failure of the heart.
3. Hypertension.
4. Conn's syndrome.
5. Liver disease.
6. Ascites common complication of hepatic cirrhosis.
7. Secondary hyperaldosteronism.
8. As diuretic spironolactone is the drugs of choice in patient with
cirrhosis.

 S.E:
1. Hyperkalemia.
2. block testosterone and estrogen lead to:(hormonal disturbance)
 In male gynecomastia
 In female menstrual disturbance and hirsutism
3. metabolic acidosis due to H retention.

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Pharmacology Ph.Dr: Adnan AL-
Group 37_B Diuretics adhal

 Non-aldosterone drugs of K-sparring diuretics:

(Triamterene &Amiloride)
- Block Na transport channels in Na/K exchange
- Are commonly used in combination with other diuretics.

➢ Liddle's syndrome "hereditary disease cases"

1) Hypokalemia
2) Hypertension
➢ The drugs we used in this case are K sparing but not spironolactone they are
called:
a. Triamterene
b. Amiloride

38
Pharmacology Ph.Dr: Adnan AL-
Group 37_B Diuretics adhal

4. Osmatic diuretics:

 MOA: increase osmatic pressure of tubular fluid which lead to decrease in water
reabsorption.
- (Mannitol) give I.V
‫بعدها يكون‬glomerulus nephron ‫يوصل بعدها الى‬ GIT ‫ألنه ال يمتص في‬oral ‫ وال يعطى‬I.V ‫يعطي‬-
.zero ‫تكون‬tubular reabsorption ‫وايضا‬100% ‫ بنسبه‬filtration ‫يعني يحصل له‬Freely fitter

 Clinical used:
1. IOP "intra ocular pressure"
2. ICP "intra cranial pressure"
3. Sweetener
4. Cerebral edema
5. Osmatic laxative
6. Acute renal failure
 S.E:
1. Hyponatremia and hypernatremia (according to dose)
2. Hypothyroidism (rare)
3. congestive heart failure
4. Pulmonary edema

39
Pharmacology Ph.Dr: Adnan AL-
Group 37_B Diuretics adhal

5. Carbonic anhydrase inhibitor (CAI)

 Site of MOA: mainly in proximal convoluted tubule
HCo3 ‫بشكل عام عمليه االساسية انه يكون البيكربونات‬
Excretion to blood that’s
▪ H2o + Co2 CA
H2Co3 HCo3 lead to metabolic alkalosis
H In PCT exchange Na that
followed by passive reabsorption
of water

diuretic ‫ وعند ايقاف هذه االنزيم توقف العملية‬،‫ ويتبعه ماء وهذه اليه االمتصاص‬،Na ‫ مع‬H ‫يتبادل الـ‬
▪ E.g.:
1. Acetazolamide (oral)
2. Dorzolamide (eye drop)
▪ Used in:
1. Glaucoma
2. Acute mountain sickness (‫)مرض االرتفاعات‬
‫ وذلك الن عند االرتفاع‬،‫يعني الشخص عندما يصعد الى االرتفاع حاد او عالي جدا يحصل له دوخه وصداع‬
‫تضغط على الخاليا العصبية‬edema ‫وهذي‬Cerebral edema ‫ يحصل له‬O2‫ ولما يقل الـ‬،‫ يقل‬O2 ‫الـ‬
.CAI ‫وبهذه الحالة يمكن ان نعطي الشخص‬
3. Urinary alkalization: We want to make the medium alkaline,
so I give him an acid treatment e.g.:
a) Aspirin
b) Diclofenac
4. Resistance causes for epilepsy (‫)الذي ال يستجيب ألي عالج اخر‬
▪ S.E:
1) Hypokalemia
2) Stone and infection
3) Metabolic acidosis:
It's treated with sodium bicarbonate and its danger is that it causes
cardiac arrhythmia.

40
Pharmacology Ph.Dr: Adnan AL-
Group 37_B Diuretics adhal

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