Diuretics

Introduction:

Diuretics are the drugs that cause the increased outflow of urine.

General action of diuretics:
Many types of diuretics
1. Decrease that amount of fluid which is reabsorbed by the renal tubules, from where the fluid returns to the blood
2. Increase glomerular filtration

General uses of diuretics:
They are used to remove excess water from the body which may contain some salts, toxins and other accumulated waste products such as urea.

They have the ability of getting rid of excess fluid from the body which may cause edema, which contains an abnormal accumulation of fluid from serum resulting in some of the disease.

Aprotinin

It is inhibitor of proteolytic enzymes.


It causes blockage of plasmin resulting in stoppage of bleeding.

It can cause inhibition of streptokinase.

It is used prophylactically for reducing blood loss around the time of operation. It is also used for hyperplasminaemia developed as a result of fibrinolytic drug overdosage.

It may start certain inflammatory conditions.

Vitamin K

It can be used for oral anti-coagulants.

Mechanism of action:
It causes post-translational modification of factors VII, IX and X.

Therapeutic uses:
It is usually administered to all newborn babies in order to prevent vitamin K deficiency leading to hemorrhagic diseases which is common in premature infants.

It is also used as an antidote of warfarin.

Adverse effects:
Rapid infusion of vitamin K may lead to chest pain, back pain and dyspnea.

Protamine sulfate

It is an antidote for heparin.

It is obtained from fish sperm.

It is strongly basic macromolecule due to the presence of more amount of arginine.

In this positive charge of protamine forms complex with negative charge of heparin (a polyanionic macromolecule) neutralizing its activity.

It is administered IV after proper dilution with physiological salt solution. Its duration of affect is 2 hours.

Hypersensitivity reactions may develop. On rapid injection, flushing, dyspnea, hypotension, and bradycardia may be caused.

Aminocaproic acid and Tranexamic acid

These are synthetic inhibitors of plasminogen activator with antiplasmin activity.

These are active orally and excreted in urine. Tranexamic acid can cross placenta.

Therapeutic uses:
Aminocaproic acid is effective in the treatment of complications caused by fibrinolysis such as in the treatment of cardiac bypass or major thoracic surgery. It is also found useful in the treatment of subarachnoid hemorrhage and angioedema.

The most important use of tranexamic acid is in the treatment of ovarian tumor which is malignant.

Adverse effects:
They may cause IV thrombosis.

Aminocaproic acid may cause rash, erythema, nausea, diarrhea and heartburn. It also some of the antiadrenergic effects leading to hypotension and nasal stuffiness.

Dosage:
Tranexamic acid is administered as 15mg/kg orallyas a loading dose then 30 mg/kg four times a day.

Classification of Coagulants

Introduction:

These are the substances which are helpful in the coagulation of the blood.

Bleeding can be caused by
1. Fibrinolytic states arising after prostatectomy or gastrointestinal surgery.
2. Hemophilia

In this case, hemophilia can be caused due to decrease of plasma coagulation factors such as factor VIII or IX.

Classification of Coagulants:
Protamine sulfate, Vitamin K, Aprotinin

Fibrinolytic inhibitors:
Aminocaproic acid, Tranexamic acid

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