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Darbs:

vai arī paaugstinot osmotisko spiedienu kanāliņa lūmenā.

Attaisnojusies ir arī ideja iegūt antagonistus hormoniem, kas regulē urīna izdales procesu. Vienu no tādiem preparātiem - aldosterona antagonistu spironolaktonu (verošpironu) plaši lieto medicīnas praksē.

Ksantīna atvasinājumi:

Teofilīns (aminofilīns) kardiostimulātors, spazmolītiķis, paplašina asinsvadus, uzbudina CNS uzlabo asinsriti nierēs, vāji palielinot diurēzi.

Pielieto pie asinsrites traucējumiem nierēs, bronhiālā astmas, plaušu emfizēmas, HOPS, kardiostimulācijas gadījumos noņem slodzi asinsvados izvadot šķidrumu.

Uzbudina CNS, sevišķi piesardzīgi bērniem, veciem cilvēkiem, novājinātiem pacientiem

Tahikardija, aritmija, hipotensija

Augsts aspirācijas risks - ietekmē peristaltiku (reflukss -kuņģa satura nokļūšana barības vadā)

Iespējama kumulācija (medikamenta uzkrāšanās un pārdozēšanas risks) prolongētas darbības ilgstoša lietošana.

C grupas preparāts piesardzīgi grūtniecēm

Aknās pārvēršas par kofeīnu, bērniem uzkrājas organismā

Nesaderīgs ar daudziem medikamentiem, iespējamas alerģijas un kardiotoksiskas reakcijas.

TIEŠAS DARBĪBAS DIURĒTIĶI

1. CILPAS DIURĒTIĶI (Furosemīds)

2. VIELAS, KAS DARBOJAS UZ DISTĀLO

KANĀLIŅU (Tiazīdi)

3. KĀLIJU AIZTUROŠIE DIURĒTIĶI (Spironolaktons)

II. NETIEŠAS DARBĪBAS DIURĒTIĶI

1. OSMOTISKIE DIURĒTIĶI (Mannitols)

2. KARBONANHIDRĀZES INHIBITORI

(Acetazolamīds)

III. VIELAS, KAS IZMAINA URĪNA PH

(Na bikarbonāts, amonija hlorīds)

IV. VIELAS, KAS IZMAINA ORGANISKO MOLEKULU EKSKRĒCIJU JEB URIKOZŪRISKĀS VIELAS (Probenecids)

- stipri iedarbojas uz Na un Cl reabsorbcijas mehānismu - būtiski izvada sāļus.

Salurētiskie līdzekļi ir tiazīdi un cilpas diurētikas.

Tie kavē nātrija un daļēji arī kālija jonu reabsorbciju nieru kanāliņos un izraisa spēcīgu diurētisku efektu.

Tiem piemīt spēcīga diurētiska un salurētiska iedarbība.

Tiek pieskaitīti pie spēcīgās diurētikas līdzekļiem.

(aktīvi izvada sāļus, arī kāliju).

Lieto pacientiem ar izteiktu sastrēgumu, traucētas nieru funkcijas gadījumā.

Parasti šos medikamentus lieto vienu reizi dienā no rīta 2-3 reizes nedēļā pacientiem ar tūskām, kaut gan hipertensijas ārstēšanai salurētikas (biežāk TIAZĪDUS) lieto katru dienu, bet mazās devās.

Tiazīdus lieto pacientiem ar hronisku sirds mazspēju tikai simptomātiskai terapijai sastrēguma simptomu samazināšanai, sākot no 2. funkcionālās klases beigām.

Diurētikas parasti lieto tikai kombinācijā ar AKE inhibitoru vai sirds glikozīdu, nevis monoterapijā.

Vienu pašu diurētiķu lietošana sekmē sirds mazspējas attīstību.

Tiazīdus lieto pacientiem ar vieglu sastrēgumu un nelielu šķidruma aizturi vai hipertensiju. Vēlams lietot tikai pacientiem ar saglabātu nieru funkciju, kad kreatinīna klīrenss > 50 ml/min.

1. CILPAS DIURĒTIĶI

Furosemide, (Furantril, Lasix),

Bumetanīds,

Piretanīds

(Piretanide),

Torasemīds (Torasemide, Trifass),

Etakrīnskābe (Ethacrynic acid)

Azosemīds (lurets),

Etozolīns (elkapīns),

Piretamīds (arelikss).

Cilpas diurētikas (ETAKRĪNSKĀBI, FUROSEMĪDU, BUMETANĪDU, TORASEMĪDU un KLOPAMĪDU) - lieto pacientiem ar izteiktu sastrēgumu un mērenu vai izteiktu šķidruma aizturi un neefektīvu terapiju ar tiazīdiem.

Cilpas diurētikas ieteicamas arī traucētas nieru funkcijas gadījumā, kad kreatinīna klīrenss ir < 50 ml/min.

Labi absorbējas no GI,

Piemīt arī venodilatējoša darbība un hipotenzīva darbība.

spēcīgi saistās ar plazmas proteīniem,

metabolizējas ar CYP 450,

pusizvad. laiks 90 min.

Tie ir visspēcīgākie - “augsto griestu” diurētiķi.

Darbība iestājas ātri un sasniedz maksimumu (“griestus”).

Preparāts darbojas galvenokārt Henles cilpas ascendējošā daļā (tāpēc to reizēm sauc par "cilpas diurētiķi"), bloķējot nātrija un hlora transportu (reabsorbciju), kā arī 2-5 reizes pastiprinot kālija jonu izdali.

Furosemīds pastiprina nieru asinsriti, aiztur organismā urīnskābi, veicina kalcija izdali, karboanhidrāzes aktivitāti neietekmē, kā arī nerada organismā ne acidozi, ne alkalozi.

Tāpat kā dihlotiazīds furosemīds var provocēt podagras un cukura diabēta paasinājumu.

Preparāts labi uzsūcas no gremošanas trakta, ap 9% saistās ar albumīniem, bet 60-70% izdalās ar urīnu.

Lietojot furosemīdu iekšķīgi, diurēzes pastiprināšanās sākas pēc 20-40 min. un saglabājas 4-8 stundas.

Ievadot preparātu vēnā, efekts attīstās pēc 5-10 minūtēm un ilgst 1,5-3 stundas.

Ātrā iedarbība ļauj to izmantot neatliekamos gadījumos.

Indikācijas:

Nātrija un ūdens pārslodze:

** akūta plaušu tūska

** hroniska sirds nepietiekamība

** aknu ciroze ar ascītu

** nefrotiskais sindroms, nieru nepietiekamība

Hipertenzija (ar nieru traucējumu komplikācijām)

Hiperkalciēmijas akūta ārstēšana

Reibonis, galvassāpes, neskaidra redze. Ortostatiska hipotensija.

Akūtas hipotensijas epizodes pārmērīgas diurēzes gadījumā.

Hipokaliēmija. Hiperglikēmija.

Nātrene, dermatīts, fotosensibilizācija.

Troksnis ausīs.

Parestēzijas, muskuļu spazmas, trīce hipokalcēmijas dēļ.

Metaboliskā alkaloze (no Na un Cl zuduma)

Ca and Mg ekskrēcija

Samazina urīnskābes izvadīšanu

Kurlums reti - nepārejošs, ja lieto kopā ar aminoglikozīdu antibiotikām

Salurētiskie līdzekļi pasliktina SIRDS GLIKOZĪDU panesamību un palielina intoksikācijas risku.

Uzmanīgi vērojiet hipokaliēmijas simptomus.

Nesteroīdie pretiekaisuma līdzekļi pavājina diurētisko iedarbību.

Diurētiskie līdzekļi pavājina INSULĪNA hipoglikēmisko darbību.

Ja vienlaikus lieto salurētisko līdzekli un AMINOGLIKOZĪDU, palielinās dzirdes traucējumu risks, var rasties dzirdes zudums.

Iedarbīgākais un biežāk lietojamais salurētiskais diurētiķis.

Furosemīda priekšrocība ir tā maztoksiskums, ātrā un spēcīgā diurētiskā darbība.

FUROSEMĪDA lietošana var izraisīt redzes traucējumus dubultošanās veidā.

Dehidrācijas risks pārmērīgas diurēzes gadījumā.

Iespējama ļoti spēcīga hipotensīva reakcija.

Pēc straujas masīvas diurēzes var būt simpatoadrenālā reakcija ar tahikardiju, vājumu un tam sekojošu atkārtotu šķidruma aizturi.

Iespējama dzimumtieksmes samazināšanās un impotence.

FUROSEMĪDA lietošana var izraisīt trokšņus ausīs, pat pārejošu kurlumu, īpaši, ja pacients vienlaikus lieto AMINOGLIKOZĪDU - (gentamicīns, streptomicīns).

Mazinās blaknes, ja lieto 1x dienā iedarbība nesamazinās.

Reti, bet tomēr var rasties paliekošs dzirdes zudums.

Ātra ievadīšana vēnā saistīta ar palielinātu ototoksiskuma risku.

Cilpas diurētikas nelieto grūtniecības laikā (C kategorija).

I.V. (plaušu tūska), darbība ir momentāna (pirms diurētiskā efekta parādās vaskulārais), maksimums 30 min laikā, darbības ilgums - 1.5 - 3 stundas.

P.O. darbības sākums un maksimums 1stundas laikā, darbojas 4 - 8 stundas. Aktivitāte samazinās pēc 2 dienu lietošanas.

Torasemīds darbojas ilgstošāk - ievada 1x dienā.

Preparātu var dot kopā ar ēdienu.

Devu visu dod no rīta vienā reizē.

Ārstēšanu parsti sāk ar 40mg dienā 2-3 reizes nedēļā.

Pacientiem ar nieru mazspēju pieļaujamā FUROSEMĪDA diennakts deva ir 500 -1000mg.

Ja parastā diurētiskā terapija nav efektīva, iespējamas devas un režīma korekcija.

! Izvēles preparāts pacientiem ar nieru mazspēju ir METOLAZONS 2,5 - 20 mg vienu reizi dienā.

I/m injekcijas ir sāpīgas!

I/v injekcijas ievadīšanas ātrums ir ierobežots.

Nelielas devas drīkst ievadīt neatšķaidītas ar ātrumu 20 mg/min.

Lielu devu nedrīkst ievadīt ātrāk par 4 mg/min.

ĀTRA IEVADĪŠANA SAISTĪTA AR PALIELINĀTU OTOTOKSISKUMA RISKU.

VAR BŪT ARĪ PĒKŠŅI NĀVES GADĪJUMI ĀTRAS FUROSEMĪDA IEVADĪŠANAS DĒĻ.

ETAKRĪNSKĀBE - nedaudz vājāka viela par FUROSEMĪDU, bet tomēr spēcīga diurētika.

Lieto tāpat kā FUROSEMĪDU.

BUMETANĪDS ir spēcīgāks par FUROSEMĪDU, ar nedaudz īslaicīgāku darbību (2-4h).

TORASEMĪDS - arī FUROSEMĪDAM līdzīgs diurētisks līdzeklis.

Nedaudz vājāka diurētiska aktivitāte, ko atklāja ķīmiķis Džeimss Spradžs 1951. gadā, ir fenoksietiķskābes atvasinājumam etakrīnskābei (edekrīnam, ekrineksam, hidromedīnam, uregitam).

Tāpat kā furosemīds tā pieder pie augsti efektīviem "cilpas diurētiķiem", jo iedarbojas uz Henles cilpas ascendējošo daļu un kavē tur galvenokārt nātrija un hlora jonu reabsorbciju, tikai nedaudz veicinot kālija


Atpakaļ  1  [2]  3  4  5  6  7  8  9 ... 12  Tālāk

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