Morimoto S
Department of Pharmacology, Osaka University of Pharmaceutical Sciences.
Nihon Rinsho. 1997 Aug;55(8):2039-44.
Diuretic agents have antihypertensive effects mainly be decreasing extracellular volume and cardiac output. These diuretics are described with regard to mechanism of action, site of action, adverse effects, and drug interactions. Thiazide diuretics inhibit the Na(+)-Cl- symporter in the distal convoluted tubule, by competing for the Cl- binding site, and increase Na+ and Cl- excretion. Loop diuretics are inhibitors of Na(+)-K(+)-2Cl- symporter in the thick ascending limb of the loop of Henle. However, loop diuretics are not the diuretic of first choice and should be reserved for patients in whom other diuretics or antihypertensive drugs do not result in a satisfactory response. The potassium sparing diuretics are used primarily to reduce the kaliuresis and potenciate the hypotensive effect of a thiazide.
利尿剂主要通过减少细胞外液量和心输出量发挥降压作用。本文从作用机制、作用部位、不良反应及药物相互作用等方面对这些利尿剂进行了描述。噻嗪类利尿剂通过竞争氯离子结合位点抑制远曲小管中的Na(+)-Cl-协同转运体,增加Na+和Cl-排泄。袢利尿剂是Henle袢升支粗段中Na(+)-K(+)-2Cl-协同转运体的抑制剂。然而,袢利尿剂并非首选利尿剂,应留用于其他利尿剂或降压药治疗效果不佳的患者。保钾利尿剂主要用于减少尿钾排泄并增强噻嗪类药物的降压效果。