Kuyambira kale, tagwiritsa ntchito tizilombo toyambitsa matenda kuti tione zambiri. Mankhwala enaake monga caffeine ndi ovuta (kuganiza tiyi kapena zakumwa zofewa). Komabe, panalibe mpaka zaka za makumi awiri ndi makumi awiri zomwe anthu adadziŵa kuti mankhwala opatsa mavitamini amawathandiza. Mu 1937, ofufuza anapeza mapuloteni a carbon anhydrase. Pofika m'chaka cha 1957, ofufuza anapeza zamphamvu kwambiri za chlorothiazide diuretics.
Diuretics amagwira ntchito powonjezera kuchuluka kwa mkodzo umene mumapanga ndikusintha nyimbo za thupi lanu la electrolyte kapena mchere. Malingaliro apamwamba ophweka, hu? Ngakhale zili choncho, njira zosiyanasiyana za chilengedwe zomwe zimawoneka kuti ndi zovuta kwambiri kuzimvetsa. Mwachitsanzo, kupanga mkodzo kumaphatikizapo magulu akuluakulu, osmosis, transporters ndi zina zotero.
Mwachidziwitso, ma diuretic amagwira ntchito pochotsa thupi lathu loposa madzi otentha kapena "madzi." Pali matenda ambiri omwe amachotsedwa ndi kutuluka kwa madzi kuphatikizapo kuthamanga kwa mtima, kulephera kwa mtima, kutupa kwa ubongo (edema), kutupa kwa diso (kutupa kwa diso) ndi kutupa kwapakati pa chiwindi kapena matenda a impso.
Musanaphunzire momwe ntchito ya diuretics imagwirira ntchito, tiyeni tipite mwachidule pa nephron ndi momwe timayira timagwirira ntchito. Ndipotu, ma diuretic amagwira ntchito pamagulu osiyanasiyana a nephron, omwe amamangidwa ndi impso omwe amachititsa kusuta mkodzo.
Kuyang'ana pa Nefrononi
Pano pali mitsempha yotchedwa nephron anatomy:
- Magazi amachotsedwa kuchokera mu thupi kulowa mu chikhotakhotchi chomwe chimapangidwa ndi glomerulus, tuft ya capillaries, ndi capsule ya Bowman. Nsalu yothandizira nsomba ndizoyambira koyambitsa kuyambitsa mkodzo.
- Katundu wa glomerulus amalowetsa m'machubu yamphongo, yomwe imayambitsa kupanga mkodzo. Mbali yoyamba ya nsomba ya tubule ndiyo mphutu yowonongeka.
- Mpumulo wokhotakhota womwe umaloledwa umadyetsa kumapeto kwa Henle. Gawo loyambirira la chiguduli likugwera pansi ndipo gawo lachiwiri ndilo limbalo lakuda.
- Chiwalo chokwera chikudyetsa mu tabule yosokonezeka.
- Tabu yokhotakhota yosungunuka imakwera kumalo osonkhanitsira.
Monga tanenera kale, mitundu yosiyanasiyana ya diuretic imagwira ntchito zosiyana siyana za tubule. Nthawi zonse, nephron imayambitsa kusungunula zowonongeka ku ultrafiltrate yomwe pamapeto pake imakhala mkodzo ndi kubwezeretsa zakudya ndi zinthu zina zabwino zomwe thupi lathu limafunikira monga sodium ions (Na + ), sodium bicarbonate (NaHCO 3 ), ioni ya potassium (K + ), madzi komanso pafupifupi mtundu wonse wa shuga ndi amino acid. (Mwachidziwitso, zambiri zobwezeretsa zakudya zamtunduwu zimachitika mumthunzi wokhotakhota womwe umatha.)
Carbonic Anhydrase Inhibitors
Carbonic anhydrase inhibitors ngati acetazolamide ntchito poletsa ma enzyme carbonic anhydrase yomwe ili pamtunda wochulukirapo. Kawirikawiri, carbonic anhydrase imayambitsa kuyamwa sodium (NHE3 antiporter), potaziyamu, madzi, amino acid ndi shuga kubwerera m'magazi anu. Poletsa tizilombo toyambitsa matendawa, mankhwala osokoneza bongo monga acetazolamide amachulukitsa kuchuluka kwa madzi mumtambo wa tubule. Mankhwala a carbonic anhydrase amagwiritsidwa ntchito pochizira glaucoma .
Sodium-Glucose Cotransporter 2 (SGLT2) Zizindikiro
Sodium-glucose cotransporter 2 (SGLT2) inhibitors ndi phosphorylated ribonucleotides yomwe imachitapo kanthu pa sodium glucose cotransporter yomwe ili pamtunda wochuluka kwambiri. Zimaletsa zochita za transporterzi ndikuchepetsa kubwezeretsa kwa shuga ndi sodium ions kubwerera m'magazi anu. Ndizitsulo zochepa za sodium zomwe zimabweretsanso madzi osachepera amatsatira (osmosis), ndi zotsatira zofatsa za diuresis. Ngakhale mankhwala a SGLT2 monga canagliflozin ndi dapagliflozin alidi ochepetsa diuretics, chifukwa cha zochita zawo za shuga, iwo amagwiritsidwa ntchito kwambiri pochiza matenda a shuga.acetazolimide
Loop Diuretics
Mankhwala otsekemera otchedwa loop monga furosemide amalepheretsa Na / K / 2Cl wonyamulira mumtsinje waukulu wa Henle; motero, kuchepetsa kubwezeretsedwa kwa sodium ndi madzi m'magazi anu. Chifukwa chakuti ma diuretic amatsitsidwanso amatha kusokoneza ndi potassium reabsorption, potaziyamu kudula kungakhoze kuchitika. Ngati potaziyamu ikutha kwambiri, hypokalemia ikhoza kuchitika. Chochititsa chidwi kwambiri ndi kuti hypokalemia ikhoza kugwiritsira ntchito momwe mtima wanu umagwirira ntchito Furosemide amagwiritsidwa ntchito pochiza mtima (kuthamanga kwa magazi), madzimadzi m'mapapo (pulmonary edema), kutupa kwa thupi, hyperkalemia (pangozi yapamwamba ya potassium) ndi hypercalcemia kapena mkulu wa calcium ( ntchito yamagetsi).
Thiazides
Thiazides amagwira ntchito powombera ndi Na / Cl wogulitsa pamtunda wokhotakhota. Kuwonjezera pa kuletsa kubwezeretsa kwa ayoni ya sodium ndi madzi, thiazides amachititsanso kuti potaziyamu iwonongeke. Thiazides amagwiritsidwa ntchito monga chithandizo choyamba cha matenda oopsa; Kwenikweni, kafukufuku wotchuka anapeza kuti thiazides ndi othandiza kwambiri ngati chithandizo choyamba cha matenda oopsa kwambiri kuposa ACE inhibitors.
Pamene tsamba la glomerular (filthration rate rate) limakhala lochepa kwambiri, thiazides sagwira ntchito bwino. Zozindikira, thiazides nthawi zambiri zimagwirizanitsidwa ndi ma diuretics omwe amamasuliridwa kuti azitsatira.
Kuphatikiza pa matenda a hypertension, thiazides amagwiritsidwanso ntchito pochiza matenda a impso ndi matenda a shuga insipidus (zosiyana ndi zofala kwambiri 1 ndi mtundu wa shuga 2).
Potaziyamu-Kuthetsa Diuretics
Monga momwe maina awo amasonyezera, potaziyamu-sparing diuretics amagwira ntchito powonjezera mphamvu ya mkodzo popanda kuwononga potaziyamu. Kuwonjezera potaziyamu monga spironolactone kapena amiloride onse amagwiritsa ntchito mitsempha yosonkhanitsa koma amagwiritsa ntchito njira zosiyana siyana.
Spironolactone imatsutsana ndi aldosterone m'njira yosamvetsetseka. Aldosterone ndi hormone ya steroid yopangidwa ndi adrenal cortex. Potsutsa zotsatira za aldosterone, potassium, sodium ndi madzi akusungirako. Spironolactone nthawi zambiri imagwiritsidwa ntchito polimbana ndi kuwonongeka kwa potaziyamu chifukwa cha ma diuretics a thiazide ndi loop. Mankhwala awa amathandizidwanso pambuyo pa matenda a mtima kapena omwe amagwiritsidwa ntchito pochiza aldosteronism pazifukwa zina.
Amiloride amaletsa njira zowonjezera mu sobule yosonkhanitsa ndipo motero amaletsa kubwezeretsanso kwa madzi m'thupi lanu. Mofanana ndi spironolactone, amiloride nthawi zambiri amagwiritsidwa ntchito polimbana ndi kuwonongeka kwa potassium.
Osmotic Diuretics
Osmotic diuretics imadutsa m'thupi mwathu. Pamene mankhwala osokoneza bongo monga mannitol alowa mumachubu yanu yodula, amakoka m'madzi pogwiritsa ntchito osmosis. (Kumbukirani ndi osmosis, madzi amatsata ndondomeko yambiri.) Komanso, osmotic diuretics mu mimba kunja kwa impso (kuganiza ubongo kapena diso) ikhozanso kuchotsa madzi ndikuchepetsa kutupa.
Kuphatikiza pa kuchizira maso (glaucoma) ndi kutupa kwa ubongo (kuwonjezeka kwapopopera), osmotic diuretics amagwiritsidwanso ntchito kuchepetsa kuperewera kwapadera kuwonjezeka katundu wolemera chifukwa cha chemotherapy kapena rhabdomyolysis (kupweteka kwa mitsempha). Mwa kuyankhula kwina, pochepetsa mankhwala osokoneza bongo ndi mitsempha mu nephron, pamakhala impso zochepa pa impso.
Vaptans
Otsutsana ndi azimayi kapena abambo (conivaptan ndi tolvaptan) ndi gulu latsopano la mankhwala. Amagwiritsa ntchito antagonism ya vasopressin kapena antidiuretic hormone ndipo amathandiza thupi lanu kutsegula madzi opanda electrolyte. Potero, vaptans amathandizira ndi hyphonatremic mikhalidwe yotchulidwa ndi otsika kwambiri sodium m'magazi ngati SIADH.
Zambiri mwa ma diuretics zomwe takambirana m'nkhani ino zimapezeka ndi mankhwala. Komabe, mukhoza kugula diuretics popanda mankhwala. Ngakhale kuti mumangowonjezera mkodzo wanu ndi kumangokhalira kumagwirizana ndi makina anu a electrolyte angaoneke kuti ndi owopsa, pamene amachitidwa molakwika, diuretics angayambitse kutaya thupi ndi kusayenerera kwa electrolyte kwaumphawi (fodya ndi thupi lanu). Diuretics ingathenso kuwonjezera chiwindi cha mtima, kulephera kwa mtima, kapena kulephera kwa chiwindi. Chonde tengani ma diiratic pokhapokha mukafunsana ndi dokotala wanu makamaka ngati muli ndi vuto la madzi.
Pamapeto pake, ngati mukudabwa za caffeine, kafukufuku amasonyeza kuti ngati munthu wathanzi amamwa chakumwa chakumwa, kutaya kwa madzi sikungapo kuposa kumwa kwakumwa kumeneku komanso kusamalidwa kwake sikunayesedwe. Mwa kuyankhula kwina, ngati muli ndi thanzi labwino, ndiye kuti cafeine ndi yotetezeka.
Zotsatira:
Eaton DC, Pooler JP. Mutu 8. Malamulo a Kukhazikika kwa Potassium. Mu: Eaton DC, Pooler JP. eds. Vander a Renal Physiology, 8e . New York, NY: Hill ya McGraw; 2013.
Sam R, Pearce D, Ives HE. Ma Diuretic Agents. Mu: Katzung BG, Trevor AJ. eds. Basic & Clinical Pharmacology, 13e . New York, NY: Hill ya McGraw; 2015.