Summarize the following text to main points and sub-points and make detailed explain for them:


Ammonium chloride  
MECHANISM OF DIURETIC EFFECT: 
a-   Ammonia   is converted in the liver to urea + H+. 
b- H+   + HCO3- ------------- H2CO3 is converted by C.A enzyme 
to CO2 + H2O... 
c- Excess Cl ions replaces bicarbonate in the blood resulting 
in: 
• Hyperchloraemic acidosis. 
• Cl load to the tubules is augmented escapes 
reabsorption along with an equivalent amount of Na 
&K& isosmotic H2O. 
 
❖ 
DOSAGE: 
6-12 gm orally/ day. 
❖ 
Uses: 
1. Diuretics with mercurials. 
2. Expectorant. 
3. Acidification of urine. 
4. ttt of alkalosis. 
5. Help excretion of basic drugs. 
 
 
. 
 
C- Osmotic diuretics 
e.g : Glucose,Urea,Mannitol 
 
• They are inert substance and excreted unchanged in 
the urine. 
• They are freely filtered by glomerulus. 
• They undergo limited or no reabsorption. 
• They  are given by i.v.infusion. 
 
Mechanism:  
• ↑ Osmotic pr. Of tubular fluid---------   ↓ water 
reabsorption from PCT and other segments. 
• ↓ Active Na+ reabsorption from tubular fluid. 
• ↑ Flow rate of the tubular fluid---------- ↓ time 
for water reabsorption. 
 
Therapeutic uses: 
1. Acute oliguric renal failure: to maintain adequate GFR and 
prevent renal tubular cell necrosis. 
2. Acute congestive glaucoma: to ↓ aq. Humor formation and 
↑ its drainage by increasing the osmotic pressure of plasma. 
3. Acute rise in the intracranial tension: to ↓ CSF formation 
and ↑ its drainage by increasing the osmotic pressure of 
plasma. 
. 
4. Drug intoxication. 
 
✓ Side effects: 
1-Acute hypervolemia:  when osmotic pressure of the plasma 
rises in the initial phase, this will withdraw extracellular fluids 
into the vascular compartment---------- ↑ plasma volume--------- 
aggravation of CHF and pulmonary congestion. 
2-Dehydration and hypernatremia {water loss is more than Na 
loss}. 
3-Headache , nausea,& vomiting. 
4-Mannitol -------------------     hypersensitivity reaction. 
5-Glycerol---------------------     hyperglycemia. 
✓ Contraindications: 
▪ CHF and pulmonary congestion: due to acute 
hypervolemia. 
▪ Severely impaired renal function. 
▪ Marked dehydration. 
▪ Active intracranial bleeding: because mannitol will 
extravasate with the leaked blood----------↑ brain damage. 
 
ANTIDIURETICS 
1. Antidiuretic hormone… 
. 
2. Releasers of A.D.H: e.g barbiturate, Morphine, Ether & 
nicotine...  
3. Thiazide diuretics only in nephrogenic diabetes insipidus... 
4. Adrenaline & Dopamine {large doses only}... 
5. Na+& H2O retaining drugs e.g : Cortisone… 
 
Antidiuretic Hormone{A.D.H }  
Pharmacological Actions: 
1. Antidiuretic Action:            +++ reabsorption of H2O  by 
D.C.T through ; 
a- Stimulating release of hyaluronidase enzyme ;        
+++++ permeability. 
b- Increase production of cyclic 3, 5 AMP. 
 
2- Cardiovascular system: 
In very large dose: it is direct vasoconstrictor. 
a- Rise of blood pressure. 
b- Coronary spasm; Anginal attack {irreversible 
shock}. 
3- Smooth muscle: 
Spasmogenic effect on intestinal tract. 
 
Contraindications: 
. 
Coronary heart diseases ------------- Fetal. 
 
A.D.H antagonists: 
1-     Lithium carbonate. 
2-     Demeclocycline ; effective in H2O intoxication to 
excess A.D.H secretion. 
 
 
 
 
 
  
 
 
 
 
  
 
 


Summary :