Carbonic Anhydrase Inhibitor
Drugs: Acetazolamide, Brinzolamide, Dorzolamide
Works on Carbonic Anhydrase enzyme located in the Kidney, Ciliary Body and Choroid Plexus in the Brain.
Mechanism of Action:
Carbonic anhydrase is located intracellularly and in the apical membrane of proximal tubular epithelium.
Inhibits carbonic anhydrase enzyme. Preventing the reabsorption of sodium bicarbonate in the Proximal
Convoluted Tubule (PCT). Results in diuresis due to loss of sodium bicarbonate and water. Urine becomes alkaline.
THERAPEUTIC USES
1. Glaucoma
o Decreases the production of aqueous humor by inhibiting carbonic anhydrase in the ciliary body. Useful
for chronic treatment of glaucoma. Alternatives: Dorzolamide, Brinzolamide (eye drops).
2. Epileptic Seizures
o Used to reduce the severity and magnitude of seizures. Often used in combination with other
antiepileptic medications.
3. Alkalinization of Urine
o Enhances renal excretion of weak acids by increasing urinary pH. Used in cases of aspirin overdose.
4. Acute Mountain Sickness
o Prophylaxis for acute mountain sickness. Administered nightly for 5 days before rapid ascent above
10,000 feet.
5. Metabolic Alkalosis
o Used to correct metabolic alkalosis.
SIDE EFFECTS
1. Metabolic Acidosis
o Due to the loss of sodium bicarbonate (NaHCO₃).
2. Renal Stone Formation
o Caused by phosphaturia and hypercalciuria. Calcium salts are relatively insoluble in alkaline urine.
3. Hypersensitivity Reactions
o Rashes, fever.
4. Renal K+ Wasting
o Enhanced potassium secretion from distal tubules.
CONTRAINDICATIONS
Liver Disease
Chronic Obstructive Pulmonary Disease (COPD)
, OSMOTIC DIURETICS
Drugs: Mannitol (administered I/V) Glycerin, Isosorbide, Urea
GENERAL CHARACTERISTICS
These are non-reactive and hydrophilic in nature. These substances are filtered through the
glomerulus without being metabolized. They increase osmolarity within the nephron, leading to
water retention in the tubules and diuresis.
1. Site of Action
o Primary site: Proximal Convoluted Tubule (PCT).
o Also acts on the Loop of Henle and Collecting Tubule.
2. Sodium Chloride Excretion
o The effect on sodium chloride excretion is minimal.
MECHANISM OF ACTION
Increases Plasma Osmolality Leads to the movement of fluid from intracellular compartments (ICC)
to extracellular fluid (ECF). Causes expansion of the extracellular fluid volume. Increases Glomerular
Filtration Rate (GFR). Increases Osmolality of Tubular Fluid Prevents water reabsorption in the
kidneys, leading to diuresis.
MANNITOL
Therapeutic Uses:
1. Prophylaxis of Acute Renal Damage :Used to prevent acute renal failure during surgery,
traumatic injuries, and hemolytic transfusion reactions.
2. Short-Term Management of Glaucoma: Reduces intraocular pressure temporarily.
3. Cerebral Edema: Reduces intracranial pressure by drawing fluid out of the brain tissue.
ADVERSE EFFECTS
1. Hypernatremia
2. Dehydration
3. Pulmonary Edema
CONTRAINDICATIONS
Congestive Cardiac Failure (CCF)
Active Intracranial Bleeding
Anuric Renal Disease
o Lack of urine production due to severe kidney dysfunction.
Drugs: Acetazolamide, Brinzolamide, Dorzolamide
Works on Carbonic Anhydrase enzyme located in the Kidney, Ciliary Body and Choroid Plexus in the Brain.
Mechanism of Action:
Carbonic anhydrase is located intracellularly and in the apical membrane of proximal tubular epithelium.
Inhibits carbonic anhydrase enzyme. Preventing the reabsorption of sodium bicarbonate in the Proximal
Convoluted Tubule (PCT). Results in diuresis due to loss of sodium bicarbonate and water. Urine becomes alkaline.
THERAPEUTIC USES
1. Glaucoma
o Decreases the production of aqueous humor by inhibiting carbonic anhydrase in the ciliary body. Useful
for chronic treatment of glaucoma. Alternatives: Dorzolamide, Brinzolamide (eye drops).
2. Epileptic Seizures
o Used to reduce the severity and magnitude of seizures. Often used in combination with other
antiepileptic medications.
3. Alkalinization of Urine
o Enhances renal excretion of weak acids by increasing urinary pH. Used in cases of aspirin overdose.
4. Acute Mountain Sickness
o Prophylaxis for acute mountain sickness. Administered nightly for 5 days before rapid ascent above
10,000 feet.
5. Metabolic Alkalosis
o Used to correct metabolic alkalosis.
SIDE EFFECTS
1. Metabolic Acidosis
o Due to the loss of sodium bicarbonate (NaHCO₃).
2. Renal Stone Formation
o Caused by phosphaturia and hypercalciuria. Calcium salts are relatively insoluble in alkaline urine.
3. Hypersensitivity Reactions
o Rashes, fever.
4. Renal K+ Wasting
o Enhanced potassium secretion from distal tubules.
CONTRAINDICATIONS
Liver Disease
Chronic Obstructive Pulmonary Disease (COPD)
, OSMOTIC DIURETICS
Drugs: Mannitol (administered I/V) Glycerin, Isosorbide, Urea
GENERAL CHARACTERISTICS
These are non-reactive and hydrophilic in nature. These substances are filtered through the
glomerulus without being metabolized. They increase osmolarity within the nephron, leading to
water retention in the tubules and diuresis.
1. Site of Action
o Primary site: Proximal Convoluted Tubule (PCT).
o Also acts on the Loop of Henle and Collecting Tubule.
2. Sodium Chloride Excretion
o The effect on sodium chloride excretion is minimal.
MECHANISM OF ACTION
Increases Plasma Osmolality Leads to the movement of fluid from intracellular compartments (ICC)
to extracellular fluid (ECF). Causes expansion of the extracellular fluid volume. Increases Glomerular
Filtration Rate (GFR). Increases Osmolality of Tubular Fluid Prevents water reabsorption in the
kidneys, leading to diuresis.
MANNITOL
Therapeutic Uses:
1. Prophylaxis of Acute Renal Damage :Used to prevent acute renal failure during surgery,
traumatic injuries, and hemolytic transfusion reactions.
2. Short-Term Management of Glaucoma: Reduces intraocular pressure temporarily.
3. Cerebral Edema: Reduces intracranial pressure by drawing fluid out of the brain tissue.
ADVERSE EFFECTS
1. Hypernatremia
2. Dehydration
3. Pulmonary Edema
CONTRAINDICATIONS
Congestive Cardiac Failure (CCF)
Active Intracranial Bleeding
Anuric Renal Disease
o Lack of urine production due to severe kidney dysfunction.
