{"id":842,"date":"2020-02-17T22:21:10","date_gmt":"2020-02-17T16:51:10","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=842"},"modified":"2020-02-17T22:21:10","modified_gmt":"2020-02-17T16:51:10","slug":"antidiuretics-hormone-arginine-vasopressin-avp-and-drugs","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/antidiuretics-hormone-arginine-vasopressin-avp-and-drugs\/","title":{"rendered":"Antidiuretics Hormone (Arginine Vasopressin-AVP) and Drugs"},"content":{"rendered":"\n
Antidiuretics Hormone (Argenine Vasopressin-AVP)<\/strong><\/p>\n\n\n\n 1. Antidiuretic hormone (ADH, Vasopressin) \u00e0 Desmopressin, Lypressin, Terlipressin<\/p>\n\n\n\n 2. Thiazide diuretics \u00e0 Amiloride.<\/p>\n\n\n\n 3. Miscellaneous: Indomethacin, Chlorpropamide, Carbamazepine.<\/p>\n\n\n\n The two main hormones released from neurohypophysis (posterior pituitary ) are Oxytocin & ADH<\/p>\n\n\n\n ADH Synthesis \u00e0 Supraoptic nucleus(SON) \u2013 75% & Paraventricular nuclei (PVHN) -3%<\/p>\n\n\n\n Actions of ADH<\/strong><\/p>\n\n\n\n VASOPRESSIN ANALOGUES<\/strong><\/p>\n\n\n\n Lypressin<\/strong><\/p>\n\n\n\n Terlipressin<\/strong><\/p>\n\n\n\n Desmopressin (dDAVP)<\/strong><\/p>\n\n\n\n Uses<\/strong><\/p>\n\n\n\n A. Based on V2 actions (Desmopressin is the drug of choice)<\/strong><\/p>\n\n\n\n 1. Diabetes insipidus<\/strong><\/p>\n\n\n\n Diabetes insipidus is a lack of antidiuretic hormone (ADH) or a lack of response to ADH. This prevents the kidneys from being able to concentrate the urine leading to polyuria (excessive amounts of urine) and polydipsia (excessive thirst). It can be classified as nephrogenic or cranial.<\/p>\n\n\n\n The major symptoms of central diabetes insipidus (DI) are polyuria, nocturia, and polydipsia due to the concentrating defect.<\/p>\n\n\n\n Treatment of this disorder is primarily aimed at decreasing the urine output, usually by increasing the activity of antidiuretic hormone (ADH, also called arginine vasopressin or AVP).<\/p>\n\n\n\n Water Deprivation Test<\/strong><\/p>\n\n\n\n The water deprivation test is also known as the desmopressin stimulation test. This is the test of choice for diagnosing diabetes insipidus.<\/p>\n\n\n\n Method<\/p>\n\n\n\n Initially the patient should avoid taking in any fluids for 8 hours. This is referred to as fluid deprivation. Then, urine osmolality is measured and synthetic ADH (desmopressin) is administered. 8 hours later urine osmolality is measured again.<\/p>\n\n\n\n Other drugs that may decrease diuresis include chlorpropamide, carbamazepine and clofibrate, nonsteroidal anti-inflammatory drug (NSAID) and thiazide diuretics.<\/p>\n\n\n\n 2. Bedwetting in children and nocturia in adults<\/strong><\/p>\n\n\n\n 3. Renal concentration test<\/strong><\/p>\n\n\n\n 4. Haemophilia, von Willebrand\u2019s disease<\/strong><\/p>\n\n\n\n B. Based on V1 actions<\/strong><\/p>\n\n\n\n 1. Bleeding esophageal varices<\/strong><\/p>\n\n\n\n 2. Before abdominal radiography<\/strong><\/p>\n\n\n\n Adverse effects<\/strong><\/p>\n\n\n\n Systemic side effects are:<\/strong><\/p>\n\n\n\n Other Antidiuretics<\/strong><\/p>\n\n\n\n Thiazides<\/strong><\/p>\n\n\n\n These drugs are used as diuretics but, exert paradoxical effect (decrease urine formation) in DI.<\/p>\n\n\n\n This paradoxical effect is believed to be due to increased formation of cAMP in the distal tubules. Another proposed mechanism is that thiazides cause dehydration that result in compensatory increase in reabsoprption of Na+ and water from the proximal portions of nephron.<\/p>\n\n\n\n These are low efficacy antidiuretics but are beneficial in both central as well as nephrogenic DI.<\/strong><\/p>\n\n\n\n Chlorpropamide, Clofibrate and Carbamazepine<\/strong><\/p>\n\n\n\n These drugs increase the action of ADH on the kidney and are useful only in the central DI.<\/strong><\/p>\n\n\n\n Amiloride – <\/strong>It is the agent of choice for the treatment of Lithium induced DI.<\/strong><\/p>\n\n\n\n VASOPRESSIN RECEPTOR ANTAGONISTS<\/strong><\/p>\n\n\n\n Relcovaptan<\/strong> \u00e0 selective V1 antagonist<\/p>\n\n\n\n lixivaptan, mozavaptan and tolvaptan<\/strong> \u00e0 V2 selective antagonists.<\/p>\n\n\n\n Conivaptan is V1a\/V2 receptor antagonist<\/strong> \u00e0 used as an aquaretic (increase water excretion without affecting electrolytes like sodium) in CHF.<\/p>\n\n\n\n Conivaptan is administered by i.v. injection whereas lixivaptan and tolvaptan can be given orally.<\/p>\n\n\n\n SYNDROME OF INAPPROPRIATE ADH SECRETION (SIADH)<\/strong><\/p>\n\n\n\n \u2022 Fluid restriction<\/strong> is treatment of choice for SIADH.<\/p>\n\n\n\n \u2022 Hypertonic saline (3% NaCl) + loop diuretics (depending upon volume status) is treatment of choice for severe symptomatic hyponatremia.<\/p>\n\n\n\n \u2022 Among drugs, tolvaptan (oral), conivaptan (i.v.)<\/strong> are preferred for long-term use.<\/p>\n\n\n\n \u2022 Alternatives are demeclocycline and lithium (not preferred now).<\/p>\n","protected":false},"excerpt":{"rendered":" Antidiuretics Hormone (Argenine Vasopressin-AVP) inhibit water excretion without affecting salt excretion \u00e0 drugs that reduce urine volume, particularly in diabetes insipidus (DI) which is their primary indication. Drugs are: 1. Antidiuretic hormone (ADH, Vasopressin) \u00e0 Desmopressin, Lypressin, Terlipressin 2. Thiazide diuretics \u00e0 Amiloride. 3. Miscellaneous: Indomethacin, Chlorpropamide, Carbamazepine. The two main hormones released from neurohypophysis[…]\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/842"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=842"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/842\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=842"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=842"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=842"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Diagnosis<\/strong><\/td> After Deprivation<\/strong><\/td> After ADH<\/strong><\/td><\/tr> Cranial Diabetes Insipidus<\/td> Low<\/td> High<\/td><\/tr> Nephrogenic Diabetes Insipidus<\/td> Low<\/td> Low<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n