Torsemide is a long acting loop diuretic that can be indicated in conditions like increased swelling which may be associated with few of the conditions such as heart failure and renal failure. This drug acts by inhibition of Na+/K+/2Cl- pump on the apical membrane of ascending loop of Henle thereby it reduces reabsorption of sodium and chloride ions.
Hi everyone today in this video we are going to discuss about torsimite how this drug acts and what are the form classical actions drug interactions and side effects of torsimide what is torsimide torsomed is one of a loop diuretic and we have few of the other loop diuretics like furosemide which is hang the similar suffix and other drugs like bumatinide eta chronic
Acid all these are the loop dietics which are acting on the ascending loop of henle and they produce the high ceiling diuresis but among them torsometer is one of the long acting loop diuretic which can be used in case of swelling as well as body volume accumulation which are associated with the renal failure or congestive heart failure in such conditions torsion
Mite can be given in order to increase the diuresis so today in this video let us see how this drug acts what is its chemical nature side effects and drug interactions what is the structure of torsimide torsomed is a loop diatic and it is having a structure like this apart from the other diuretics interestingly this drug is having one of the function group that
Is the sulfonylurea urea moity is attached with the sulfonyl group so it is called as sulfonylurea so when we write the iupac name the suffix is ending with the sulfonylurea now on the nitrogen of the urea one of the group is the isopropyl group and another one is the pyridine group so since isopropyl is starting with the letter i we can start the numbering here
One and this is third now first position it is having a isopropyl group and third portion it is having the period in ring system but this pyridine is attached by third portion so period in three eye and it is attached at the third portion so three dash period in three i but this pyridine is further attached within any lean moiety at the fourth question so we can
Write this as 4-3-methyl any line so that is a complete name of the torsimide so torsimide is one of the sulfonylurea which acts as a loop diorite now let us see how this drug acts torsometer is acting on the thick ascending loop of henle and here this is the basolateral membrane and is the apical membrane that is the inner membrane of the lumen now within the
Lumen the filtrate is having the so many number of ions like the sodium ions as well as it’s also in potassium and chloride ions now here sodium cannot be reabsorbed passively through this apical membrane it requires some pump and one of the pump is the sodium potassium two chloride exchange pump this pump is a simpler which is going to send the ions in the same
Direction so it can send one of the sodium ion as well as one of the potassium ion and two molecules of the chloride ions in this way the net change in the membrane potential is zero because two positive ions and two native ions are transported through the membrane and once the sodium is present within the tubular membrane it can be reabsorbed into the systemic
Circulation by ender pump sodium potassium atpase pump now the sodium can be reabsorbed in the system circulation where the potassium can be exchanged so this is the sodium potassium atpase pump which requires the energy potassium can be recycled by ender pump potassium is again reabsorbed into the sesame circulation where the chloride ions are also reabsorbed
So this pump is the potassium chloride symport which is going to reabsorb the potassium as well as the chloride ions so what is the net effect at the thick ascending loop of henle sodium and chloride are reabsorbed and potassium is just recycled this entire process is mediated by one of the pump sodium potassium two chloride exchange pump which is present on the
Apical membrane now if we block this pump we can inhibit the absorption of the sodium chloride thereby sodium chloride is not reabsorbed and it is excreted and as the sodium chloride is excreted it results in the large expression of the urinary volume resulting in the high ceiling diuresis so here torsomat is one of the drag which can block this sodium potassium
Two chloride exchange pump thereby it increase the sodium chloride excretion what are the formulas reactions now we have clearly seen that torsionment is going to increase the sodium chloride excretion but along with the sodium and chloride ions other ions are also excreted now the form classical actions of torsimite can be classified into two categories where
The ions which are going to be excreted otherwise where the excretion is going to be reduced so torsional can increase the execution of sodium ions as well as calcium ions and magnesium ions so all these important electrolytes are excreted and potassium ions are also excreted because as the sodium is more excreted the water the filtrate coming at the collecting
Tubules is rich in the sodium which results in the more potassium excretion and it also results in the excretion of the anions like the chloride ions and because of excretion of all these ions osmotic pressure increases thereby water excretions also increases so torsimide can increase the excretion of sodium calcium magnesium potassium chloride and water but
It decrease the excretion of the uric acid so this is a general pattern that can be observed with all the loop biotics loop diets increase the excretion of all other ions except the uric acid what are the side effects the side effects of torsomed is because of the vasodilatory effects because it produced the excretion of the sodium and other electrolytes so it
Produced few of the side effects like headache dizziness excessive urination weakness because of loss of all these important electrolytes it produces some fatigue and weakness in the patients and excessive thirst because the water is going to be lost it results in the excessive thirst and dry mouth a large volumes of expulsion of urine result in the hypovolemia
And few of the other side effects like dyspepsia nausea and vomiting hypokalemia can be observed with the torsimi torsment can produce all the hypo but it can reduce the uric acid excretion resulting in the hyperuricemia so if any patient already having increased uric acid levels torsometer should be carefully given because it produced the hyperuricemia and another
Important effect is the increased glucose levels it can produce a hyperglycemia because it is a sulfonylurea it may be related with the sulfonylurea actions but here instead of reducing the glucose levels torsomate is found to increase the glucose levels so these are the common side effects of torsamide and it can also produce some hypersensitive reactions because
The torsometer is having a sulfonylureum what are the dry interactions the main drug interaction of the torsion can be found at the metabolic phase dorsamide is going to be metabolized to its metabolites by cytochrome p450 system and one of the important enzyme is the cyp2c9 so if you have the drugs like fluconazole mechanizole and amiodarone all these are the
Potent inhibitors of the cyp2c9 thereby they can inhibit the metabolism of the torsimide resulting in the increased levels of the torsimide so whenever these drugs are given there is an excess of urination and increased actions of torsoid that can be found in the patients similarly if you have the drugs like refampin is an enzyme inducer which can induce the enzymes
Like cyp2c9 thereby can increase the metabolism of the torsomide resulting in the failure of action so these drug interactions should be carefully monitored when the torsomed is co-prescribed what are the precautions the main precaution is the hypotension all we have seen torsomet can produce a variable effects it can produce a dehydration by increased excretion
Of water and it can produce a hypotension by increased excretion of sodium as well as chloride and as the sodium chloride is excreted it can also decrease the body volume and this drug can also reduce the renal functionality by increase the expulsion of the urinary volumes so torsomen mainly produce a high potential effects so hypotension is one of the important
Precaution that should be considered whenever the torsometer is given with the other drugs which are producing the hypotension second one is the electrolyte imbalance again torsometer can produce the imbalance of the electrolytes by increasing the excretion of many of the electrolytes so torsometer can increase the sodium excretion resulting in the hyponatremia
And it can also increase the calcium excretion resulting in the hypocalcemia and potassium excretion hypokalemia and magnesium excretion hypomagnesemia and finally chlorine excretion hypochloremia so all these hypoconditions are produced by torsomed which can produce some electrolyte imbalance which may result in few of the cardiac arrhythmias weakness fatigue in
The patients which should be carefully monitored and third important precaution is the water toxicity torsionmite can increase the autotoxicity and it can precipitate the tinnitus some budging noise in the ears as well as some hearing loss this side effect is also observed with other drugs like furosemide and this side effect may be related to their action on the
Sodium potassium two chloride pump which is present on the inner ear so whenever other drugs are co-prescribed such as aminoglycosides because aminoglycosides can also produce a water toxicity and this water toxic effect produced by aminoglycosides is further enhanced by torsimine so that’s why torsomite should not be combined with other drugs which are having
The risk of vestibular disorders as well as ototoxicity how it is given torment is given as a tablet form and dose of torsome depends on the type of clinical situation in the treatment of heart failure the initial dose may be started from 10 to 20 mg once daily and the dose can be slowly increased based on the patient conditions similarly in the chronic renal
Failure the initial dose starts from 20 mg once daily and in the liver cirrhosis the dose may be started at the 5 to 10 mg once daily so that’s about the torsionmy torsoment is one of a long acting loop diuretic which belongs to peridenyl sulfonylurea and because of this sulfonylurea moiety it can produce the hypersensitive reactions and can also increase the
Glucose levels resulting in the hyperglycemia this drug inhibits the sodium potassium two chloride exchange pump on the apical membrane of the ascending loop of henle thereby can inhibit the reabsorption of sodium and chloride ions therefore this drug increases sodium chloride excretion along with the sodium chloride it can also increase the excretion of other
Ions like the potassium magnesium calcium chloride ions and water but it will reduce excretion of uric acid so this drug can be used in the conditions where there is excess of body volume resulting in the swelling which may be associated with heart failure or renal failure in such conditions torsomet can be given to increase the urination and urinary volume but
Hypotension electrolyte imbalances and voter toxicity are the important precautions that should be considered when our torsoment is going to be prescribed so that’s about the torso mite hope you have enjoyed this video if you like this video please subscribe to our channel share this video with your friends post your comments in the comment box thank you for watching this video
Transcribed from video
Torsemide – Mechanism, side effects and uses By egpat
