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VASOPRESSIN TAGLE Vasopressin Body fluid osmolality- controlled by homeostatic mechanism Released by the posterior pituitary during: 1.

Water deprivation 2. Increased plasma osmolality-principal stimulus 3. Hypovolemia/hypotension -acts primarily in the renal collecting duct -inc permeability of cell membrane -Potent vasopressor with potent vasoconstrictor action -Inc plt aggregation Regulation of Vas secretion 1.hyperosmolality -Above 280mosm/kg, 2-3x inc in plasma conc -Allows pt to survive longer periods of water deprivation. 2. hepatic portal osmoreceptors 3. Hypovolemia, hypotension 4. Hormones neurotransmitters Stimulates rel: Ach, aspartate, cck Histamine, dopa, glutamine, neuropeptide y,subs p, intestinal polypeptide,prostaglandin, angiotensin 2 Inhibitor: Atrial Natriuretic Peptide, GABA, opioids 5. Pharmacological agents Basic pharmacological Vasopressin Receptors -V1a -V1b -V2 V1 receptor-effector coupling Immediate responses -Vasoconstriction

-Glycogenolysis -Plt aggregation -Acth release V1 receptor-effector coupling -Degradation of multivesicular bodies -Endocytosis -Phophorylation of proteins -Exocytosis Renal actions of vasopressin Figure chuva Non renal actions -Cv sys -Cns -Bld coag Dse affecting the vaso Diabetes Insipidus -Dse of impaired renal conservation of h20 -Central DI- dec sec of neurohyphysis -Nephrogenic DI-insufficient renal resp to vasopressin -S/s Polyuria-more than 30/ml/kg/day Dilute urine- less than 200 mosm/kg Polydipsia Fluid deprivation test Desmopressin-will differentiate central from nephrogenic DI Inappropriate ADH -Dse of impaired h20 excretion with accompanying hyponatremia and hypoosmolality -Lethargy, anorexia, n/v, muscle cramps, coma, convulsions, death -Malignancies (oat cell ca), pulmo dse cns injuries, gen surgery -Dilutional hyponatremia -fluoxetine, haloperidol, TCA -Sulfonylureas -Vinca alkaloids -Tx: for symptomatic pts Lithium Tetracycline

Therapeutic Uses -Pitressin -Desmopressin -Lypressin (diapid)-intranasally -Terlipressin (glypressin) bleeding esophageal varices Toxicity: -Mostly d/t v1 receptors acting on vascular and smooth muscle -Less common in desmopressin -Marked facial pallor -Inc GI act nausea, belching -Caution in cad arrhythmias, dec cardiac output Adverse effect -H20 intoxication -Potentiated by carbamazepine chlorpropramide, morphine, TCA and NSAIDS -Dec by lithium, demeclocylcine, ethanol Future directions: Conivaptin (vaprisol) -V2 recptor antagonist -Recently approved by fda for tx of euvolemic hyponatremia in hospitalized pts w/o chf -Pts with SIADH, hypothyroidism, adrenal insufficiency