Drugs of this group inhibit activity of carbonic anhydrase, an enzyme that catalyzes the reversible reaction of water and carbon dioxide, which forms carbonic acid. The mechanism of action of this group of drugs is not fully understood. However, inhibition of carbonic anhydrase activity leads to a reduction of carbonic acid formation and an increase in bicarbonate, sodium, and potassium excretion with urine, which eventually leads to a significant increase in the process of excreting water from the organism.
Symptoms for using carbonic anhydrase inhibitors are: edema in cardiopulmonary insufficiency, glaucoma (wide angle, secondary, and preoperational narrow-angle glaucoma), minor epileptic attacks, premenstrual high blood pressure, and severe altitude sickness. It is believed that in glaucoma, the effect of drugs is possibly linked to suppression of carbonic anhydrase in ciliary bodies, which can result in decreased secretion of cerebrospinal fluid. Of the drugs that suppress carbonic anhydrase activity, acetazolamide, methazo-lamide, and dichlorphenamide are used in medical practice.
Acetazolamide: Acetazolamide, 5-acetamido-1,3,4-thiadiazol-2-sulfonamide (9.7.5), is synthesized according to a scheme given in Chapter 9.
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