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Pharmacology > 13 Kidney > Flashcards

13 Kidney Flashcards

1
Q

13.01 LOOP DIURETICS

Furosemide, bumetanide - actions

A

cause copious urine production by inhibiting NaCl reabsorption in the thick ascending loop
increase excretion of Ca2+ and Mg2+
decrease excretion of uric acid

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2
Q

13.01 LOOP DIURETICS

Furosemide, bumetanide - MOA

A

inhibit the Na+/K+/2Cl− co-transporter in the luminal membrane by combining with the chloride binding site

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3
Q

13.01 LOOP DIURETICS

Furosemide, bumetanide - abs/distrib/elim

A

given orally (can be given IV in severe cases)
well absorbed
reaches site of action by being secreted into the proximal tubule
half-life 90 min

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4
Q

13.01 LOOP DIURETICS

Furosemide, bumetanide - clinical use

A

pulmonary oedema
chronic heart failure
ascites due to liver cirrhosis
hypercalcaemia

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5
Q

13.01 LOOP DIURETICS

Furosemide, bumetanide - adverse effects

A

hypokalaemic alkalosis
hyperuricaemia (can precipitate gout)
hypovolaemia and hypotension in elderly patients
nephro- and ototoxicity

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6
Q

13.02 THIAZIDE DIURETICS

Hydrochlorothiazide, bendroflumethiazide, chlortalidone - actions

A

cause moderate degree of diuresis by inhibiting NaCl reabsorption in the distal tubule
increase excretion of K+, H+ and Mg2+
decrease excretion of Ca2+ and uric acid
some vasodilator action

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7
Q

13.02 THIAZIDE DIURETICS

Hydrochlorothiazide, bendroflumethiazide, chlortalidone - MOA

A

inhibit the Na+/Cl− co-transporter in the luminal membrane of the distal convoluted tubule

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8
Q

13.02 THIAZIDE DIURETICS

Hydrochlorothiazide, bendroflumethiazide, chlortalidone - abs/distrib/elim

A

given orally
reaches site of action by being secreted into the proximal tubule
half-life 90 min

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9
Q

13.02 THIAZIDE DIURETICS

Hydrochlorothiazide, bendroflumethiazide, chlortalidone - clinical use

A

hypertension
mild heart failure
nephrogenic diabetes insipidus
kidney stones

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10
Q

13.02 THIAZIDE DIURETICS

Hydrochlorothiazide, bendroflumethiazide, chlortalidone - adverse effects

A

potassium loss
metabolic alkalosis
hyperuricaemia (can precipitate gout)
hypotension
mild hypercalcaemia
insulin resistance
erectile dysfunction

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11
Q

13.03 POTASSIUM-SPARING DIURETICS

Spironolactone, amiloride, eplerenone, triamterene - actions

A

inhibits Na+ reabsorption in the distal nephron
has limited diuretic efficacy
reduces K+ excretion

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12
Q

13.03 POTASSIUM-SPARING DIURETICS

Spironolactone, amiloride, eplerenone, triamterene - MOA

A

amiloride inhibits the sodium channel in the luminal membrane of the collecting tubule, reducing sodium influx
spironolactone is a competitive antagonist of aldosterone; causes diuresis by preventing the production of the aldosterone mediator that normally causes influx of sodium by activating the sodium channel in the luminal membrane of the collecting tubule

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13
Q

13.03 POTASSIUM-SPARING DIURETICS

Spironolactone, amiloride, eplerenone, triamterene - abs/distrib/elim

A

given orally
triamterene has a more rapid onset and shorter duration of action than amiloride
spironolactone half-life 10 min, but its active metabolite canrenone has a plasma half-life of 16h
eplerenone has a shorter elimination half-life and has no active metabolites

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14
Q

13.03 POTASSIUM-SPARING DIURETICS

Spironolactone, amiloride, eplerenone, triamterene - clinical use

A

given with K+-losing diuretics (thiazides, loop diuretics) to limit K+ loss
spironolactone or eplerenone are used in heart failure, primary hyperaldosteronism, resistant essential hypertension, secondary hyperaldosteronism caused by hepatic cirrhosis complicated by ascites

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15
Q

13.03 POTASSIUM-SPARING DIURETICS

Spironolactone, amiloride, eplerenone, triamterene - adverse effects

A

hyperkalaemia, may cause acidosis
spironolactone can cause gynaecomastia

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16
Q

13.04 OSMOTIC DIURETICS

Mannitol - actions

A

increases the amount of water excreted by the kidney
has a smaller effect on sodium excretion

17
Q

13.04 OSMOTIC DIURETICS

Mannitol - MOA

A

is an inert compound that passes across into the filtrate at the glomerulus and is not resorbed
acts in those parts of the nephron that are freely permeable to water

18
Q

13.04 OSMOTIC DIURETICS

Mannitol - abs/distrib/elim

A

given IV
not metabolised
excreted in ~30 min

19
Q

13.04 OSMOTIC DIURETICS

Mannitol - clinical use

A

cerebral oedema
increased intraocular pressure (only if no other treatment is available)

20
Q

13.04 OSMOTIC DIURETICS

Mannitol - adverse effects

A

temporary expansion of the ECF compartment and hyponatraemia due to osmotic extraction of intracellular water
pulmonary oedema

Pharmacology (34 decks)

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