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Clinical Pharmacology > 19) Diuretics and Drugs in Kidney Disease > Flashcards

19) Diuretics and Drugs in Kidney Disease Flashcards

1
Q

What are the functions of the kidneys?

A

Regulatory - fluid, acid-base and electrolyte balances
Excretory
Endocrine - RAAS, EPO
Metabolism - vit D and polypeptides

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2
Q

List drugs that acts at the renal tubules:

A 
Carbonic anhydrase inhibitors
Osmotic diuretics
Loop diuretics
Thiazides
Potassium sparing diuretics
ADH antagonists
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3
Q

When are osmotic diuretics used?

A

Cerebral oedema

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4
Q

What are the side effects of osmotic diuretics?

A

Hypernatremia

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5
Q

What is the effect of loop diuretics on electrolytes?

A

Inhibit Na+ and Cl- reabsorption
Concurrent Ca2+ and Mg2+ excretion
Hypokalemia

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6
Q

What is the effect of thiazides on electrolytes?

A

Inhibit Na+ and Cl- reabsorption
Ca2+ reabsorption
Hypokalemia and hyperuricemia

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7
Q

What are the general adverse drug reactions of diuretics?

A

Hypovolemia and hypotension
Electrolyte disturbances
Anaphylaxis

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8
Q

What are some side effects of thiazides?

A

Gout

Erectile dysfunction

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9
Q

What are some side effects of furosemide?

A

Ototoxicty

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10
Q

What are some side effects of spironolactone?

A

Hyperkalemia

Painful gynaecomastia

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11
Q

What drug interactions should we be aware of with loop diuretics?

A

Aminoglycosides: ototoxicity and nephrotoxicity
Digoxin: hypokalemia
Steroids: hypokalemia

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12
Q

What drug interactions should we be aware of with thiazides?

A

Beta blockers: hyperglycemia, hyperlipidemia, hyperuricemia
Carbamazepine: hyponatremia
Digoxin: hypokalemia
Steroids: hypokalemia

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13
Q

What drug interactions should we be aware of with K+ sparing diuretics?

A

ACEi - hyperkalemia

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14
Q

What are some reasons as to why patients might have a ‘diuretic resistance’?

A 
Incomplete treatment of primary disorder
Continuation of high Na+ intake
Non-compliance
Poor absorption - gut oedema
NSAIDs
Volume depletion
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15
Q

When are diuretics indicated?

A

Heart failure
Hypertension
Decompensated liver disease
Conn’s syndrome

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16
Q

What factors should be considered when prescribing in chronic renal failure?

A

Avoid nephrotoxins
Reduce dosage in line with GFR if excreted by kidney
Monitor renal function

17
Q

What are some nephrotoxic drugs?

A 
ACEi
Aminoglycosides
Penicillins
Cyclosporin
Metformin
NSAIDs
18
Q

Describe why ACEi may be given in renal artery stenosis and the danger of this:

A

Reduced blood flow to kidney cause decreased GFR, activation of RAAS and increased BP
Give ACEi for HTN but this dilated EA and causes further reduction in GFR

19
Q

How does hyperkalemia present on ECG?

A

Loss of P waves, wide QRS, tented T waves

20
Q

What is the treatment for hyperkalemia?

A

Calcium gluconate, insulin and dextrose

Clinical Pharmacology (24 decks)

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