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Renal > 2.3 Clinical Aspects: Diuretics > Flashcards

2.3 Clinical Aspects: Diuretics Flashcards

1
Q

Dieretic:

A

drug that increases the rate of urine flow

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2
Q

How are diretics achieved?

A

increased Na+ exretion (+ an anion like chloride) - water follows

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3
Q

site of action for diuretics?

A

different diuretics act in different parts of the tubules

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4
Q

Weakest diuretic?

A

Carbonic anhydrase inhibitors
- acetazolamide (ACE), diclorphenamide

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5
Q

Carbonic anhydrase inhibitors : main clinical use?

A

treatment of glaucoma

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6
Q

Where do Carbonic anhydrase inhibitors occur

A

Proximal tubule

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7
Q

main purpose of Carbonic anhydrase inhibitors ?

A

reabsorb sodium bicarbonate –> acid secretion will occur in response

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8
Q

Effects of CAI:

A

-increase in bicarbinate extretion in urine
- increased urine pH
- metabolic acidosis

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9
Q

Side effects of CAI:

A

-reduce renal blood flow and GFR
- metabolic acidosis
-alkaline in urine (bladder stones)
- Hypokalaemia ( increased distal delivery of Na+)

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10
Q

Where are osmotic diuretics filtered?

A

freeliy filtered at the glomerulus
- tend to sit in urine

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11
Q

Osmotic diuretics increase?

A
  • osmolarity of tubular fluid (& plasma)
  • excretion of almost all electrolytes
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12
Q

Example of osmotic diuretics?

A

Mannitol

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13
Q

Osmotic diuretics pull…

A

water out of intercellular space and into extracellular space

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14
Q

major sit of action for osmotic diuretics?

A

loop of Henle

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15
Q

osmotic diuretics do what?

A
  • expand ECF, decrease blood viscocity, inhibit renin release
  • Increase RBF and reduce medullary tonicity
    -reduce water reabsorption (lowers NaCl in tubule)
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15
Q

osmotic diuretics do what?

A
  • expand ECF, decrease blood viscocity, inhibit renin release
  • Increase RBF and reduce medullary tonicity
    -reduce water reabsorption (lowers NaCl in tubule)
16
Q

What type of reabsorption is osmotic diuretic?

A

passive reabsorption

17
Q

Osmotici diuretics: clinical uses

A

Mainly for :
- intacranial pressure / cerebral oedema (brain tumor

rarely used for :
- acute glaucoma (topical from CAI prefereed)
- acute kidney injury (renal failure

18
Q

side effects of osmotic diuretics:

A
  • volume expansion (cant be used in over-hydrated patient)
  • can cause pulmonary oedema
  • intracranial heomorrage via bleed in brain ( volume expansion would increase)
19
Q

Most common diuretics?

A

loop diuretics:
ex: Furosemide

20
Q

are loop diuretics weak or potent?

A

Potent

21
Q

How do loop diuretics work?

A

inhibit Na+ K+ Cl- symporter in thick ascending loop of henle

22
Q

Most common reason to use loop diuretics?

A

acute and chronic heart failure patients (specifically pulmonary oedema)
-get rid of NaCl and reduce ECF volume

23
Q

Loop diuretics mechanism of action:

A
  • increase excretion of Na and Cl
  • prevent formation of hypertonic medullary interstitium (V potent)
  • increase excretion of Ca2+ and Mg
24
Q

loop diuretics: side effects:

A
  • abnormal fluid and electrolyte balance
  • increase Na delivery to diastal tubule results in loss of H+ and K+
25
Q

Thiazides diuretics inhibit:

A

Na/ Cl symport in the distal convulted tubule

26
Q

Thiazides diuretics used in treatment of?

A

oedema associated with heart failure and cirrhosis

27
Q

Veterinary use of Thiazide?

A

quite limited:
-additive therapy/ refractory heart failure
- prevent calcium oxalate urolithiasis

28
Q

potassium sparing diuretics:

A

cells in late distal tubule and collecting duct
- ENaC inhibitors (ex: amiloride)
-Mineralcorticosteroid (ex: spironolactone)

29
Q

Diuretics with proximal sites of action increase delivery of ___ to distal tubule to increase?

A

delivery of Na+ to the distal tubule to increase K+ and H+ excretion

30
Q

ENac Inhibitors:
Increase __ excretion
decrease ___ and ___ excretion

A

increase Na+ excretion
decrease H+ and L+ excretion

31
Q

ENaC side effects:

A

-limited diuretic potency (not much Na+ reabsorbed)
- contra-indicated in hyperkalaemia

32
Q

ENaC inhibitors:

A
  • not used in veterinary use often
  • sometimes used as 2nd diuretic in refractory oedema
33
Q

Aldosterone effects:

A
  • binds to mineralcortical steroid receptor
  • regulates expression of aldosterone induced proteins (ENaC)
  • ## Increase Na+ conductance in lumen and Na+ pump activity
34
Q

Aldosterone antagonist:

A

commonly used in managment of heart failure and hepatic cirrhosis
-anti-fibrotic effects

35
Q

spironolactone redes risk of

A

hypokalaemia - which can lead to hepatic coma

Renal (5 decks)

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