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Yr 2 Sem 2 CPT > 4.1 Diuretics and Renal Pharmacology > Flashcards

4.1 Diuretics and Renal Pharmacology Flashcards

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1
Q

What is the renal physiology mnuemonic?

A

Regulatory
Excretory
Endocrine
Metabolism

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2
Q

What are the regulatory functions of the kidney?

A

Fluid balance
Acid-base balance
Electrolyte balance

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3
Q

What are the excretory roles of the kidney?

A

Excretion of

  • Waste products
  • Drugs (glomerular filtration, tubular secretion)
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4
Q

What are the endocrine roles of the kidney?

A

Renin
Erythropoietin
Prostaglandins
1-alpha calcidol

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5
Q

What is the role of 1-alpha calcidol?

A

To hydroylate vitamin D

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6
Q

What is metabolised by the kidney?

A

Vitamin D
Polypetides - insulin
Drugs - morphine, paracetamol

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7
Q

Why may a diabetic present with hypoglycaemia when they have kidney damage?

A

Insulin is metabolised int he kidney

If they have kidney damage then insulin will stay in the body of longer

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8
Q

What is diuresis?

A

Loss of water

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9
Q

What word describes loss of sodium?

A

Natriuresis

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10
Q

What does aldosterone do?

A

Increases expression of ENaC and Na/K/ATPase in the principle cells of CD

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11
Q

Name two substances with diuretic action

A

Alcohol

Caffeine

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12
Q

How does alcohol act as a diuretic?

A

Inhibits ADH release

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13
Q

How does caffeine act as a diuretic?

A

Increase GFR
Decrease tubular Na reabsorption

Can become habituated to it

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14
Q

Name two ADH antagonists

A

Lithium

Tolvaptan

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15
Q

How does lithium work?

A

Inhibits action of ADH

Diuretic but not natriuretic

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16
Q

Is tolvaptan a natriuretic?

A

No

It is a diuretic though

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17
Q

What is tolvptan used to treat?

A

Hyponatraemia

Prevent cyst enlargement in APCKD

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18
Q

What are some generic adverse drug reactions to diuretics?

A 
Anaphylaxis/photosensitivity rash 
Hypovolaemia and hypotension 
- Activates RAAS and can lead to acute kidney injury 
Electrolyte disturbance 
Metabolic abnormalities
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19
Q

Name some diuretics

A

Thiazides
Furosemide
Spironolactone
Bumetanide

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20
Q

Name some common specific ADRs to thiazides

A 
Gout
Hyperglycaemia 
Erectile dysfunction 
Increase LDL and TG 
Hypercalcaemia
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21
Q

Name some common specific ADRs to furosemide

A

Ototoxicity
Alkalosis
Increase LDL and TG
Gout

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22
Q

Name some common specific ADRs to spironolactone

A

Hyperkalaemia
Impotence
Painful gynaecomastia

23
Q

Name a common specific ADR to bumetanide

A

Myalgia

24
Q

Name some uses for diuretics

A 
Hypertension 
Heart failure 
Decompensated liver disease 
Nephrotic syndrome 
Chronic kidney disease
25
Q

Which diuretics could be used to treat hypertension?

A

Thiazides (also vasodilate)
Spironolactone
Loop diuretics (short duration of action so only work well in people with renal failure)

26
Q

Which diuretics can be used to treat HF?

A

Loop diuretics

Spironolactone (Remodelling of heart)

27
Q

Which drugs can be used for decompensated liver disease?

A

Spironolactone

Loop diuretics

28
Q

Which diuretics can be used to treat nephrotic syndrome?

A

Large dose of loop diuretic

+/- thazides and potassium sparing diuretic/K supplements

29
Q

What diuretics can be used to treat CKD?

A 
Loop diuretics (+/- thiazides) 
Avoid K sparing
30
Q

Why may someone with CKD need a diuretic?

A

Decreased GFR leads to salt and water retention

31
Q

What three types of patient may have diuretic resistance?

Why?

A

Chronic renal failure - Less nephrons working

Nephrotic syndrome - oedematous so gut doesn’t absorb as well, low albumin

Heart failure - Less delivery to kidney

32
Q

Where are diuretics absorbed?

A

In the gut

33
Q

What do diuretics bind to in the body?

A

Albumin

34
Q

Why may a patient develop diuretic resistance if they have acute tubular necrosis?

A

Diuretics are bound to albumin so can’t cross the glomerulus
Transported by OATs in proximal tubule
Proximal tubule won’t work well in acute TN

35
Q

What action should be taken in refractory oedema?

A

Check salt intake
Give furosemide IV is gut oedema likely
Find minimum effective dose
Five repeated bolus or infusion as short half life

36
Q

Why do thiazides cause hyponatraemia and hypokalaemia?

A

Work in cortex so dont affect medullary interstitial concentration
Block sodium reabsorption and water -> hypovolemic -> activate RAAS
But water is resorbed because there is still a hypertonic interstitium so ADH still works

37
Q

What are carbonic anhydrase inhibitors used for?

A

Glaucoma

Altitude sickness

38
Q

Why are carbonic anhydrase inhibitors not used for a diuretic?

A

Because the rest of the nephron would compensate

Would only end up losing bicarbonate

39
Q

What are osmotic diuretics used for?

A

Reduce high intracerebral pressure

40
Q

What are loop diuretics used for?

A

Oedema

Hypertension in CKD

41
Q

What are thiazides used for?

A

Hypertension

42
Q

What are potassium sparing diuretics used for e.g. amiloride?

A

Low potassium where diuretic required

May cause hyperkalaemia

43
Q

What are aldosterone antagonists used for?

A

HF
Ascites
Hypertension
Hyperadrenalism - block effect of aldosterone

44
Q

What are ADH antagonists used for?

A

Hyponatraemia

45
Q

Name some potentially nephrotoxic drugs

A

Aminoglycosides eg gentamicin
Vancomycin IV
Aciclovir
NSAIDs

46
Q

Name some drugs that can cause problems with renal dysfunction

A

ACE inhibitors
Diuretics
NSAIDs

47
Q

What is the problem with metformin in people with renal dysfunction?

A

Metformin is not nephrotoxic but is acidotic
Impaired renal function can already lead to acidosis
So it is adding acidosis to already acidosis

48
Q

How do NSAIDs affect renal perfusion?

A

Decrease GFR by stopping vasodilation of the afferent arteriole by prostaglandins

49
Q

How do ACE inhibitors affect renal perfusion?

A

Decrease GFR by stopping AngII from vasoconstriction the efferent arteriole

50
Q

What are two major risk factors for hyperkalaemia?

A

Increased catabolism/tissue damage

Reduced urine production

51
Q

What initial ECG changes can be seen in hyperkalaemia?

A

Tall T waves

52
Q

What on an ECG would indicate severe hyperkalaemia?

A

Sine waves

53
Q

Outline the treatment of hyperkalaemia

A

1) Protect the heart - calcium gluconate
2) Lower serum K - insulin/dextrose
3) Remove K from body - Calcium resonium

Yr 2 Sem 2 CPT (9 decks)

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