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PHARMACOLOGY > 5. DIURETICS > Flashcards

5. DIURETICS Flashcards

1
Q

kidney function associated with urinary excretion (4)

A
  1. stabilize osmolarity and volume of extracellular fluid
  2. regulate concentration in extracellular fluid
  3. remove metabolic wastes and foreign substances from blood
  4. contribute to acid-base balance by varying urinary excretion of hydrogen and bicarbonate ions
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2
Q

other functions of kidneys

A

-production of renin: enzyme that regulates formation of angiotensin 2
-production of glucose from substances other than carbohydrates (during prolonged starving)
-production of erythropoietin, hormone that stimulates formation and maturation of erythrocytes
-production of calcitrol, active form of vitamin D (important in regulating of Ca metabolism)

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3
Q

basic renal processes: urine formation 3 steps

A
  1. filtration
    2.reabsorption
  2. secretion
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4
Q

hormones controlling diuresis : hormones of adrenal cortex of adrenal gland

A

aldosterone, desoxycotricosterone and hydrocortisone

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5
Q

hormone of pituitary gland

A

antidiuretic hormone (ADH).
causes water retention in distal kidney tubules. it does not cause changes in electrolyte balance in physiological concentration

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6
Q

aldosterone: most important factor in regulation of

A

urinary excretion of Na

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7
Q

aldosterone total amount of Na in body is most important in determining

A

blood volume and volume of extracellular fluid

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8
Q

aldosterone amount of Na is regulated by

A

aldosterone

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9
Q

total lack of aldosterone causes

A

reduction in blood volume and fatal circulatory shock

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10
Q

ADH produced in

A

paraventricular nucleus of hypothalamus

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11
Q

ADH released as result of

A

change in osmolarity of extracellular fluid > ‘‘dilution’’ of extracellular fluid causes decrease in production of ADH

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12
Q

following increase ADH production

A

-acetylcholine
-general anaesthetics
-histamine
-morphine
-some barbiturates

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13
Q

ADH is reduced by

A

-diabetes insipidus
-multiple medicinal products
-pain
-psychological disorders

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14
Q

impulses sent by hypothalamic osmoreceptors

A

regulate production of ADH

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15
Q

in case of blood electrolytes and osmotic pressure increase

A

-amount of ADH will increase
-reabsorption of water from kidney tubules is enhanced
-osmotic pressure of urine increases
-production of urine is inhibited

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16
Q

renin-angiotensin system (RAS) or renin-angiotensin-aldosterone system (RAAS) is a hormone system that regulates

A

-blood pressure
-fluid and electrolyte balance
-systemic vascular resistance

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17
Q

…. activates RAS or RAAS

A

renin

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18
Q

renin released in body as response to physiological stimulus

A

-hypontension
-hypokalemia
-rapid decrease of blood pressure
-decreased blood volume
-stimulation of beta-receptors

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19
Q

renin catalyses formation of angiotensin 1 from

A

angiotensinogen (in liver)

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20
Q

angiontesin 1 is converted to angiotensin 2 by

A

specific enzymes

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21
Q

angiotensin 2 effects

A

-blood vessels constrict
-blood pressure increases
-synthesis of aldosterone increases

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22
Q

as negative feedback synthesis of renin is

A

inhibited

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23
Q

production of urine

A

balance of water and electrolytes in organism is assured

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24
Q

..% of primary urine is reabsorbed

A

99

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25
Q

reabsorption of electrolytes is active process, occurring

A

against concentration gradient, ATP energy is consumed

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26
Q

participating enzymes in production of urine

A

-carbonic anhydrase
-succinate dehydrogenase

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27
Q

with enhancement of blood supply in kidneys, amount of primary urine

A

increases

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28
Q

diuretics substances that

A

promote production of urine

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29
Q

diuretics enhance ….and reduce…

A

enhance secretion of electrolytes and reduce amount of extracellular fluid

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30
Q

diuretics alleviating oedema. oedema typically occurs as

A

result of retention of sodium in organism and increase in accumulation of extracellular fluid

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31
Q

objective of administration of diuretics - to increase excretion

A

of water from organism

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32
Q

most diuretics exert their effects by

A

inhibiting specific enzymes, transport proteins, hormone receptors or ion channels that mediate reabsorption of sodium in kidney tubules

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33
Q

diuretics also impact excretion of

A

other ions and renal hemodynamics

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34
Q

diuretics primary indications: swelling that is caused by

A

-heart failure
-liver failure
-kidney failure
> different indications for different diuretics

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35
Q

…. caused by diuretics may occur

A

hypovolemia

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36
Q

mechanism of swelling

A

-plasma colloid osmotic pressure is reduced
-intravascular volume depletion occurs and fluid flows to interstitial compartment
-blood plasma volume is lowered > reabsorption of water and salts increases in kidneys
-increased reabsorption of fluid increases plasma volume and plasma hydrostatic pressure, outflow of fluid from capillaries increases and swelling occurs

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37
Q

swelling in case of heart failure

A

-congestive heart failure reduces outflow of blood from heart> reduces blood supply of kidneys > activation of renin-angiotensin-aldosterone system> followed by reabsorption of salts and water in kidneys
-increase in central venous pressure causes increase in hydrostatic pressure in capillaries > fluid penetrates capillary walls > swelling occurs

38
Q

classification of diuretics (9)

A

-water and osmotic diuretics
-salts that form acidic solutions
-carbonic anhydrase inhibitors
-loop diuretics
-epithelial sodium channel blockers
-thiazide diuretics
-aldosterone antagonists
-substances reducing tissue hydrophilicity
-essential oils or plant-based substances

39
Q

h2o and osmotic diuretics

A

-water=more fluid organism contains>more is being excreted. flushing of organism
-pure urea
-mannitol
-sodium chloride
-sodium bicarbonate

40
Q

osmotic diuretics

A

osmotic pressure of blood plasma increases > extracellular fluid and sodium flow into blood > excreted via kidneys
-strong tissue dehydration effect

41
Q

osmotic diuretics cannot be used

A

when kidney function is impaired > will instead lead to swelling

42
Q

side effects of osmotic diuretics - mannitol

A

-nausea , vomiting
-dehydration, hypernatremia
-loss of other electrolytes, incl. K

43
Q

therapeutic uses of mannitol

A

-with other diuretics to mobilize edema
-for reduction of intracranial and intraocular pressure
-treatment of renal failure > reduction of swelling of tubular elements

44
Q

diuretics contraindicated in case of

A

ongoing cranial hemorrhage, anuric renal failure, severe dehydration, pulmonary edema, heart failure

45
Q

salts that form acidic solutions

A

-ammonium chloride
-ammonium nitrate
-salt is dissociated into NaCl and ammonia > diuretic effect is based upon releasing Cl ion, which binds to Na from extracellular fluid > forming NaCl > which in turn causes osmotic diuresis. Na and K are excreted
-acidosis occurs as side effect

46
Q

salts that form acidic solutions are contraindicated in case of

A

kidney failure and liver failure

47
Q

salts that form acidic solutions can be used to

A

dissolve certain types of bladder stones
> also be used to promote excretion of certain toxins or drugs into urine

48
Q

salts that form acidic solutions side effects

A

-vomiting
-increased thirst
-rapid breathing
-drowsiness
-rapid or irregular heart beat

49
Q

carbonic anhydrase inhibitors

A

-acetazolamide
-dichlorphenamide
-methazolamide
-carbonic anhydrase promotes reabsorption of sodium and water in kidney tubules > diuresis increase in event of blocking

50
Q

carbonic anhydrase inhibitors reduce the excretion of

A

ammonium, toxic effect on liver

51
Q

carbonic anhydrase inhibitors excrete

A

K ions

52
Q

carbonic anhydrase inhibitors mainly used to

A

reduce internal eye pressure in case of glaucoma in dogs

53
Q

CA inhibitors are sulfonamide derivatives-side effects occur when

A

animals are sensitive to sulfonamides

54
Q

CA inhibitors contraindicated in patients with

A

electrolyte disturbances and those with metabolic or respiratory acidosis

55
Q

loop diuretics that act

A

at loop of Henle

56
Q

loop diuretics with most potent effect, they inhibit

A

primary sodium reabsorption mechanism

57
Q

loop diuretics - Furosemide- most frequently used

A

diuretic

58
Q

loop diuretics it is used in case of

A

oedema caused by heart failure, liver failure or kidney failure

59
Q

loop diuretics-NSAIDs inhibit

A

diuretic, natriuretic and chloruretic responses to furosemide

60
Q

loop diuretics side effects are related to

A

disorders involving electrolyte balance, K is excreted

61
Q

loop diuretics- extracellular volume depletion and hyponatremia-reduced

A

blood pressure, diminished organ perfusion

62
Q

loop diuretics-hypochloremic … and …

A

alkalosis and hypokalemia

63
Q

loop diuretics potential for …toxicity

A

ototoxicity (sisäkorvan vaurioituminen)

64
Q

loop diuretics cats are more … than dogs

A

sensitive

65
Q

furosemide can be used in case of

A

heart failure in patients already receiving ACE inhibitors , digoxin, or both

66
Q

torasemide-loop diuretics-treatment of clinical signs, including

A

oedema and effusion, related to congestive heart failure

67
Q

bumetanide (loop diuretic) is indicated for treatment of

A

edema associated with congestive heart failure, cirrhosis of liver and renal disease including nephrotic syndrome (group of symptoms that include protein in urine, low blood protein levels, high triglyceride levels , and swelling)

68
Q

renal epithelial sodium channel blockers

A

-triamterene
-relatively weak-acting diuretic, to certain extent potassium-sparing, used in combination with thiazide diuretics or loop diuretics (generally not commonly used)
inhibit reabsorption of sodium
-side effects are increase in risk of hyperkalemia and kidney dysfunction

69
Q

thiazide diuretics

A

-chlorothiazide
-hydrochlorothiazide
-they increase excretion of sodium and potassium from organism
-have been used to treat swelling with different root causes
-part of treatment scheme in treatment of nephrogenic diabetes insipid > diuretic-induced volume contraction leads to increased proximal tubule reabsorption and decrease in urine volume

70
Q

thiazide diuretics side effects are

A

hypokalemia, hyponatraemia, hypochloraemia, simultaneously hypercalcemia > several substances from sulfonamide class of drugs, effect is diuretic, also used in human medicine to treat hypertension

71
Q

aldosterone antagonist-aldosterone hormone of

A

adrenal cortex of adrenal glands, mineralocorticoid, participates in water and electrolyte metabolism, enhances reabsorption of sodium and water and excretion of potassium

72
Q

spironolactone-aldosterone antagonist-with steroidal structure, enhances

A

elimination of sodium, reduces secretion of K and urea (potassium-sparing diuretics)

73
Q

spironolactone can be used in combination with

A

other diuretics, primarily furosemide

74
Q

aldosterone antagonist side effects

A

hyperkalemia, dehydration, hyponatremia

75
Q

substances reducing tissue hydrophilicity

A

-caffeine (weakest diuretic)
-theophylline (most potent diuretic)
-euphyllin
-theobromine

76
Q

substances reducing tissue hydrophilicity they also have cardiostimulating effect, increase

A

blood supply of kidneys and cause tissue dehydration. Blood inflow to heart and kidneys increases, reflexive ADH production decrease occurs

77
Q

plant diuretics

A

-motly plants containing essential oils
-juniper berries
-bearberry leaves
-field horsetail herb
-parsley root
-lingonberry leaves
-mechanism of action is unclear, probably irritant effect on kidney tissue

78
Q

substances with diuretic effect

A

-cardiac glycosides (digitalis compounds)
-ACE inhibitors

79
Q

telmisartan (semintra) for reduction of proteinuria resulting

A

from chronic kidney disease in cats

80
Q

telmisartan is orally active and specific angiotensin 2 receptor (AT1 type) antagonist, which causes

A

decrease in mean arterial blood pressure, depending upon dosage, in mammal species, including cats

81
Q

telmisartan clinical study of cats with kidney disease found

A

reduction in proteinuria within first 7 days from start of therapy

82
Q

telmisartan forces out angiotensin 2 from its

A

binding site with AT 1 receptor subtype

83
Q

telmisartan selectively binds AT 1 receptor and does not

A

show affinity to other receptors, including AT 2 receptor and other less characterized AT receptors

84
Q

AT1 reveptor stimulation causes pathological effects of

A

angiotensin 2 on kidneys and other organs that are linked to angiotensin 2 > example vasoconstriction, sodium and water retention, increase in synthesis of aldosterone and changes in organ shape

85
Q

telmisartan effects of AT2 receptor stimulation, including vasodilation, natriuresis and inhibition of undesired cell growth

A

are not suppressed

86
Q

telmisartan binding receptors of long-term duration due to

A

slow dissociation of telmisartan from AT1 receptor binding site

87
Q

telmisartan ‘’’’’ partial agonist activity on AT1 receptor type

A

DOES NOT HAVE

88
Q

combinations of active substances : benazepril + spironolactone (Cardalis) treatment of

A

congestive heart failure caused by chronic degenerative valvular disease in dogs ( with diuretic support, as appropriate)

89
Q

spironlactone inhibits

A

aldosterone-induced sodium retention in kidneys > leading to increase in sodium and subsequently water excretion and potassium retention
-accompanying reduction in extracellular volume reduces cardiac preload and left ventricle pressure

90
Q

benazepril hydrochloride is

A

prodrug that is hydrolyzed in vivo into active metabolite benazeprilat

91
Q

benazeprilat is potent and selective

A

angiotensin-converting enzyme (ACE) inhibitor, preventing inactive angiotensin 1 from being converted into active angiotensin 2

92
Q

benazeprilat mediated actions of angiotensin 2 are

A

blocked > including constriction of arteries and veins and retention of sodium and water by kidneys

PHARMACOLOGY (14 decks)

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