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4 Clinical Pharmacology and Intro to Prescribing > 6 Diuretics and Renal Pharmacology > Flashcards

6 Diuretics and Renal Pharmacology Flashcards

1
Q

Identify four endocrine secretions of the kidney

A
  • Renin
  • Erythropoetin
  • Prostaglandins
  • 1-alpha calcidol - vitamin D
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2
Q

Which substances does the kidney metabolise? (3)

A
  • Vitamin D
  • Polypeptides e.g. insulin
  • Drugs e.g. morphine, paracetamol
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3
Q

What are the seven different types of diuretic drugs acting on the kidney?

A
  • Carbonic anhydrase inhibitors
  • Osmotic diuretics
  • Loop diuretics
  • Thiazides
  • K+ sparing diuretics
  • Aldosterone antagonists
  • ADH Antagonists
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4
Q

Describe the actions (2) and side effects (2) of carbonic anhydrase inhibitors

A

Actions:

  • Sodium bicarbonate diuresis
  • Excretion of Na+, K+ and PO3

Side effects:

  • Metabolic acidosis
  • Hypokalemia
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5
Q

Describe the actions and side effects of osmotic agents

Name an example of an osmotic agent.

A

Actions:

  • Filtered at glomerulus
  • Increase osmotic gradient throughout nephron
  • Excessive water loss

Side effects:

  • Hypernatraemia

Example:

  1. Mannitol
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6
Q

Describe the actions and effects of aldosterone antagonists.

Name an example:

A
  • Competes with aldosterone at mineralcorticosteroid receptor
  • Aldosterone increases expression of ENaC and Na/K/ATPasein principal cells of the collecting duct

Example:

Spironolactone (potassium sparing)

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7
Q

Describe the actions and side effects of loop diuretic.

Name 2 examples.

A

Actions:

  • Thick ascending limb loop of Henle
  • Inhibit NaCl reabsorption (block Na/K/2Cl co-transporter)
  • Concurrent Ca/Mg excretion

Side effects:

  • Hypokalaemia (CD)

Examples:

  1. Bumetanide
  2. Furosemide
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8
Q

Describe the actions and side effects of thiazides.

Name 2 examples.

A

Actions:

  • Inhibits NaCl reabsorption
  • Promotes Ca reabsorption

Side effects:

  • Hypokalaemia
  • Hyperuricaemia

Examples:

  1. Bendroflmethiazide
  2. Indapamide
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9
Q

Identify 5 common specific ADRs from thiazides

A
  • Gout
  • Hyperglycaemia
  • Erectile dysfunction
  • ↑LDL & TG
  • Hypercalcaemia
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10
Q

Outline the action of ADH antagonists. (aquaretics)

Give 2 examples

A

ADH antagonists reduce concentrating ability of urine in collecting ducts

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11
Q

Explain how the following substances have diuretic action:

  • Alcohol
  • Caffeine
A
  • Alcohol – inhibits ADH release
  • Caffeine – ↑GFR and ↓ tubular Na+ reabsorption
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12
Q

Identify four generic adverse drug reactions from diuretics

A
  • Anaphylaxis / photosensivity rash
  • Hypovolaemia & hypotension
  • Electrolyte disturbance (Na+, K+, Mg2+, Ca2+)
  • Metabolic abnormalities
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13
Q

Identify 3 common specific ADRs from spironolactone

A
  • Hyperkalaemia
  • Impotence
  • Painful gynaecomastia (male breasts)
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14
Q

Identify 4 common specific ADRs from furosemide (loop diuretic)

A
  • Ototoxicity
  • Alkalosis
  • ↑LDL & TG
  • Gout
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15
Q

Identify a common specific ADRs from bumetanide (loop diuretic)

A

Myalgia

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16
Q

Explain the effect of ACE Inhibitors interacting with K+ sparing diuretics

A

Increased hyperkalaemia → cardiac problems

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17
Q

What is the effect of aminoglycosides interacting with loop diuretics?

A
  • Ototoxicity
  • Nephrotoxicity
18
Q

Explain the effect of digoxin interacting with thiazide and loop diuretics

A

Hypokalaemia → increased digoxin binding & toxicity

19
Q

What is the effect of β- Blockers interacting with thiazide diuretics?

A
  • Hyperglycemia
  • Hyperlipidemia
  • Hyperuricaemia
20
Q

What is the effect of steroids interacting with thiazide & loop diuretics?

A

Increased risk of hypokalaemia

21
Q

What is the effect of lithium interacting with thiazide & loop diuretics?

A
  • Lithium toxicity (thiazides)
  • Reduced lithium levels (loop)
22
Q

What is the effect of carbamazepine interacting with thiazide diuretics?

A

Increased risk of hyponatraemia

23
Q

Which diuretics are commonly used to treat hypertension? Why are loop diuretics not usually used?

A
  • Thiazide diuretics (vasodilatation as well as diuresis)
  • Spironolactone

(Loop diuretics) - don’t work well as body compensates quickly

24
Q

Which diuretics are commonly used to treat heart failure?

A
  • Loop diuretics
  • Spironolactone (non-diuretic benefits)

(ACE inhibitors/ ARBs)

(Beta- blockers)

25
Q

Which diuretics are commonly used to treat decompensated liver disease?

A
  • Spironolactone
  • Loop diuretics
26
Q

Which diuretics are commonly used to treat nephrotic syndrome?

A
  • Loop diuretic (often big doses needed)
  • ± Thiazides
  • ± K+ sparing diuretic / K+ supplements
27
Q

Which diuretics are commonly used to treat Chronic Kidney Disease?

A
  • Loop diuretics
  • ± Thiazide-like
  • Generally avoid K+ sparing diuretics

(Alkalosis and kalliuretic effects potentially beneficial)

Kalliuretic= getting rid of potassium in urine)

28
Q

Describe the process and requirements for diuretic delivery to renal tubule e.g. furosemide

Need to consider these when it comes of delivering drugs because if gut oedema for examples- fluid overloaded anyway so drug not well absorbed

A
  • Blood flow to proximal tubule must be intact (transport via albumin)
  • Proximal tubule must be functioning to transport furosemide across
  • Thich Ascending Limb must be intact to respond to furosemide
29
Q

In four steps, describe the clinical approach to treat a patient with refractory oedema

(Refractory oedema= peripheral oedema that does not respond to dietary sodium restriction and combined diuretic treatment including a loop diuretic, often caused by an evident underlying cardiac or pulmonary condition)

A

⇒ Check salt intake

⇒ IV furosemide (if gut oedema likely)

⇒ Find minimum effective dose

⇒ Give repeated bolus or infusion (short t1/2)

30
Q

Describe the relationship between diuretic drugs and kidney function in terms of adverse reactions (2 important points to consider)

A
    • Drugs may reduce kidney function by direct/indirect toxicity
    • Drugs may accumulate to toxic levels if they are excreted through the kidneys and renal function is impaired
31
Q

Identify four potentially nephrotoxic drugs

A
  • Aminoglycosides e.g gentamicin
  • Vancomycin (IV only)
  • Aciclovir (antiviral)
  • NSAIDs
32
Q

Identify four drugs which can exacerbate renal dysfunction

A
  • ACE-Inhibitors
  • Diuretics
  • NSAIDs
  • Metformin
33
Q

Describe the three steps in the emergency treatment of hyperkalaemia

A

⇒ Protect the heart → calcium gluconate

⇒ Lower serum K+ → insulin / dextrose

⇒ Remove K+ from body → calcium resonium

34
Q

What do the terms natriuretic and aquaretic mean? (vs diuretic)

A

Natriuretic- peeing sodium

Aquaretic- peeing water only

Diuretic- peeing urine

35
Q

Fill in the missing labels showing which drugs work at which site:

A
36
Q

Useful table for drug-drug interactions with diuretics:

A
37
Q

Apart from spironolactone, give another example of a potassium sparing diuretic and state how is works:

A

Amiloride

Block ENaC at luminal surface of renal tubule

38
Q

What are carbonic anhydrase inhibitors used to treat?

A
  • Glaucoma
  • Mountain sickness

(BUT tolerance builds up in 2-3 days)

39
Q

Mannitol is an osmotic agent (diuretic), what is it used for?

(need to be careful as patients can become hypernaetraemic)

A

Used as diuretic in ITU to 1) relieve ICP and to 2) force urine production in people with acute (sudden) kidney failure

40
Q

What are SGLT2 inhibitors used for?

A

Treating type 2 diabetes

Get rid of uric acid

4 Clinical Pharmacology and Intro to Prescribing (27 decks)

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