9. Pharmacology

Question 1

What does ACEi stand for?

Answer 1

Angiotensin converting enzyme inhibitor

Question 2

What is the function of the renin-angiotensin system?

Answer 2

Increase blood pressure
By:
1. ↑ sodium retention in kidneys
2. ↑ vasoconstriction

Question 3

Renin is released by the kidneys.

What drug type inhibits its release?

Answer 3

Beta-blockers

Question 4

What role does aldosterone have in the renin-angiotensin system?

Answer 4

Stimulates sodium uptake & potassium excretion in the kidneys.
Thus retaining water.

Question 5

What effect do ACE inhibitors have and how do they do this?

Answer 5

ACEi decrease blood pressure.
They inhibit the conversion of angiotensin I > angiotensin II in the lungs by ACE.
Therefore vasoconstriction is stopped and aldosterone release is inhibited, so sodium is not retained by kidneys.

Question 6

The glomerulus is found in the medulla of the kidney.

True or False?

Answer 6

FALSE
cortex
loop of Henle is in medulla

Question 7

Why must the use of ACEi be stopped if a patients kidney function has significantly declined?

Answer 7

ACE inhibitors reduce GFR (glomerular filtration rate) by preventing the efferent arteriole constricting.
If the patient has such a low kidney function that they are relying on the renin-angiotensin to maintain their GFR, then using ACEi will reduce the GFR even further causing acute renal failure.
So ACEi must be stopped.

Question 8

Which of these does not cause hyperkalaemia?
ACEi
ARBs
Thiazides
Loop Diuretics

Answer 8

Thiazides

Question 9

What effect do ARB’s have?

Answer 9

Pretty much exact same profile as ACEi.

Angiotensin Receptor Blockers inhibit the vasoconstrictive effect of angiotensin II, thus reducing blood pressure.

Question 10

Give an example of a loop diuretic.

Answer 10

Furosemide

Bumetanide

Question 11

Why are loop diuretics used to treat Chronic Kidney Disease and how do they do this?

Answer 11

Salt is retained in CKD, loop diuretics remove this salt.

By inhibiting the uptake of sodium, potassium, chlorine in the ascending loop of Henle.

Question 12

What effect do Thiazides have and how do they achieve this?

Answer 12

They remove sodium and water.

By inhibiting sodium reabsorption in the kidneys.

Question 13

Diuretics can cause hypovolaemia.

What is this?

Answer 13

Low blood plasma volume.

Due to low salt levels.

Question 14

What do spironolactones do?

Answer 14

Inhibit aldosterone.

Therefore sodium is not reabsorbed and potassium is not excreted.

Question 15

What do amilorides do?

Answer 15

Inhibit the sodium/potassium transporter directly.

Sodium is not reabsorbed and potassium is not excreted.

Question 16

Vitamin D is activated in the kidney.

True or False?

Answer 16

TRUE

Question 17

Vitamin D analogues are activated in the kidney.

True or False?

Answer 17

FALSE

activated in liver

Question 18

Why is vitamin D important for healthy bones?

Answer 18

Increases calcium and phosphate uptake in the gut.

Question 19

Erythropioetin is made by the kidneys, what is its role?

Answer 19

erythropoiesis (red blood cell production)

Question 20

Why can non steroidal anti-inflammatory drugs like ibuprofen and naproxen be harmful to patients with CKD or at risk of AKI?

Answer 20

They inhibit prostaglandins which vasodilate the afferent arteriole to increase GFR.

Question 21

Accumulation of drugs in the body can cause serious side effects.
What drugs are exclusively removed by the kidneys?

Answer 21

1. penicillin
2. opioid analgesics
3. digoxin
4. hypoglycaemic agents
5. metformin

Question 22

All penicillins are excreted by the kidney.

True or False?

Answer 22

FALSE

flucloxacillin is not