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PODT- Treatment > 9. Pharmacology of Diuretics > Flashcards

9. Pharmacology of Diuretics Flashcards

1
Q

What are the four different types of diuretics?

A

Osmotic Diuretics
Loop Diuretics
Thiazide
Potassium sparing diuretics

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2
Q

Where do osmotic diuretics act?

A

PCT

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3
Q

What do osmotic diuretic do?

A

Reduce H20 reabsorption

Reduce electrolyte reabsorption

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4
Q

What are side effects of osmotic diuretics?

A

Hypotension

Fluid and electrolyte disturbance

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5
Q

Define the term diuretic

A

Causing increased passing of urine

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6
Q

What is an example of carbonic anhydrase inhibitor?

A

Acetazolamide

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7
Q

What is the mode of action of acetazolamide?

A

Inhibits carbonic anhydrase in PCT

Reduces Na+ and HCO3- reabsorption

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8
Q

What are carbonic anhydrase inhibitors used for clinically?

A

Glaucoma and acute altitude sickness

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9
Q

What are adverse effects of cabonic anhydrase inhibitors?

A

Metabolic acidosis
Hypokalaemia
Renal stone formation

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10
Q

Examples of loop diuretics?

A

Furosemide, bumetanide torasemide

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11
Q

How are loop diuretics given?

A

Orally or i.v.

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12
Q

What do loop diuretics do?

A

Bind to proteins in plasma, limiting glomerular filtration

Secreted into tubular lumen by PCT cells via organic anion transporters

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13
Q

What is the mode of action of loop diuretics?

A

Inhibit Na+/K+/2Cl- cotransopter in ascending limb of Loop pf Henle

Decrease osmolarity of medullary interstitium leading to decrease reasbsporption of water from collecting duct

Increase in excretion of Ca2+ and Mg2+ occurs becuase of inhibition of paracellular diffusion

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14
Q

When are loop diuretics used clinically?

A 
Congestive heart failure 
Resistant hypertension 
Liver ascites 
Nephrotic syndrome
Acute hypercalcaemia
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15
Q

What are adverse effects of loop diueretics?

A 
Hypovolaemia and dehydration 
Hypokalaemia 
Hypomagnesaemia 
Hyponatraemia 
Hyperuricaemia 
Oto and renal toxicity 
Allergic reactions to skin and kindey
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16
Q

What happens when loop diuretics interact with thiazide diuretics?

A

Increased risk of electrolyte disturbance

17
Q

What happens when loop diuretics interact with aminoglycoside antibiotics?

A

Increased oto and nephrotoxicity

18
Q

What happens when loop diuretics interact with ACE inhibitor and other vasodilator drugs?

A

Risk of hypotension

19
Q

What happens when loop diuretics interact with non-steroidal anti-inflammatory drugs ?

A

Impaired diuresis

20
Q

What is the mode of action of thiazides in the early distal convoluted tubule?

A

Increase excretion of Na+ and Cl- by inhibiting Na+/Cl- cotransporter

Reabsorption of Ca2+ is increased due to stimulation of Na+/Ca2+ counter- transport as consequence of increased conc grad. for Na+ across basolateral membrane

21
Q

When are thiazide diuretics used clinically?

A

Uncomplicated hypertension
Occasionally in resistant oedema in heart failure or other causes of oedema
Protective in osteoporosis and for prevention of calcium renal stones

22
Q

What are the adverse effects of thiazide diuretics?

A

Same as loop but

> urate retention
increase in cholersterol and hypergylceamia
Reduced calcium excretion
Less oto and nephrotoxicity in combination with aminoglycosides

23
Q

What are the interactions with thiazide diuretics?

A

Same as a loop with a few exceptions

24
Q

What are the interactions of thiazide diuretics and ACE inhibitors?

A

Hypotension less likely

25
Q

What are the interactions of thiazide diuretics and lithium?

A

More likely to cause lithium toxicity

26
Q

What are the interactions of thiazide diuretics and SSRI anti-depressants?

A

More likely to cause hyponatraemia

27
Q

Where do potassium sparing diuretics act?

A

Action localised to late DCT/early collecting duct

28
Q

Examples of potassium sparing diuretics?

A

Soidium channel blockers

Aldosterone receptor antagonists

29
Q

What is the mode of action of amiloride and triamterine in late distal tubule and collecting duct?

A

Block apical Na+ channels
Decrease in potential difference across principal cell
Decrease driving force for K+ secretion from principal cell and H+ from intercalated cell
Leading to increase Na+ excretion and decrease K+ and H+ excretion

30
Q

What is the mode of action of aldosterone
antagonists in late distal
tubule and collecting duct?

A

Alderstone - steroid hormone that acts on a nuclear receptor to increase synthesis of proteins which activate silent Na+ channels

Increase synthesis of K+ channels ….look at this

31
Q

What blocks effects of aldosterone and what happens?

A

Spironolactone
Eplerenone

Leading to the increase of Na+ excretion and decrease in K+ and H+ excretion

32
Q

When are potassium sparing diuretics used clinically?

A

Used to prevent thiazide or loop diuretic- induced hypokaleamia

33
Q

When is spironolactone prescribed?

A

In conditions associated with primary and secondary hyperaldosteronism

34
Q

Adverse effects of potassium sparing diueretics?

A

Hyperkalaemia
Metabolic acidosis

Gynaecomastia, impotence and testicular atrophy, menstrual irregularities

35
Q

Hyperkalaemia occurs when potassium-sparing diuretics interact with what?

A 
ACE inhibitors
Angiotensin II receptor antagonists
Renin inhibitors 
Beta adrenoceptor antagonists
Non steroidal anti-inflammatory drugs
36
Q

Are diuretics routine treament for renal failure?

A

No

37
Q

What should be used if chronic kidney disease with associated oedema is present?

A

Use loop diuretics with caution

PODT- Treatment (12 decks)

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