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ESA 5 > CPT S9 - Diuretics > Flashcards

CPT S9 - Diuretics Flashcards

1
Q

What are the physiological mechanisms the kidney is responsible for?

A

Regulatory
Excretory
Endocrine
Metabolism

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2
Q

What regulatory functions is the kidney responsible for?

A

Fluid balance
Acid-base balance
Electrolyte balance

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3
Q

What endocrine functions is the kidney responsible for?

A

Renin-Angiotensin-Aldosterone
Erythropoetin
Prostaglandins

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4
Q

What excretory mechanisms does the kidney control?

A

Waste product excretion
Drug elimination;
-Glomerular filtration
-Tubular secretion

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5
Q

What metabolic functions is the kidney responsible for?

A

Vitamin D
Polypeptides;
-Insulin
-PTH

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6
Q

What are some ADRs for Thiazides?

A

Gout

Erectile dysfunction

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7
Q

What are some ADRs for furosemide?

A

Ototoxicity

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8
Q

What are some ADRs for spironolactone?

A

Hyperkalaemia

Painful gynaecomastia

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9
Q

What are some ADRs for bumetanide?

A

Myalgia

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10
Q

Which diuretics do ACE inhibitors interact with, and what is the result of this?

A

K sparing diuretics
Causes increased hyperkalaemia
Leads to cardiac problems

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11
Q

Which diuretics does aminoglycosides interact with, and what is the result of this?

A

Loop diuretics
Ototoxicity
Nephrotoxicity

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12
Q

Which diuretics does digoxin interact with, and what is the result of this?

A

Thiazides and loop diuretics
Hypokalaemia
Leads to increased digoxin binding and toxicity

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13
Q

Which diuretics do β-blockers interact with, and what is the result of this?

A

Thiazide diuretics
Hyperglycaemia
Hyperlipidaemia
Hyperuricaemia

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14
Q

Which diuretics do steroids interact with, and what is the result of this?

A

Thiazides and loop diuretics

Increased risk of hypokalaemia

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15
Q

Which diuretics does carbamazepine interact with, and what is the result of this?

A

Thiazide diuretics

Increased risk of hyponatraemia

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16
Q

What is the recommended treatment for heart failure?

A 
Loop diuretics
Thiazide diuretics - as an add-on
(Spironolactone - non-diuretic benefits)
ACEi or angiotensin II antagonists
β-blockers
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17
Q

Why does diuretic resistance occur?

A

Incomplete treatment of the primary disorder
Continuation of high Na intake
Patient non-compliance
Poor absorption
Volume depletion decreases filtration of diuretics
Volume depletion increases serum aldosterone, which increases Na reabsorption
NSAIDs can reduce renal blood flow

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18
Q

What is the recommended treatment for hypertension?

A 
Thiazide diuretics
Spironolactone
(Loop diuretics)
ACEi or angiotensin II antagonists
β-blockers
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19
Q

What is the recommended treatment of decompensated liver disease?

A

Spironolactone (HUGE doses)

Loop diuretics

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20
Q

What are some potentially nephrotoxic drugs?

A 
ACEi
Aminoglycosides eg gentamicin
Penicillins
Cyclosporin A
Metformin
NSAIDs
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21
Q

What are some important things to remember when prescribing to CKD patients?

A 
Avoid nephrotoxins
Reduce dosages in line with GFR if metabolism or elimination via kidneys (except furosemide)
Monitor renal function and drug levels
Uraemic patients more likely to bleed
Hyperkalaemia more likely in CKD
22
Q

What are some important things to remember when prescribing to elderly patients?

A

Renal function often over-estimated as creatinine is body mass-dependent
Start low and titrate up cautiously
Polypharmacy more likely

23
Q

What is the management of hyperkalaemia?

A

Identify cause

ECG!!

24
Q

How is hyperkalaemia treated?

A 
Calmcium gluconate
Insulin+dextrose
Calcium resonium
Sodium bicarbonate
Salbutamol
25
Q

What are some general ADRs for diuretics?

A 
Anaphylaxis/rash
Hypovolaemia
Hypotension
Electrolyte disturbance
Metabolic abnormalities
26
Q

What are the types and causes of hypertension?

A

Primary/essential hypertension;
-High BP without any single evident cause
-90% hypertensive population
Secondary hypertension;
-High BP with a discrete, identifiable underlying cause
-10% hypertensive population

27
Q

What is the treatment of hypertension?

A

Identify & treat any underlying cause
Identify & treat any CVS risk factors or co-morbidities
Lifestyle advice
Pharmacological therapy

28
Q

What is the threshold BP for treatment?

A

> 140/90

29
Q

Give some examples of lifestyle advice you might give patients with hypertension

A 
Maintain normal BMI
Reduce salt intake to 30 mins/day
Eat >5 fruit/veg per day
Reduce fat intake
Smoking cessation
Relaxation therapies
30
Q

What is the 1st line treatment for hypertension?

A

ACEi/angiotensin receptor blockers (ARBs)
Ca channel blockers
Diuretics

31
Q

Give some ACEi ADRs

A

Dry cough (10-15%)
Angio-oedema
Renal railure
Hyperkalaemia

32
Q

Give some examples of ACEi drugs

A

Lisinopril

Ramipril

33
Q

Give some examples of ARBs

A

Losartan
Valsartan
Candesartan

34
Q

What are some ADRs for ARBs?

A

Renal failure

Hyperkalaemia

35
Q

Give some examples of Ca channel blockers

A

Amlodipine
Diltiazem
Verapamil

36
Q

What are some ADRs for amlodipine?

A

Sympathetic activation
Oedema
Flushing, sweating, throbbing headache
Gingival hyperplasia

37
Q

What are some ADRs for verapamil?

A

Constipation
Bradycardia
Reduced myocardial contractility

38
Q

What are some ADRs for diltiazem?

A

Bradycardia

Reduced myocardial contractility (not as bad as verapamil)

39
Q

Give an example of a thiazide

A

Bendroflumathiazide

40
Q

What are some ADRs for bendroflumethiazide?

A 
Hypokalaemia
Increased urea and uric acid
Impaired glucose tolerance
Increased cholesterol and triglyceride
Activates RAAS
41
Q

What are some atypical anti-hypertensive drug classes?

A 
α-adrenoceptor blockers
β-adrenoreceptor blockers
Direct renin inhibitors
Centrally acting agents
Vasodilators
42
Q

What are the properties of α-adrenoceptor blockers?

A

Selective antagonism at post-synaptic α-1 receptors
Reduce peripheral vascular resistance
Safe in renal disease
Eg Doxazosin

43
Q

Give some ADRs for α-adrenoceptor blockers

A 
Postural hypotension
Dizziness
Headache
Fatigue
Oedema
44
Q

Give some properties of β-adrenoreceptor blockers

A

Reduce heart rate and cardiac output
Inhibit renin release
Initially TPR increases but returns to normal
Eg Atenolol, bisoprolol

45
Q

Give some ADRs for β-adrenoreceptor blockers

A 
Lethargy
Impaired concentration
Reduced exercise tolerance
Bradycardia
Cold hands
Impaired glucose tolerance
Bronchospasm
Dry cough
46
Q

What are the properties of direct renin inhibitors?

A

Low bioavailability

Mainly eliminated unchanged in faeces

47
Q

Give some examples of centally acting agents

A

Methyldopa
Clonidine
Monoxidine

48
Q

What is rebound hypertension?

A

Withdrawal of a centrally acting anti-hypertensive agent causes;

  • Desensitisation of inhibitory α2 receptors
  • Super-sensitivity of post-synaptic α1 receptors
49
Q

How may heart failure develop?

A

Ischaemic heart disease
Hypertension
Cardiopathies
Valve disease

50
Q

How is heart failure treated?

A 
RAAS antagonism;
-ACEi
-ARB
-Aldosterone
β-blocker

ESA 5 (17 decks)

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