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Year 1 NME Core Drugs > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are diuretics?

A
  • drugs that ⬆️ urine excretion
  • drugs that ⬆️ Na+ and Cl- excretion
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2
Q

What is the most commonly used thiazide diuretic to treat high blood pressure?

A
  • bendroflumethiazide
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3
Q

Where in the kidneys is blood filtered to form the filtrate?

A
  • blood enters glomerulus
  • blood is then filtered into the filtrate
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4
Q

Once the filtrate is formed from the glomerulus, what happens to the fluid as it move through the tubules and out of the collecting duct as urine?

A
  • H2O and other molecules are re-absorbed into blood
  • what is left is urine
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5
Q

Where are ions mainly re-absorbed in the renal system?

A
  • proximal conveluted tubules
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6
Q

What passively follows ion re-absorption in the distal tubules of the renal system, which ion specifically does it follow?

A
  • Na+
  • due to osmosis (H2O dilutes Na+ in blood)
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7
Q

In normal physiology how are Na+ and Cl- re-absorbed from the filtrate into the blood from the renal system?

A
  • through thiazide sensitive Na+ / Cl- co-transporter into epithelial cells in the distal tubules
  • Na+ reabosrbed using Na+ / K+ ATPase
  • Cl- channels reabsorb Cl-
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8
Q

What is the mechanism of action of bendroflumethiazide on the renal system and thus lower blood pressure?

A
  • inhibits thiazide sensitive Na+ / Cl- co-transporter
  • Na+ and Cl- excreated out in urine
  • H2O follows Na+
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9
Q

How does increased Na+ in the blood cause an increase in blood pressure?

A
  • Na+ retains H2O
  • ⬆️ volume in blood vessels = ⬆️ pressure
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10
Q

What is one of the most commonly used thiazide like drugs to treat hypertension?

A
  • Indapamide
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11
Q

In normal physiological response of smooth muscle vasoconstriction or vasodilation, what happens to the ATP sensitive K+ channels and the Ca2+ voltage gated channels on the smooth muscle cells?

A
  • vasoconstriction = ⬇️ K+ ATPase
  • ⬇️ ATPase activity = ⬇️ K+ leaves and ⬆️ Ca2+ enters cell
  • vasodilation = ⬆️ K+ ATPase
  • K+ channel opens ⬆️ K+ inside cell and hyperpolarisation (⬆️ negative)
  • ⬆️ K+ leaves and ⬇️ Ca2+ enters cell
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12
Q

In addition to inhibiting the thiazide sensitive Na+ / Cl- co-transporter, Indapamide also acts at lowering blood pressure through a second mechanism, what is this?

A
  • dilate blood vessels
  • ATPase sensitive K+ channels ⬆️ K+ leaving cell (⬆️ negative inside)
  • reduces Ca2+ entry into blood vessels
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13
Q

In addition to bendroflumethiazide and Indapamide, what is the 3rd diuretic drug we are expected to know?

A
  • furosemide
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14
Q

What are the 3 thiazide or thiazide like diuretics that are are expected to know? (all end in ide)

A

1 - bendroflumethiazide

2 - indapamide

3 - furosemide

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15
Q

What are some common side effects of diuretics?

A
  • Hyponatraemia (Na+) - Hypokalaemia (K+) - Alkalosis (H +) - Hypercalcaemia (Ca2+) - Hypomagnesaemia (Mg2+) - ⬆️ in urate (gout) - ⬆️ blood glucose - ⬆️ lipids
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16
Q

When treating hypertension, we need to remember how to calculate BP, which is cardiac output (CO) x systemic vascular resistance (SVR). Therefore what are the main effects on CO and/or SVR that thiazide and/or thiazide like diuretics have on CO and/or SVR?

A
  • blood volume
  • blood volume, increases preload
  • preload increases SV
  • SV increases CO
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17
Q

How can thiazide and thiazide like diuretics cause hyponatraemia (⬇️ Na+), Hypokalaemia (⬇️ K+) and hypercalcaemia (⬆️ Ca2+)?

A
  • Na+ and K+ not re-absorbed
  • Na+ moves down concentration gradient from blood into epithelial cells
  • Na+ / Ca2+ exchanger swaps Na+ anjd Ca2+
  • Ca2+ swaps places and leaves epithelail cell into blood
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18
Q

In normal physiology how does Na+ and Cl- get re-absorbed from the distal tubules into the cells?

A
  • through the Na+ / Cl- co-transporter
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19
Q

In normal physiology, once Na+ and Cl- have been re-absorbed from the distal tubules through the Na+ / Cl- co-transporter into the epithelial cells, how is Na+ able to be re-absorbed into the blood?

A
  • through Na+ / K+ ATPase pump
  • 3 Na+ out of cell into blood
  • 2 K+ into cell and out of blood
  • K+ is able to leave eputhelail cell through K+ channel
20
Q

In addition to moving from the distal tubules through the Na+ / Cl- co-transporter and back into blood through the N+ / K+ ATPase pump, how can some of the Na+ re-enter the same cell epithelail cell it just left?

A
  • through Na+ / Ca2+ exchanger
  • Ca2+ in renal cells is ⬇️
  • creates Ca2+ and Na+ concentration gradient
  • higher Ca2+ in distal tubules epithelial cells compared to blood
  • Ca2+ moves from epithelail cells into blood
21
Q

How can thiazide and thiazide like diuretics cause metabolic acidosis?

A
  • ⬇️ Cl- re-absorbed - Cl- used to balance carbonic anhydrase with HCO3-
22
Q

In chronic kidney and liver disease something occurs in the extremeties, what is this?

A
  • oedema
23
Q

Atrial natriuretic peptide (ANP) is released from the heart when it it is stressed. What does this hormone do and what does natriuretic mean?

A
  • natriuretic = substance that reduces Na+ reabsorption causing increased urine production
  • ANP increases Na+ and H2O excretion, which reduces blood volume and blood pressure
  • therefore reduces the stress on the heart
24
Q

What does Kaliuretic mean?

A
  • a substance that reduces K+ reabsorption causing increased urine production
25
Q

What hormone is the main factor controlling factor for H2O levels in the body?

A
  • anti-diretic hormone
26
Q

Where is anti-diuretic hormone (ADH) secreted from and when?

A
  • made in hypothalamus and into the pituitary gland
  • when hyperosmolarity is present (high concentration of electrolytes in plasma)
  • ADH initiates thirst and H2O absorbtion in collecting ducts
27
Q

What is the mechanism of action of anti-diuretic hormone?

A
  • binds to V2 receptors on tubules which are Gs GPCRs
  • adenylyl cyclase converts ATP into cAMP
  • cAMP activates protein kinase A (pKA)
  • pKA increaes aquaporins on collecting ducts
  • H2O moves out and is reabsorbed
28
Q

How does alcohol effect fluid levels?

A
  • inhibits anti-diuretic hormone (ADH)
  • increases urine secretion
29
Q

How does nicotine and morphone effect fluid levels?

A
  • increases anti-diuretic hormone (ADH)
  • reduces urine excretion
30
Q

Carbonic anhydrase inhibitors are an old type of drug used as a diuretic. What is the name of this drug and where does it act?

A
  • acetazolamide
  • proximal tubule
31
Q

Osmotic diuretic drugs are used as a diuretic. What is the name of this drug and where does it act?

A
  • mannitol
  • proximal tubule and descending loop of henle
32
Q

We need to know 4 core drugs that are all diuretics, namely bendroflumethaizide, indapamide, furosemide and spironolactone. Which of these is a loop diuretic, and what does that mean?

A
  • furosemide
  • acts on the thick ascending loop of henle
33
Q

We need to know 4 core drugs that are all diuretics, namely bendroflumethaizide, indapamide, furosemide and spironolactone. Which of these is a thiazide diuretic, and where do they act generally in the kidney?

A
  • bendroflumethiazide and Indapamide
  • excretion of Na+ and Cl-
  • distal tubules
34
Q

We need to know 4 core drugs that are all diuretics, namely bendroflumethaizide, indapamide, furosemide and spironolactone. Which of these is a potassium-sparing diuretic, and where do they act generally in the kidney?

A
  • spironolactone
  • distal tubules and collecting ducts
35
Q

What is the mechanism of action of the loop diuretic furosemide?

A
  • inhibit Na+/K+/Cl- (NKCC) contransporter
  • Na+/K+/Cl- remain in tubule and H2O follows Na+
  • causing increased urine output called diuresis
36
Q

What is the most powerful diuretics?

A
  • loop diuretics - generally last 6 hours
  • furosemide is the core drug
37
Q

The most powerful diuretics are the loop diuretics, with furosemide being the drug we need to know. What are the most common side effects?

A
  • hypo of all electrolytes (Na+, K+, Cl-, Ca2+, Mg+)
  • hyper uric acid
  • ototoxicity (hearing loss)
38
Q

Loop diuretics have some side effects, namely reductions in all electrolytes. What could be a serious effect of this?

A
  • cardiac arrhythmias
39
Q

Loop diuretic furosemide is able to inhibit Na+/K+/Cl- (NKCC) contransporter, menaing Na+/K+/Cl- remain in tubule and H2O follows Na+, and all are secreted out in the urine. Furosemide has a number of side effects, with a key one being hypokalaemia. Although some of this occurs in the loop, the main site of K+ loss from the capillaries is in the distal tubules. Why is this?

A
  • furosemide increases Na+ in tubules
  • K+ is exchanged for Na+
  • Na+ is reabsorbed into capillaries but K+ is excreated
40
Q

Bendroflumethaizide and indapamide are thiazide diuretics. What is its mechanism of action?

A
  • acts on distal tubules
  • ihibits Na+/Cl- cotransporter
  • hypokalaemia follows due to Na+/K+ pump in distal tubules
41
Q

Bendroflumethaizide and indapamide are thiazide diuretics that act on the distal tubules by ihibiting the Na+/Cl- cotransporter. Is this a strong or weak diurectic?

A
  • a weak one but last longer
  • mild oedema and used for hypertension
42
Q

Indapamide is a thiazide diuretics and in addition to inhibiting Na+/Cl- reabsorbtion in the distal tubules, they are generally used for hypertension. Why is this?

A
  • able to act on ATP K+ channels that are linked with Ca2+ channels on smooth muscle
  • increased K+ will reduce Ca2+ and blood vessels dilate
  • Ca2+ increase is a side effect
43
Q

Spirolactones are referred to as K+ sparring diurectis. What is the mechanism of action and where does this occur?

A
  • Spirolactones = Stay
  • inhibit Na+ channels in distal tubule and collecting ducts on the tubule side
  • H2O will follow the Na+ that remains in the tubule
44
Q

Which drug is recognised as an aldoesterone inhibitor?

A
  • spirolactone
45
Q

Spirolactone has a similiar structure as oestrogen. What is one of the most common side effects?

A
  • gynaecomastia

Year 1 NME Core Drugs (1 decks)

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