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Renal and Urology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

which type of diuretics are most efficacious

A

loop diuretics
because LoH reabsorbs 25% na and cl

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2
Q

name a loop diuretic

A

furosemide
also bumetanide and torasemide

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3
Q

where do loop diuretics work and MoA

A

decrease sodium, potassium and chloride reabsorption in thick ascending
act on Na+ K+ 2Cl- channels

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4
Q

indications of loop diuretics

A

heart failure (acute and chronic)
renal failure (including nephrotic syndrome)
liver cirrhosis with ascites

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5
Q

adverse effects of loop diuretics

A

hyponatraemia
hypokalaemia
metabolic alkalosis (due to H+ being secreted)
fluid depletion - dehydration, hypovolaemia
incontinence
ototoxicity - damage to auditory nerve

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6
Q

what molecule is retained in the body when on loop diuretics and what is the potential consequence of this

A

uric acid
gout

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7
Q

name a thiazide diuretic

A

bendroflumethiazide (most common)
also hydrochlorothiazide
thiazide type - indapamide, chlortialidone

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8
Q

where do thiazide diuretics work

A

DCT

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9
Q

MoA of thiazides

A

inhibit Na+/Cl+ co-transport in the DCT
- this offloads a little Na+ and water which follows
also cause vasodilation

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10
Q

indications of thiazides

A

hypertension
don’t offload much fluid so not helpful in heart failure etc.

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11
Q

adverse effects of thiazides

A

hypokalaemia
hyponatraemia
hypomagnesaemia
alkalosis
hyperuricaemia -> gout
hyperglycaemia
fluid depletion, incontinence
erectile dysfunction

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12
Q

what type of diuretic can cause erectile dysfunction and why

A

thiazides
they cause vasodilation

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13
Q

can thiazides be used in diabetics

A

yes but be aware that they can cause hyperglycaemia

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14
Q

what type of drug is spironolactone

A

potassium sparing diuretic

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15
Q

what are the two types of potassium sparing diuretics

A

aldosterone receptor antagonists
sodium channel blockers

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16
Q

what type of drug is amiloride

A

sodium channel blocker potassium sparing diuretic

17
Q

where do potassium sparing diuretics work

A

distal DCT
early collecting duct

18
Q

what effect does aldosterone have in the DCT

A

when it binds to its receptor it stimulates the formation of the Na+/K+ exchanger in the basolateral membrane
so increases Na+ reabsorption in exchange for potassium secretion

19
Q

how do aldosterone receptor antagonist potassium sparing diuretics work

A

blocks the action of aldosterone (aldosterone would normally increase sodium reabsorption in exchange for potassium)
this means that more sodium is excreted and potassium is retained in the body

20
Q

how does amiloride work

A

blocks the sodium channel in the luminal membrane which means it can’t get reabsorbed and more is excreted

21
Q

indications of potassium sparing diuretics

A

chronic heart failure
liver failure with ascites
primary hyperaldosteronism (Conn’s syndrome)
resistant hypertension

22
Q

what drug would be a treatment for primary hyperaldosteonism

A

spiranolactone

23
Q

adverse effects of potassium sparing diuretics

A

hyperkalaemia
spironolactone has oestrogenic effects which can cause gynaecomastia

24
Q

where do osmotic diuretics work

A

anywhere in nephron where water is reabsorbed -
PCT
DL of LoH
medullary collecting duct

25
Q

MoA of osmotic diuretics

A

freely filtered but not reabsorbed so this creates and osmotic drag so less water and sodium is reabsorbed in nephron

26
Q

indications of osmotic diuretics

A

raised intracranial pressure due to cerebral oedema
raised intra-ocular pressure

27
Q

name a osmotic diuretic and how it is administered

A

mannitol
IV

28
Q

give examples of carbonic anhydrase inhibitors

A

acetazolamide
brinzolamide

29
Q

indications of carbonic anhydrase inhibitors

A

glaucoma
altitude sickness

30
Q

adverse effects of carbonic anhydrase inhibitors

A

metabolic acidosis

31
Q

MoA of carbonic anhydrase inhibitors

A

inhibitors carbonic anhydrase in PCT
this decreases the H+ and HCO3- available for exchange with Na+
means a little less sodium is reabsorbed and urine is alkalised

Renal and Urology (16 decks)

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