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ESA 5 - Pharmacology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the important components of renal physiology?

A
  • Regulation
  • Excretion
  • Endocrine
  • Metabolism
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2
Q

What are the regulatory functions of the kidneys?

A
  • Fluid balance
  • Acid-base balance
  • Electrolyte balance
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3
Q

What are the excretory functions of the kidney?

A
  • Excretes waste products
  • Excretes drugs
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4
Q

How does the kidney eliminate drugs?

A
  • Glomerular filtration
  • Tubular secretion
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5
Q

What are the endocrine functions of the kidney?

A
  • Renin-angiotensin-aldosterone system
  • Produces erythropoietin
  • Produces prostaglandins
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6
Q

What produces angiotensinogen?

A

The liver

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7
Q

What happens to angiotensinogen?

A

It is converted to angiotensin I by renin

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8
Q

What happens to angiotensin I?

A

It is converted to angiotensin II by ACE

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9
Q

What is the function of angiotensin II?

A
  • Causes an increase in aldosterone
  • Causes retention of salt and water
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10
Q

What molecules does the kidney metabolise?

A
  • Vitamin D
  • Polypeptides - insulin, PTH
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11
Q

What drugs act on the renal tubules?

A
  • Carbonic anhydrase inhibitors
  • Osmotic diuretics
  • Loop diuretics
  • Thiazides
  • Potassium sparing diuretics
  • Aldosterone antagonists
  • ADH antagonists
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12
Q

Where do acetazolamide/dorzolamide act?

A

On the PT

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13
Q

What does acetazolamide/dorzolamide lead to?

A

Diuresis of NaHCO3-

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14
Q

Give an example of an osmotic agent

A

Mannitol

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15
Q

What do osmotic agents cause?

A

Massive diuresis

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16
Q

Why do you get massive diuresis with osmotic agents?

A

Because they act on the whole of the nephron

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17
Q

What is the problem with osmotic agents such as mannitol?

A

You get a lot of water loss, but not much electrolyte loss, so at risk of electrolyte imbalances such as hyponatraemia

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18
Q

Give an example of a loop diuretic

A

Furosemide

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19
Q

Where do loop diuretics act?

A

On the thick ascending loop

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20
Q

What can loop diuretics lead to?

A

Electrolyte abnormalities, such as hypocalcaemia

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21
Q

How long is the onset of action of furosemide when given IV?

A

30 minutes

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22
Q

What is the half life of furosemide?

A

About 90 minutes

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23
Q

What is good about the relatively short half life of furosemide?

A

If taken in morning, doesn’t give nocturia

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24
Q

Where are thiazides used?

A

As an adjunct, e.g. in heart failure

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25
Q

How do thiazide diuretics cause diuresis?

A

They increase sodium loss, so increase water loss

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26
Q

Give an example of an aldosterone antagonist

A

Spironolactone

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27
Q

What conditions are aldosterone antagonists used in?

A
  • Heart failure
  • Hypertension
  • Liver disease
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28
Q

Why does aldosterone antagonists have a long half life?

A

Because they are metabolised to active metabolites

29
Q

What conditions are ADH antagonists used in?

A

Treatment of SIADH

30
Q

How does digoxin act as a diuretic?

A

It inhibits tubular Na/K-ATPase

31
Q

How does amiloride act as a diuretic?

A

Inhibits Na channels in DCT/CD

32
Q

What effect does amiloride have on potasisum?

A

It is potassium sparing

33
Q

Generally, what adverse drug reactions might diuretics cause?

A
  • Anaphylaxis/rash
  • Hypovolaemia and hypotension, leading to acute renal failure
  • Electrolyte disturbance
  • Metabolic abnormalities
34
Q

What electrolyte disturbances commonly result from diuretics?

A

Hyponatraemia

35
Q

When is there a particular risk of electrolyte disturbances?

A

When using diuretics in combination

36
Q

What are the adverse drug reactions of thiazide diuretics?

A
  • Gout
  • Erectile dysfunction
37
Q

What are the ADRs of spironolactone?

A
  • Hyperkalaemia
  • Painful gynaecomastia
38
Q

What are the adverse drug reactions of spironolactone related to?

A

Dose

39
Q

What are the adverse drug reactions of frusemide?

A

Ototoxicity

40
Q

What are the adverse drug reactions of bumetanide?

A

Myalgia

41
Q

What drugs do K+ sparing diuretics interact with?

A

ACE inhibitors

42
Q

What results from interaction between K+ sparing diuretics and ACE inhibitors?

A

Increased hyperkalaemia leading to cardiac problems

43
Q

What drugs do aminoglycosides interact with?

A

Loop diuretics

44
Q

What might result from interaction between aminoglycosides and loop diuretics?

A

Ototoxicity and nephrotoxicity

45
Q

What drugs do thiazide diuretics interact with?

A
  • Digoxin
  • ß-blockers
  • Steroids
  • Carbamazepine
46
Q

What drugs do loop diuretics interact with?

A
  • Digoxin
  • Steroids
47
Q

What might result from the interaction between thiazide or loop diuretics and digoxin?

A

Hypokalaemia, leading to increased digoxin binding and toxicity

48
Q

What might result from interaction between thiazide diuretics and ß-blockers?

A
  • Hyperglycaemia
  • Hyperlipidaemia
  • Hyperuricaemia
49
Q

What might result from interaction between thiazide or loop diuretics and steroids?

A

Increased risk of hypokalaemia

50
Q

What might result from the interaction between thiazide diuretics and carbamazepine?

A

Increased risk of hyponatraemia

51
Q

What might cause diuretic resistance?

A
  • Incomplete treatment of the primary disorder
  • Continuation of high sodium intake
  • Patient non-compliance
  • Poor absorption
  • Volume depletion
  • NSAIDs
52
Q

Why does volume depletion cause diuretic resistance?

A
  • Decreases filtration of diuretics
  • Increases serum aldosterone, which enhances sodium reabsorption
53
Q

Why does NSAID use lead to diuretic resistance?

A

Can reduce renal blood flow

54
Q

What are the major indications for diuretic use?

A
  • Heart failure
  • Hypertension
  • Decompensated liver disease
55
Q

What diuretics are used in the treatment of heart failure?

A
  • Loop diuretics
  • Thiazide diuretics
  • Spironolactone, which has non diuretic benefits
56
Q

Describe the nature of use of thiazide diuretics in heart failure

A

Add on-therapy

57
Q

What do you need to be cautious of when using thiazide diuretics in heart failure?

A

Hypocalaemia

58
Q

What diuretics are used in hypertension?

A
  • Thiazide diuretics
  • Spironolactone
  • Loop diuretics
59
Q

Why are diuretics required in decompensated liver disease?

A

Reduced protein, therefore oedematous state

60
Q

What diuretics are used in decompensated liver disease?

A
  • Spironolactone
  • Loop diuretics
61
Q

What are the categories of ways that drugs might reduce kidney function?

A

Direct or indirect toxicity

62
Q

When might drugs accumulate to toxic levels?

A

If they are excreted through the kidneys, and renal function is impaired

63
Q

What drugs are potentially nephrotoxic?

A
  • ACE inhibitiors
  • Aminoglycosides, e.g. gentamicin
  • Penicillins
  • Cyclosporin A
  • Metformin
  • NSAIDs
64
Q

What impact on renal function will ACE inhibitiors have on most patients?

A

Up to 10% decrease before worrying

65
Q

At what kidney function should you consider stopping metformin?

A

50%

66
Q

What guidelines should be following when prescribing drugs in chronic renal failure?

A
  • Avoid nephrotoxins if possible
  • Reduce doseages in line with GFR if metabolised or eliminated via the kidneys
  • Monitor renal function and drug levels
  • Hyperkalaemia is more likely
  • Consider bleeding, as uraemic patients have a greater tendency to bleed
67
Q

What should be considered, regarding the kidneys, when prescribing in the elderly?

A
  • Renal function is over-estimated, as creatinine is dependant on body mass
  • Start low
  • Titrate cautiously
  • Polypharmacy more likely to be present
68
Q

How is hyperkalaemia treated?

A
  • Calcium gluconate
  • Insulin/dextrose
  • Calcium resonium
  • Sodium bicarbonate
  • Salbutamol

ESA 5 - Pharmacology (28 decks)

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