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Pharmacology Drugs > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What is the mechanism of action of Thiazide diuretics?

A
  • Inhibiton of NaCl symporter

- Inhibits NaCl reabsorption in distal convuluted tubule

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2
Q

When are thiazide diuretics used?

A

-Hypertension (Used for vasodilation and diuresis)

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3
Q

What are the side effects of thiazide diuretics?

A
  • Gout
  • Hyperglycaemia
  • Erectile Dysfunction
  • Increase in LDL and Triglycerides
  • Hypercalcaemia (promotion of Ca reabsorption)
  • Hypokalaemia
  • Hyperuricemia
  • Impotence
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4
Q

What are the examples of Loop Diuretics?

A
  • Furosemide

- Bumetanide

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5
Q

What is the mechanism of action of Loop Diuretics?

A
  • Affects the thick ascending limb of the Loop of Henle

- Inhibits NaCl reabsorption

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6
Q

When are Loop Diuretics used?

A
  • Heart failure
  • Decompensated Liver Disease
  • Nephrotic Syndrome
  • Chronic kidney Disease (+/- thiazides sometimes as a boost)
  • Oedema (+/- hypertension in advanced CKD)

(Hypertension - less used due to shorter duration of action)

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7
Q

What are the side effects of Furosemide?

A
  • Ototoxicity
  • Alkalosis (Blunt H+ secretion)
  • Increase in LDL and triglycerides
  • Gout
  • Ca2+/Mg excretion
  • Hypokalaemia (Blunt K+ secretion)
  • Androgen cross-reactivity
  • Metabolic effects
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8
Q

What are some side effects of Bumetanide?

A
  • Myalgia

- Alkalosis

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9
Q

What is the mechanism of action of Spironolactone?

A
  • Inhibits Na retention by antagonising aldosterone. (3Na+/2K+ and Na+reflux)
  • Works via the eNaC
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10
Q

What are the uses of Spironolactone?

A
  • Hypertension (primary drug for primary hyperaldosteronism)
  • Decompensated Liver Disease
  • Heart failure
  • Ascites
  • Hyperadrenalism
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11
Q

What are the side effects of Spironolactone?

A

-Hyperkalaemia
-Impotence
-Painful gynaecomastia
Don’t use in CKD

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12
Q

What is the mechanism of action of carbonic anhydrase inhibitors?

A
  • Inhibits the enzyme carbonic anhydrase

- Leads to excretion of Na+, K+ and PO3

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13
Q

What are uses of carbonic anhydrase inhibitors?

A
  • Glaucoma

- Altitude sickness

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14
Q

What are the side effects of carbonic anhydrase inhibitors?

A
  • Metabolic Acidosis
  • Hypokalaemia
  • Acidosis
  • Renal stone
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15
Q

What is the mechanism of action of osmotic diuretics (mannitol)?

A
  • Filtered at glomerulus

- Increases osmotic gradient throughout nephron

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16
Q

What are the uses of osmotic diuretics?

A

-Reduce high intracerebral pressure

17
Q

What are the side effects of osmotic diuretics?

A
  • Excessive water loss
  • Hypernatremia
  • Allergic Reactions
18
Q

What is the mechanism of action of lithium (ADH antagonists)?

A
  • Inhibits action of ADH
  • Diuretic but not natriuretic

Reduces concentrating ability of urine in collecting ducts

19
Q

When are ADH antagonists used? (lithium, tolvaptan)

A
  • Hyponatraemia

- Prevention of cyst enlargement in APCKD

20
Q

What are the side effects of ADH antagonists?

A
  • Hypernatremia

- Deranged liver function

21
Q

What are the general side effects of diuretics?

A
  • Anaphylaxis/Photosensitivity rash
  • Hypovolaemia and hypotension (Activation of RAAS which can lead to acute kidney injury)
  • Electrolyte Disturbance (Na+, K+, Mg2+, Ca2+)
  • Metabolic abnormalities (depends on individual drug)
22
Q

Why do some patients fail to respond to diuretics?

A
  • Oedema of the gut so less absorption
  • Heart failure so less delivery of the diuretic
  • The nephrons are affected so work less well
23
Q

How do you treat diuretic resistance due to oedema of the gut?

A

Give multiple doses to find the minimum effective dose

24
Q

What are some potentially nephrotoxic drugs?

A
  • Aminoglycosides
  • Vancomycin
  • Aciclovir
  • NSAIDs
25
Q

What are some drugs that can cause renal dysfunction?

A
  • ACE inhibitors
  • Diuretics
  • NSAIDs
  • Metmorfin (acidosis)
26
Q

What is the mechanism of action of Tolvaptan (ADH antagonist)?

A
  • ADH antagonist
  • Diuretic and not natriuretic

Reduces concentrating ability of urine in collecting ducts

27
Q

What are other substances that have diuretic action?

A

Alcohol – Inhibits ADH release

Caffeine – Increase in GFR and decrease tubular Na+ reabsorption

28
Q

What do you have to be careful of when prescribing in patient with chronic kidney disease?

A
  • Avoid nephrotoxins

- Dose gentamicin/vancomycin carefully with consultation of pharmacist

29
Q

Which long term drugs have to be checked for alteration when diagnosed with chronic kidney dose?

A
  • Allopurinol
  • Digoxin
  • Cyclosporin / Tacrolimus
  • Low molecular weight heparins
30
Q

Which common drugs have increased side effects with CKD?

A
  • Morphine & other opiates
  • Nitrofurantoin
  • Statins
31
Q

What are the risk of hyperkalaemia?

A
  • Can cause life threatening cardiac arrhythmias

- Any ECG change is cause of immediate action

32
Q

What are causes of hyperkalaemia?

A
  • Excess intake (virtually never the only cause)
  • Movement out of cells (Acidosis, Hypertonicity, Tissue damage)
  • Reduced urine loss (Reduced GFR, Reduced distal delivery of Na+ (oliguric AKI, obstruction), Reduced secretion in collecting duct)
  • Drugs (ACE-Inhibitors, spironolactone, NSAIDs, ENaC blockers)
33
Q

What are major risk to cause hyperkalaemia?

A
  • Increase catabolism/tissue damage

- Reduced urine production

34
Q

How is hyperkalaemia management approached?

A
  • Identify the cause
  • ECG
  • Treatment
35
Q

What are the treatment methods?

A

Protect the heart - Calcium Gluconate
Lower serum K+ - Insulin/Dextrose
Remove K+ from the body - Calcium Resonium

Other drugs - Salbutamol, Sodium Bicarbonate

Pharmacology Drugs (22 decks)

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