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Pharmacology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the main physiological roles of kidneys

A

Regulation: Fluid, electrolytes, acid base
Excretion: metabolites, Drugs
Endocrine: renin, Erythropoietin
Metabolism: Vitamin D, insulin, PTH

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2
Q

What are the types of commonly used diuretics

A

Loop
Thiazide
K sparing diuretics
Aldosterone antagonists

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3
Q

What are types of rarely used diuretics

A

Carbonic anhydrase inhibitors
Osmotic diuretics
ADH antagonists

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4
Q

What are Drugs that have diuretic-like effects

A

Digoxin

Amiloride

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5
Q

What is mechanism of action of carbonic anhydrase inhibitors

A

Inhibit carbonic anhydrase at PCT

Inhibit Na reabsorption

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6
Q

What are side effects of carbonic anhydrase inhibitors

A 
Metabolic acidosis (bicarb loss) 
Hypokalaemia
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7
Q

What is Carbonic anhydrase inhibitors indicated

A

Glaucoma

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8
Q

What is mechanism of action of osmotic diuretics

A

Freely filtered and poorly reabsorbed
Increases filtrate osmolality
Draws water into filtrate down osmotic gradient

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9
Q

When is osmotic diuretics indicated

A

Cerebral oedema

Pulmonary oedema

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10
Q

What are side effects of osmotic diuretics

A

Hypovolaemia

Hypernatraemia

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11
Q

What is mechanism of action of ADH Antagonists

A

Inhibit ADH receptors at DCT and CD

Inhibit water reabsorption

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12
Q

What are types of ADH antagonists

A

Lithium

Demeclocycline

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13
Q

What is mechanism of action of digoxin

A

Inhibit Na/K+ ATPase

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14
Q

When is digoxin indicated

A

Atrial fibrillation

Has a mild diuretic effect

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15
Q

Give examples of loop diuretics

A

Furosemide

Bumetanide

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16
Q

What is mechanism of action of Loop diuretics

A

Inhibit NKCC2 co transporter at thick ascending limb
Inhibit Na reabsorption (25%)
Inhibit K reabsorption

17
Q

When is loop diuretics indicated

A

Heart failure

Liver failure

18
Q

What are side effects of loop diuretics

A

Hypokalaemia
Hypokalaemic metabolic alkalosis
Ototoxicity

19
Q

What are drug interactions with loop diuretics

A

Aminoglycosides: ototoxicity, nephrotoxicity
Steroids: hypokalaemia
Digoxin: hypokalaemia, digoxin toxicity

20
Q

Give examples of thiazide diuretic s

A

Bendroflumethiazide

Thiazide-like diuretics: chlortalidone, metolazone

21
Q

What is mechanism of action of thiazide diuretics

A

Inhibit NaCl co transporter at DCT
Inhibit Na reabsoprtion

Decreased Ca excretion
Decreased Uric acid excretion

22
Q

What are indications of thiazide diuretics

A

Hypertension
Heart failure
Kidney stones

23
Q

What are side effects of thiazide diuretics

A 
Hypokalaemia
Hyponatraemia
Hypercalcaemia
Hyperuricaemia
Gout 
Erectile dysfunction
24
Q

What are drug interactions of thiazide diuretics

A

Steroids
Digoxin
Beta blockers - hyperglycaemia, hyperlipidaemia
Carbemazepine - hyponatraemia

25
Q

What are types of K sparing diuretics

A

Amiloride

Aldosterone antagonists

26
Q

What is mechanism of action of amiloride

A

Inhibit ENaC at DCT + CD
Inhibit Na reabsorption (2%)

Inhibit ROMK activity
Reduce K excretion

27
Q

When is amiloride indicated

A

Add-on therapy to K-losing diuretics

28
Q

What are drug interactions with amiloride

A

Ace-inhibitors: Hyperkalaemia

29
Q

Give examples of aldosterone antagonists

A

Spironolactone

Eplerenone

30
Q

What is mechanism of action of spironolactone

A

Inhibit aldosterone binding to Mineralocorticoid receptors at DCT + CD
Inhibit Na/K ATPase and ENaC synthesis
Inhibit Na reabsorption
Reduce K excretion

31
Q

When is spironolactone indicated

A

Hypertension
Heart failure
Liver failure
Hyperaldosteronism

32
Q

What are side effects of spironolactone

A

Gynaecomastia

Hyperkalaemia

33
Q

What are the general side effects of diuretics

A

Hypersensitivity - Anaphylaxis, rash
Hypovolaemia, postural hypotension
Electrolyte imbalance
Metabolic disturbance

34
Q

What are causes of diuretic resistance

A 
Patient in compliance
High Na intake
Volume depletion
NSAID
Incomplete treatment of primary disorder
35
Q

What are issues of prescribing drugs in renal disease

A

Drug Nephrotoxicity

Accumulation of drugs to toxic levels

36
Q

What are prescribing rules in renal disease

A

Avoid nephrotoxins
Monitor U+Es and renal function
Use lower dose according to GFR

37
Q

Give examples of nephrotoxic drugs

A 
Ace inhibitors
NSAIDs
Aminoglycosides
Penicillin
Metformin
38
Q

What are prescribing rules in the elderly with renal disease

A

Renal function overestimated
Start at low dose, titrate slowly

Polypharmacy is common
Cautious of DDIs

Pharmacology (19 decks)

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