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Alan's lecture - Pharmacology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

how much urine does an adult filter per day and what is the urine output?

A
  • Adult filters 180L per day

- Urine output 1-2L

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2
Q

what do volume sensors regulate? and describe what each type does?

A
  • Vascular tone –to control organ perfusion

- Renal Na+ excretion -to control total fluid volume

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3
Q

what are the low pressure sensors in the pulmonary vasculature?

A
  • renal sympathetic nerves
  • renin-angiotensin aldosterone axis
  • pituitary release vasopressin
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4
Q

What is the main purpose of diuretics?

A
  • To decrease BP by incresaing the excretion of water and Na+ (less burden on cardiovascular disease)
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5
Q

Where is the main site for Na+ reabsorption? How much Na+ is absorbed?

A

Proximal convulated tubules

- Absorbs about 60-70%

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6
Q

Where can NAHCO3 also be absorbed?

A

proximal convulated tubules

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7
Q

Where is water reabsorbed in the nephron?

A

In the descending limb

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8
Q

What is the golden rule of the kidney?

A
  • Water tends to follow Na+
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9
Q

Name the different types of duiretics?

A
  • Thiazides
  • Osmotic
  • Loop
  • K+ sparing
  • Carbonic anhydrase inhibitors
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10
Q

Where does each type of diuretics work in the nephron?

A
  • Thiazides: Distal convulated tubule
  • Loop: Thick ascending limb of the loop of Henle
  • K+ sparing: Cortical collecting duct
  • Carbonic anhydrase inhibitors: Proximal convulated tubule
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11
Q

What does Angiotensin 2 control?

A
  • Aldosterone secretion
  • Na+ Re-absorption (renal proximal tubule)
  • Constriction of the renal afferent arterioles
  • Thirst (Hypothalamus vasopressin secretion)
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12
Q

When and where is vasopressin or Anti-diuertic hormone ADH secreted?

A
  • secreted from the pituitary in response to low blood volume
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13
Q

What is an oedema and provide an example?

A
  • An increase in interstitial fluid in any organ e.g pulmonary oedema causes severe breathlessness
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14
Q

Describe nephrotic syndrome?

A
  • Renal damage
  • Leads to increase in permeability of glomerular basement membrane
  • Leads to proteinura and a decrease in plasma
  • Which leads to an increase in interstitial fluid
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15
Q

What are the symptoms of nephrotic syndrome?

A
  • Swelling of ankles and legs
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16
Q

describe oedema in heart failure?

A
  • Decreased cardiac output triggers kidney to respond as if hypovolemia causing increased salt and fluid retention
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17
Q

What occurs in hepatic cirrhosis?

A
  • Portal vein flow obstructed

- Leads to fluid escape into the peritoneal cavity

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18
Q

When are carbonic anhydrase inhibitors used to treat?

A
  • Used for treatment in glaucoma

But rapid development of toletance

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19
Q

What are loop diuretics indicated for?

A
  • Most efficacious diuretics

- Used to treat marked oedema commonly after heart failure, acute pulmonary oedema (i.v admin) and other oedema (P.O)

20
Q

Loop diuretics are less useful in hypertension. TRUE OR FALSE?

A

TRUE

21
Q

What are the side effects of loop duiretics?

A
  • Hyperkalaemia
  • Hypercalcaemia
  • Hyponatraemia
22
Q

Name some loop diuretic drugs and describe how each drug is cleared?

A
  • Furosemide (P.O) - cleared by the kidney
  • Bumetanide (P.O) - cleared by hepatic metabolism
  • Torasemide (P.O) - Cleared by hepatic metabolism
23
Q

Name some Thiazide and thiazide-like diuretics and the half lifes?

A
  • Metolazone (t1/2 4hr)
  • Indapamide (t1/2 16hr) - lowers bp at dose where no effect on diuretics (for hypertension)
  • Chlortalidone
  • Bendroflumethiazide (t1/2 6hr)
24
Q

What are Thiazide and thiazide-like diuretics indicated for?

A
  • mild oedema e.g Heart failure, hepatic cirrhosis, nephrotic syndrome
  • Hypertension
  • Diabetes insipidus
25
Q

Thiazide and thiazide-like diuretics are less efficacious compared to loop diuretics? TRUE OR FALSE?

A

TRUE

26
Q

Define hypokalaemia?

A
  • < 3.5 mM serum K+
27
Q

In which two types of diuretics drugs is hypokalaemia common?

A
  • Loop

- Thiazide

28
Q

Why is hypokalaemia more severe in thiazide?

A
  • Because they have longer t1/2
29
Q

Patients are at increased risk of hypokalaemia if aldosterone levels are high. TRUE OR FALSE?

A

TRUE

30
Q

What can hypokalaemia cause?

A
  • Arrythmia (in case of myocardial ischemia)
  • Encephalopathy
  • Diabetes mellitus because of reduced insulin secretion
  • Fatigue and lethargy
31
Q

What are the treatments of hypokalaemia?

A
  • K+ sparing diuretics
  • K+ supplement
  • Diet - bananas
32
Q

What are the indications for potassium sparing diuretics?

A

-Mild diuretics on own - often used in combination with loop diuretics or with thiazides to counteract K+ loss

33
Q

What are potassium sparing diuretics particularly useful for?

A
  • Conserving potassium if loop diuretic or thiazide used
  • Concomitant digoxin therapy (because of interaction of digoxin and loop/thiazides)
  • Secondary hyperaldosteronism
  • Elderly
34
Q

potassium sparing diuretics are generally used on own to treat oedema? TRUE OR FALSE?

A
  • FALSE
35
Q

what is an advantage of using potassium sparing diuretics?

A
  • Avoids extensive diuresis
36
Q

Name a potassium sparing diuretics and what is the half life of the drug?

A
  • Spirinolactone - variable absorption but improved if taken with food
  • Short t1/2 1hr - but rapidly metablosied to more stable metabolite canrenone with a t1/2 20hr
37
Q

Why does Spirinolactone have a slow onset of action?

A
  • Because it has to be metabolised into the more stable form canrenone which has a half life of 20hr
38
Q

What are some ADRs of potassium sparing diuretics?

A
  • Hyperkalemia - due to reduced K+ loss at CCD
  • Metabolic acidosis - H+ secretion at CCD is also inhibited
  • Spirinolactone also inhibits androgen receptor
39
Q

What are some drug interactions with potassium sparing diuretics?

A
  • NSAIDS can impair renal function and cause hyperkalemia with spirinolactone
  • Amiloride - direct inhibition of ENaC
40
Q

What is metabolic alkalosis and name some symptoms?

A
  • Increased alkalinity (Loop and thiazide diuretics cause H+ loss at CCD)
  • Tremor, muscle twitching
  • Numbness
  • lightheaded, confusion, possible coma
41
Q

What is metabolic acidosis and name some symptoms?

A
  • Increased blood acidity
  • K+ sparing diuretics inhibit H+ loss at CCD
  • Rapid breathing, confusion, lethargy
  • May lead to shock or death
42
Q

Name an osmotic diuretic drug?

A
  • Mannitol
43
Q

Describe how mannitol works?

A
  • Undergoes glomerular filtration
  • Not reabsorbed in renal tubule
  • Decreases osmotic gradient in descending limb of loop of henle
  • less water reabsorbed
  • More diuresis
44
Q

What are indication for osmotoc diuetics?

A
  • Emergency use - cerebral oedema

- Excreted unchanged in urine

45
Q

What are some ADR of osmotoc diuetics?

A
  • Heart failure

- Hypokalaemia

Alan's lecture - Pharmacology (16 decks)

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