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Renal system > Diuretics > Flashcards

Diuretics Flashcards

1
Q

what makes up renal corpuscle?

A

glomerulus

bowman’s capsule

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2
Q

what are the types of nephron?

A

cortical nephrons
juxtamedullary nephrones
depends on how deep they go into the nephron

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3
Q

function of glomerulus

A

filter fluid and small molecules

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4
Q

function of PCT

A

split into piles convoluter and piles recta

major absorption and secretion

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5
Q

function of LoH

A

generating hypertonic interstitium in medulla

salt absorption

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6
Q

function of DCT

A

fine tuning
additional absorption and secretion
macula densa

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7
Q

function of macula densa

A

detects salt and filtrate production and triggers juxtaglomerular cells to produce renin

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8
Q

collecting fuct

A

collects filtrate
hormone sensitive
to adjust salt and water movement
aldosterone and ADH affect it

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9
Q

what are the classes of diuretics?

A 
osmotic
carbonic anhydrase inhibitors 
loop diuretics
thiazide-like diuretics
potassium sparing diuretics
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10
Q

osmotic diuretics

A

simplest
filtered into tubules and not reabsorbed so increase osmolality of tubules so draws water into the tubules
osmotically active molecules are filtered out of the glomerulus
increases net H2O loss

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11
Q

e.g. of osmotic diuretics

A

mannitol - sugar

for cerebral oedema

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12
Q

carbonic anhydrase inhibitors

A

complex mechanism
PCT
carbonate and H+ combine to form bicarbonate and then forms H2O and CO2 due to carbonic anhydrase
CO2 and H2O enter the cell paracellularly
inside the cell carbonic anhydrase then converts it back to HCO3- and H+
HCO3- is reabsorbed
protons are needed inside the cell for anti-porter to reabsorb Na+
inhibiting carbonic anhydrase reduces H+ movement in filtrate and reduces sodium reabsorption
increases filtrate osmolality and causes H2O

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13
Q

principal behind carbonic anhydrase inhibitors

A

inhibit recycling of bicarbonate

reducing Na+ reabsorption

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14
Q

e.g. of carbonic anhydrase inhibitors

A

acetazolimide
not used for oedema
clinically minor effect

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15
Q

what are carbonic anhydrase inhibitors used for?

A

altitude sickness

glaucoma

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16
Q

where do Loop diuretics work?

A

act at LoH

thick ascending limb

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17
Q

epithelial of thick ascending limb of LoH

A

cuboidal

18
Q

epithelial of thin ascending limb of LoH

A

squamous

19
Q

how do loop diuretics work?

A

NKCC as ascending LoH where 25% of Na+ is absorbed
these inhibit the NKCC sympoter on the apical/ luminal side
Na+ accumulates in tubule - water cannot follow as the ascending LoH is impermeable to water
increases osmotic gradient for water loss later on in the nephron - DCT and collecting duct

20
Q

apical side

A

side of epithelial cell facing tubules

21
Q

basolateral side

A

side of epithelial cell facing blood vessels

22
Q

e.g. of loop diuretic

A

furosemide

23
Q

use of loop diuretic

A

oedema

24
Q

meniscus and fluid under left hemidiaphragm

A

gastric bubble

25
Q

where do thiazide-like diuretics work?

A

DCT - only 3% Na+ reabsorbed

26
Q

thiazide-like diuretics

A

DCT becomes more water permeable proximally to distally
these diuretics block NaCl symporter on apical side
retains Na+ in tubule
reduces reabsorption of water
movement of water into tubules
to maintain Na+ levels in cell Na+/Ca2+ exchanger increases moving more Na+ from the blood into the cell and Ca2+ into the blood - risk of hypercalcaemia

27
Q

hypercalcaemia with thiazide like diuretics

A

normally not a problem because calcium homeostasis negates the effect
but can be a problem for people with certain conditions related to calcium homeostasis

28
Q

e.g. of thiazide-like diuretics

A

indapamide

thiazide molecules are not longer used due to high side effect profile - hyponatraemia

29
Q

uses of thiazide-like diuretics

A

step 3 antihypertensives
not that effective as diuretics
decrease sensitivity of smooth muscle in vasculature to circulating vasoconstrictors

30
Q

kidney stones and thiazide-like diuretics

A

calcium increased in blood by thiazide-like diuretics

so can protect patients from kidney stones because calcium is transported into the blood not urine

31
Q

diuretics

A

most increase risk of kidney stones, except thiazide-like diuretics

32
Q

where do potassium sparing diuretics act?

A

principal cell of collecting duct

33
Q

side effect of loop diuretics and thiazide-like diuretics?

A

hypokalaemia, only potassium-sparing diuretics do not increase K+ loss

34
Q

what is the responsibility of intercalated cell?

A

acid/base balance

35
Q

what are the types of potassium sparing diuretics

A

aldosterone antagonists

non-mineralocorticoid antagonist

36
Q

how do non-mineralocorticoid antagonist K+ sparing diuretics work?

A

inhibit Na+ channel - ENaC on apical membrane so Na+ accumulates in the tubule

37
Q

how do aldosterone antagonist K+ sparing diuretics work?

A

block the effect of aldosterone which causes protein synthesis of ENaC and Na+/K+ pump so reduces the amount of these present

38
Q

where do aldosterone antagonist K+ sparing diuretics work?

A

act on nuclear receptors

act on apical and basolateral side of epithelial cells

39
Q

e.g. of aldosterone antagonist K+ sparing diuretics work

A

spironolactone

eplerenone

40
Q

use of aldosterone antagonist K+ sparing diuretics work

A

reduced cardiac remodelling
use in heart failure with reduced ejection fraction
poor antihypertensive if nothing else has worked
may be used as diuretic in those with oedema caused by cirrhosis

41
Q

when is spironolactone used?

A

potassium retention
used with other diuretics to spare potassium
can caused breast tissue development in men

Renal system (17 decks)

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