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Year 1 - HLB Core Drugs > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are diuretics?

A
  • drugs that ⬆️ urine excretion
  • drugs that ⬆️ Na+ and Cl- excretion
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2
Q

What is the most commonly used thiazide diuretic to treat high blood pressure?

A
  • bendroflumethiazide
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3
Q

Where in the kidneys is blood filtered to form the filtrate?

A
  • blood enters glomerulus
  • blood is then filtered into the filtrate
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4
Q

Once the filtrate is formed from the glomerulus, what happens to the fluid as it move through the tubules and out of the collecting duct as urine?

A
  • H2O and other molecules are re-absorbed into blood
  • what is left is urine
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5
Q

Where are ions mainly re-absorbed in the renal system?

A
  • distal conveluted tubules
  • location of most diuretics actions
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6
Q

What passively follows ion re-absorption in the distal tubules of the renal system, which ion specifically does it follow?

A
  • Na+
  • due to osmosis (H2O dilutes Na+ in blood)
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7
Q

In normal physiology how are Na+ and Cl- re-absorbed from the filtrate into the blood from the renal system?

A
  • through thiazide sensitive Na+ / Cl- co-transporter into epithelial cells
  • Na+ reabosrbed using Na+ / K+ ATPase
  • Cl- channels reabsorb Cl-
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8
Q

What is the mechanism of action of bendroflumethiazide on the renal system and thus lower blood pressure?

A
  • inhibits thiazide sensitive Na+ / Cl- co-transporter
  • Na+ and Cl- excreated out in urine
  • H2O follows Na+
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9
Q

How does increased Na+ in the blood cause an increase in blood pressure?

A
  • Na+ retains H2O
  • ⬆️ volume in blood vessels = ⬆️ pressure
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10
Q

What is one of the most commonly used thiazide like drugs to treat hypertension?

A
  • Indapamide
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11
Q

In normal physiological response of smooth muscle vasoconstriction or vasodilation, what happens to the ATP sensitive K+ channels and the Ca2+ voltage gated channels on the smooth muscle cells?

A
  • vasoconstriction = ⬇️ K+ ATPase
  • ⬇️ ATPase activity = ⬇️ K+ leaves and ⬆️ Ca2+ enters cell
  • vasodilation = ⬆️ K+ ATPase
  • K+ channel opens ⬆️ K+ inside cell and hyperpolarisation (⬆️ negative)
  • ⬆️ K+ leaves and ⬇️ Ca2+ enters cell
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12
Q

In addition to inhibiting the thiazide sensitive Na+ / Cl- co-transporter, Indapamide also acts at lowering blood pressure through a second mechanism, what is this?

A
  • dilate blood vessels
  • ATPase sensitive K+ channels ⬆️ K+ leaving cell (⬆️ negative inside)
  • reduces Ca2+ entry into blood vessels
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13
Q

In addition to bendroflumethiazide and Indapamide, what is the 3rd diuretic drug we are expected to know?

A
  • furosemide
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14
Q

What are the 3 thiazide or thiazide like diuretics that are are expected to know? (all end in ide)

A

1 - bendroflumethiazide

2 - indapamide

3 - furosemide

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15
Q

What are some common side effects of diuretics?

A
  • Hyponatraemia (Na+) - Hypokalaemia (K+) - Alkalosis (H +) - Hypercalcaemia (Ca2+) - Hypomagnesaemia (Mg2+) - ⬆️ in urate (gout) - ⬆️ blood glucose - ⬆️ lipids
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16
Q

When treating hypertension, we need to remember how to calculate BP, which is cardiac output (CO) x systemic vascular resistance (SVR). Therefore what are the main effects on CO and/or SVR that thiazide and/or thiazide like diuretics have on CO and/or SVR?

A
  • blood volume
  • blood volume, increases preload
  • preload increases SV
  • SV increases CO
17
Q

How can thiazide and thiazide like diuretics cause hyponatraemia (⬇️ Na+), Hypokalaemia (⬇️ K+) and hypercalcaemia (⬆️ Ca2+)?

A
  • Na+ and K+ not re-absorbed
  • Na+ moves down concentration gradient from blood into epithelial cells
  • Na+ / Ca2+ exchanger swaps Na+ anjd Ca2+
  • Ca2+ swaps places and leaves epithelail cell into blood
18
Q

In normal physiology how does Na+ and Cl- get re-absorbed from the distal tubules into the cells?

A
  • through the Na+ / Cl- co-transporter
19
Q

In normal physiology, once Na+ and Cl- have been re-absorbed from the distal tubules through the Na+ / Cl- co-transporter into the epithelial cells, how is Na+ able to be re-absorbed into the blood?

A
  • through Na+ / K+ ATPase pump
  • 3 Na+ out of cell into blood
  • 2 K+ into cell and out of blood
  • K+ is able to leave eputhelail cell through K+ channel
20
Q

In addition to moving from the distal tubules through the Na+ / Cl- co-transporter and back into blood through the N+ / K+ ATPase pump, how can some of the Na+ re-enter the same cell epithelail cell it just left?

A
  • through Na+ / Ca2+ exchanger
  • Ca2+ in renal cells is ⬇️
  • creates Ca2+ and Na+ concentration gradient
  • higher Ca2+ in distal tubules epithelial cells compared to blood
  • Ca2+ moves from epithelail cells into blood
21
Q

How can thiazide and thiazide like diuretics cause metabolic acidosis?

A
  • ⬇️ Cl- re-absorbed - Cl- used to balance carbonic anhydrase with HCO3-

Year 1 - HLB Core Drugs (21 decks)

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