Diuretics And Renal

Question 1

What are the 4 functions of the kidney? (Think REEM)

Answer 1

Regulatory
Excretory
Endocrine
Metabolism

Question 2

What are the regulatory functions?

Answer 2

Fluid balance
Acid-base balance
Electrolyte balance

Question 3

What are the excretory functions?

Answer 3

Waste products

Drug elimination: glomerular filtration and secretion

Question 4

Endocrine functions?

Answer 4

Renin
Erythropoietin
Prostaglandins
1 alpha calcidiol

Question 5

Metabolism functions?

Answer 5

Vitamin D
Polypeptides: insulin
Drugs: morphine + paracetamol

Question 6

What are the different classifications of drugs acting on the renal tubules (6)

Answer 6

Carbonic anhydrase inhibitors
Osmotic agents e.g. Mannitol
Loop diuretics
Thiazide diuretics
Aldosterone antagonists
K+ sparing diuretics

Question 7

What effect does alcohol have on the kidneys?

Answer 7

Inhibits ADH release

Question 8

What effect does caffeine have?

Answer 8

Increased GFR
And reduced tubular reabsorption

(If drank regularly effect is reduced)

Question 9

What are some ADH antagonists?

Answer 9

Lithium - diuretic but not a naturetic

Inhibits action of ADH

Question 10

What are the best diuretics for heart failure?

Answer 10

Loop diuretics e.g. Furosemide

Spironolactone - non diuretic benefits - good for remodelling of the heart

Question 11

What diuretics are best for hypertension?

Answer 11

Thiazides (vasodilation as well as diuresis)
Spironolactone
(Loop diuretics - not brilliant as short duration but work well with renal disease)

Other drugs:
ACE-i
Ca2+ channel blockers
? Beta blockers

Question 12

When would you use a carbonic anhydrase inhibitor?

Answer 12

Glaucoma

Carbonic anhydrase inhibitor blocks bicarbonate reabsorption and more likely to get renal stones

Question 13

Why are carbonic anhydrase inhibitors not often used as a diuretic?

Answer 13

As the nephron would compensate downstream