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Cpt > Diuretics And Renal Pharmacology > Flashcards

Diuretics And Renal Pharmacology Flashcards

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1
Q

What are the functions of the kidney 0

A

• Regulatory
– Fluid balance
– Acid-base balance – Electrolyte Balance

• Excretory
– Waste products (protein metabolism) – Drug elimination
– Glomerular Filtration – Tubular Secretion

• Endocrine
– Renin
– Erythropoetin
– Prostaglandins – 1-alpha calcidol

• Metabolism – Vitamin D
– Polypeptides • Insulin
– Drugs
• Morphine
• paracetamol
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2
Q

What are drugs acting on the real tubules

A
  • Carbonic anhydrase inhibitors • Osmotic Diuretics
  • Loop Diuretics
  • Thiazides
  • Potassium sparing diuretics • Aldosterone antagonists
  • ADH Antagonists
  • NB: Diuresis – loss of water; Natriuresis – loss of sodium
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3
Q

Give an overview o mannitol

A

0

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4
Q

Give an overview ofloop diuretics

A

-

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5
Q

Gove an overview of thiazids

A

S

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6
Q

Give an overview fo amilorise and spironolactne

A

S

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7
Q

What are other substances with diuretic action

A
  • Alcohol – inhibits ADH release

* Caffeine - ↑GFR and ↓ tubular Na+ reabsorption

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8
Q

Desribe ADH antagonists

A
  • Lithium – diuretic but not natriuretic. Inhibits action of ADH - Can get hypernatremic
  • Tolvaptan – ADH antagonist. Diuretic but not natriuretic. Used to treat hyponatraemia (& prevent cyst enlargement in APCKD)
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9
Q

What are the general adverse effects of diuretics

A

• Hypovolaemia & hypotension
– Activates RAAS
– Can lead to acute kidney injury
• Electrolyte Disturbance (Na+, K+, Mg2+, Ca2+)
• Metabolic Abnormalities (depends on individual drug) • Anaphylaxis / photosensivity rash etc (rare)

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10
Q

What ae common specific adrs o diuretics

A 
Thiazides
• Gout
• Hyperglycaemia
• Erectile dysfunction
• ↑LDL↑TG
• Hypercalcaemia

Spironolactone
• Hyperkalaemia
• Impotence
• Painful gynaecomastia

Frusemide
• Ototoxicity • Alkalosis
• ↑LDL ↑TG • Gout

Bumetanide
• Myalgia

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11
Q

Describe potential specific drug effects/interactions

A

Ss

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12
Q

What diuretics are used in htn

A
  • Thiazide diuretics (vasodilatation as well as diuresis)
  • Spironolactone
  • (Loop diuretics)
  • ACE inhibitors / Ang II antagonists
  • b-blockers
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13
Q

What diuretics are used in hf

A
  • Loop diuretics
  • Spironolactone – non-diuretic benefits
  • ACEInhibitors/AngIIantagonists • b-blockers
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14
Q

What diuretics are used in decmpesated liver disease

A

• Spironolactone • Loop diuretics

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15
Q

What are used in nephrotic syndrome

A

Nephrotic syndrome
https://www.flickr.com/photos/vicg/4695453355
• Loop diuretic (often big doses needed)
• +/- thiazides
• +/- potassium-sparing diuretic / potassium supplements

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16
Q

What ere used in ckd

A
  • ↓GFR leads to salt and water retention • Loop diuretics
  • (+/- thiazide-like)
  • Alkalosis & kalliuretic effects potentially beneficial
  • Generally avoid K+-sparing diuretics
17
Q

Describe diuretic resistance

A

Furosemide bound. Albumin.absorbed form storm into blood stream needs to then get to pct. then needs to be moved to loop where it acs on NKCC2. If pump doesnt work - furosemide doesnt go around bldstream as wel. If you have cks. Es nephrons to less tubules for it to cross. Anion transporters have to try to do a lot more than normal - less furosemide across. Nephrotic - less protein for it to bind to to get across.
Can get ascites (oedema in gut?) - then they dont absorb as well - may have to give iv

18
Q

Describe refractory oedema

A
  • Check salt intake (24 hour sodium excretion if necessary)
  • Give furosemide iv if gut oedema likely
  • Find minimum effective dose
  • Give repeated bolus or infusion (short t1/2)
19
Q

Why are thiazides typically not good as diuretics

A

-

20
Q

Give a overview as diuretic usage

A

Ss

21
Q

What are potentially neurotoxicitydrugs

A

• Aminoglycosides: e.g: gentamicin • Vancomycin (intravenous only)
• Aciclovir
• NSAIDs
• ++ more
Worse if renal function is impaired Can cause irreversible renal damage esp acute

22
Q

What are drugs that can cause problems it’s real dysfunction

A
  • ACE-Inhibitors • Diuretics
  • NSAIDs
  • Metformin
23
Q

How to acei and nsaids affect renal perfusion

A

Precipitous drop when environment is hostile - can tip someone from cusp of an into ful bow ski. I healthy, wont have much efect
Disease of the afferent arteriole (BP, renal artery stenosis, progressive kidney disease, DM) can result in too great or too little a response to these stimuli1

24
Q

Describe prescribing in ckd

A 
Avoid nephrotoxins.
• If gentamicin / vancomycin required, dose very carefully in
consultation with pharmacist.
• Check with pharmacist – whether any of existing drugs need dose altering
– Allopurinol
– Digoxin
– Cyclosporin / Tacrolimus
– Low molecular weight heparins
• Side effects of some common drugs are increased with renal disease (accumulation of metabolites)
– Morphine & other opiates
– Nitrofurantoin
– Statins
25
Q

What are the causes of hyperkalaemia

A

• Excess intake (virtually never the only cause)
• Movement out of cells
– Acidosis
– Hypertonicity
– Tissue (especially muscle) damage
• Reduced urine loss
– Reduced GFR
– Reduced distal delivery of Na+ (oliguric AKI, obstruction)
– Reduced secretion in collecting duct
• Drugs
– RAAS Inhibitors (ACE-Inhibitors, spironolactone), NSAIDs, ENaC blockers (trimethoprim, amiloride)

26
Q

What are the effects of hyperkalaemia

A

Can cause life-threatening cardiac arrhythmias.
• Any ECG change is cause of immediate action.
ECG changes ss

27
Q

What is the management or hyperkalaemia

A 
• Identify cause! • ECG
• Treatment:
– 1. Protect the heart:
– 2. Lower serum K+
– 3. Remove K+ from body
(Sodium bicarbonate) (Salbutamol)
Calcium gluconate Insulin / Dextrose Calcium resonium

Cpt (24 decks)

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