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Semester 4 - Clinical Pharmacology And Therapeutics > Diuretics And Renal Pharmacology > Flashcards

Diuretics And Renal Pharmacology Flashcards

1
Q

What is the renal physiology mnemonic?

A

REEM

Regulatory (fluid balance, acid-base balance, electrolyte balance)

Excretory (waste products (protein metabolism), Drug elimination (glomerular filtration, tubular secretion))

Endocrine (renin, EPO, prostaglandins, 1-alpha calcidol)

Metabolism (vitamin D, polypeptides (insulin), Drugs (morphine, paracetamol))

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2
Q

What drugs act on the renal tubules?

A 
Carbonic anhydrase inhibitors 
Osmotic diuretics
Loop diuretics
Thiazides
Potassium sparing diuretics
Aldosterone antagonists 
ADH antagonists
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3
Q

What is mannitol and how does it work?

A

An osmotic diuretic (is just present to create an osmotic pull)

Loss of water
Reduced intracellular volume
Hypernatrimia risk

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4
Q

What type of diuretic is ferosomide?

A

Loop diuretic

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5
Q

How do loop diuretics work?

A

Loss of Na and water
Hypokalaemia metabolic acidosis
Increased Ca2+ loss

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6
Q

Who do you not give thiazides do?

A

Patients with hyperkalaemia

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7
Q

How do thiazide diuretics work?

A

Loss of Na and water
Hypokalemic metabolic acidosis
Increased Ca2+ reabsorbtion

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8
Q

How does aldosterone work?

A

Aldosterone increases expression of ENaC and Na+K+ATPase in principle cells of the collecting duct.

Hold into salt

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9
Q

Amiloride and Spironolactone

A

Both reduce Na+ in and K+ out of collecting duct but in different ways.

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10
Q

Why does alcohol make you want to wee?

A

As inhibits ADH release

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11
Q

Why does caffeine make you want to wee?

A

Increase GFR and decrease tubular Na+ reabsorbtion

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12
Q

Give examples of ADH antagonists

A

Lithium -diuretic nut not natriuretic. Inhibits action of ADH.

Tolvaptan - ADH antagonist. Diuretic but not netriuretic. Used to treat hyponatremia and prevent cyst enlargement in APCKD.

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13
Q

What are the ADRs for diuretics?

A

Hypovolaemia and hypotension -active RAAS, lead to AKI

Electrolyte disturbance (Na+, K+, Mg2+, Ca2+)

Metabolic abnormalities

Anaphylaxis / photosensitive rash ect. (rare)

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14
Q

What are the side effects of thiazides?

A 
Gout
Hyperglycaemia 
Erectile dysfunction 
Increase LDL and TG
Hypercalcaemia
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15
Q

What are the side effects of ferosimide?

A

Ototoxicity
Alkalosis
Increase LDL and TG
Gout

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16
Q

What are the side effects of Spironolactone?

A

Hyperkalaemia
Impotence
Painful gynaecomastia

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17
Q

What are the side effects of bumetanide?

A

Myalgia

18
Q

What diuretics do ACEi interact with and what are the effects?

A

K+ diuretic

Increase hyperkalaemia - cardiac problems

19
Q

What diuretics do Aminnoglycosides interact with and what are the effects?

A

Loop diuretics

Ototoxicity and nephrotoxicity

20
Q

What diuretic does digoxin interact with and what are the effects?

A

Thiazide and loop

Hypokalaemia - increased digoxin binding and toxicity

21
Q

What diuretics do B-blockers interact with and what are the effects?

A

Thiazide diuretics

Hyperglycaemia, hyperlipidaemia, hyperuricaemia

22
Q

What diuretics do Steroids interact with and what are the effects?

A

Thiazide and loop diuretics

Increased risk of hypokalaemia

23
Q

What diuretics does Lithium interact with and what are the effects?

A

Thiazide and loop diuretics.

Lithium toxicity (thiazides), reduced lithium levels (loop)

24
Q

What diuretics does Carbamazepine interact with and what are the effects?

A

Thiazide diuretics.

Increased risk of hyponatraemia.

25
Q

What diuretics can you use to treat hypertension?

A

Thiazide diuretics
Spironolactone
Loop if fluid overload

26
Q

What diuretics can you use to treat heart failure?

A

Loop diuretics (these will not improve the prognosis but patients will feel symptomatically better)

Spironolactone (this has non-diuretic benefits so the patients will feel better and it deceases mortality)

27
Q

What diuretics do you use for decompensated liver disease?

A

Spironolactone

Loop diuretics

28
Q

What diuretics can you use for nephrotic syndrome?

A

Loop diuretics (large doses)
Maybe thiazides
Maybe K+ sparing diuretics / K+ supplements

29
Q

How do you treat CKD?

A

Need diuretics as the decrese in GFR leads to salt and water retention.

Loop diuretics

Maybe thiazide diuretics

The alkalosis and the kalliuretic effects are potentially beneficial.

Avoid K+ sparing diuretics

30
Q

Describe how diuretics get delivered to the renal tubule

A

Ferosimide delivered to basolateral side of the PCT.

Ferosimide actively secreted into tubular lumen by organic anion transporter.

Ferosemide delivered to Luminal side of the TAL, including diuresis.

31
Q

Why is salt bad?

A

As if you eat salt, it counteracts the effects of diuretics.

Causes oedema

32
Q

What is refractory oedema and how do you treat it?

A

Refractory oedema is defined as peripheral oedema that does not respond to dietary sodium restriction and combined diuretic treatment including a loop diuretic, often caused by an evident underlying cardiac or pulmonary condition.

Check salt intake
Give ferosimide iv if gut oedema likely
Find minimum effective dose
Give repeated bolus or infusion.

33
Q

Why can you have different electrolytes when similar doses of directs?

A

As although loosing same salt and K, loosing loss water.

So when gfr causes changes in electrolytes in thiazide more than ferosamides.

34
Q

What drugs are Nephrotoxic?

A 
Aminoglycosides e.g. gentamicin
Vancomycin (I.V. only)
Acyclovir
NSAIDs
Ect...
35
Q

What drugs can cause problems with renal dysfunction?

A

ACEi
Diuretics
NSAIDs
Metformin

36
Q

How do ACEi and NSAIDs affect renal perfusion?

A

NSAIDs - prevent vasodilation of afferent arteriole by prostaglandins

ACEi prevents vasoconstriction of efferent arteriole by Ang II.

37
Q

How do you prescribe in patients with CKD?

A

Avoid nephrotoxins.

If gentamicin / vancomycin required - dose carefully and ask pharmacist.

Check with pharmacist if drugs need dose altering.

Side effects common drugs are increased with renal disease because of the accumulation of metabolites.

38
Q

What are some causes of hyperkalaemia?

A

Excess intake (virtually never the only cause)

Movement out of cell (acidosis, hypertonicity, tissue (esp muscle) damage)

Reduced urine loss (reduced GFR, reduced distal delivery of Na+, reduced secretion in collecting duct)

Drugs (RAAS inhibitors, NSAIDs, ENaC blockers)

39
Q

What are the ECG changes of hyperkalaemia?

A 
Tall, symmetrical T waves
Small or absent P waves
Increased P=R interval
Wide QRS complex
Sine wave pattern
Asystole.
40
Q

How do you manage hyperkalaemia?

A

Identify cause

ECG

Treat:
Protect the heart - calcium gluconate (not reduce K)
Lower serum K+ - Insulin / Dextrose
Remove K+ from body - calcium resonium

Semester 4 - Clinical Pharmacology And Therapeutics (26 decks)

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