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Pharmacology > Diuretics And Renal Pharmacology > Flashcards

Diuretics And Renal Pharmacology Flashcards

1
Q

On what part of the nephron do carbonic anhydrase inhibitors work?

A

Proximal convoluted tubule

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2
Q

How do carbonic anhydrase inhibitors elicit their actions

A

They prevent reabsorption of bicarbonate from the renal tubule which results in decreased activity of apical sodium-hydrogen exchanger so causes diuretics due to retention f sodium in the renal tubules

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3
Q

When are carbonic anhydrase inhibitors contraindicated

A

Hepatic cirrhosis

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4
Q

Are carbonic anhydrase inhibitors Aquaretic, Natriuretic or Diuretic?

A

Diuretic

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5
Q

What warnings are associated with carbonic anhydrase inhibitors?

A

Metabolic acidosis
Kidney stones due to alkaline urine
Hypokalaemia

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6
Q

What is Mannitol?

A

An osmotic agent

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7
Q

Where do osmotic agents elicit their actions?

A

PCT and decending loop of Henley

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8
Q

How do osmotic agents such as mannitol work?

A

Inhibit resorption of water and sodium thus increasing the osmolarity of blood and renal filtrate

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9
Q

What is risk of osmotic agents?

A

Hypernatraemia risk

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10
Q

What are SGLT2 inhibitors

A

They inhibit sodium-glucose transport protein 2 to lower blood sugar

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11
Q

Which diuretic drug class causes decreased body weight, decreased blood pressure, decreased plasma glucose, decreased plasma Uri acid and decreased glomerular hyperfiltration?

A

SGLT2 inhibitors

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12
Q

SGLT2 inhibitors act on which part of the nephron?

A

Proximal tubular cells

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13
Q

Where do loop diuretics act on the nephron?

A

Ascending limb of Henle

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14
Q

Loop diuretics are better than thiazides in patients with what?

A

Impaired kidney function

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15
Q

On what protein do loop diuretics act and to what effect?

A

They act on the NKCC2 ( Na+ K+, 2Cl-) symporter to inhibit reabsoprtion causing loss of water and sodium

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16
Q

What electrolyte disturbance could be induced by a loop diuretic such as furosemide?

A

Hypokalaemia metabolic acidosis

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17
Q

What are the Adverse drug reactions associated with the loop diuretic furosemide?

A

Ototoxicity
Alkalosis
Increased LDL and triglyceride
Gout

18
Q

Which transporter is the target of thiazides?

A

Sodium chloride transporter

19
Q

Where do thiazides act on the nephron?

A

Distal convoluted tubule

20
Q

How do thiazides work?

A

The inhibit the Na-Cl transporter.
The transporter usually pulls NaCl from the lumen of the DCT, but its inhibition means that NaCl and water remain in the lumen so more urine is made per day

21
Q

What electrolyte disturbance can be caused by thiazides?

A

Hypokalaemia metabolic acidosis

22
Q

Do thiazide increase or decrease calcium resorption?

A

Increase

23
Q

Which drug class is a competitive antagonist for aldosterone

A

Potassium sparing diuretic

24
Q

How do potassium diuretics work?

A

Competitive antagonist with aldosterone
Prevent sodium reabsorption
Prevent K+ and H+ ion secretion in the late distal tubule and collecting duct

25
Q

What ADRs are associated with thiazides?

A 
Gout
Hyperglycaemia
Erectile dysfunction
Increased LDL
Increased triglyceride
Hypercalcaemia
26
Q

Name a potassium sparing diuretic

A

Spironolactone

27
Q

What ADR’s are associated with potassium sparing diuretic?

A

Hyperkalaemia
Impotence
Painful gymaecomastia

28
Q

To what drug class does Tolvaptan belong?

A

An ADH antagonist - Aquaretic

29
Q

Which drug class is used to treat hyponatraemia and prevent cyst enlargement in adult polycystic kidney disease

A

ADH antagonists

30
Q

ADH antagonists word at which receptor?

A

V2 receptor - it blocks it

31
Q

Which metal has the same activity as ADH antagonists as a side effect?

A

Lithium

32
Q

How does alcohol act as a diuretic?

A

Inhibits ADH release

33
Q

How does caffeine act as a diuretic?

A

Increases GFR and decreased tubular Na+ reabsorption

34
Q

What is an ADR of Bumetanide

A

Myalgia

35
Q

Which diuretics would you use for hypertension?

A

Thiazide diuretics
Spironolactone
Loop diuretics

36
Q

Which drugs would traditionally be used in heart failure?

A

Loop diuretics

Spironolactone

37
Q

Which drugs would traditionally be used in decompensated liver disease?

A

Spironolactone

Loop diuretics

38
Q

Which drugs would traditionally be used in the treatment of nephrotic syndrome

A

Loop diuretics - big doses needed
+/- thiazides
+/- potassium sparing diuretics / potassium supplements

39
Q

Which drugs would be used in CKD

A

Loop diuretics

40
Q

What 3 things must be present for diuretics to be delivered to the renal tubule?

A

Blood flow to proximal tube
Proximal tube must be functioning to transport furosemide across
Thick ascending limb must be intact to respond to furosemide

41
Q

Decribe Barrters and Gitelmans syndromes

A

Autosomal recessive disorder
Defect in thick ascending limb
Causes alkalosis and hypokalaemia and results from no function

42
Q

How does bartters and gitelmans syndrome differ from Liddles syndrome

A

Bartters - reduced or no function

Liddles - increased function

Pharmacology (11 decks)

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