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CPT > Diuretics & Renal Pharm > Flashcards

Diuretics & Renal Pharm Flashcards

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1
Q

What drugs act on the renal tubule?

A

Diuretics

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2
Q

What is an example of an osmotic diuretic?

A

Mannitol

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3
Q

How do osmotic diuretics work?

A

Build up in the lumen of the PCT and descending limb of LoH

Osmotic effect causes water to be pulled into the lumen => loss of water

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4
Q

What is a risk of using osmotic diuretics?

A

Hypernatraemia

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5
Q

What are some examples of loop diuretics?

A

Furosemide

Bumetanide

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6
Q

How do loop diuretics exert their effects?

A

Inhibition of NaKCC in the thick ascending limb

Na builds up in lumen => water builds up in lumen

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7
Q

What are some risks of loop diuretics?

A

Hypokalaemic metabolic alkalosis
Enhanced Na delivery to collecting duct => increased K loss

Hypocalcaemia

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8
Q

How do aldosterone antagonist diuretics exert their actions?

A

Inhibition of aldosterone => reduction in expression of ENaC and Na/K ATPase in the collecting duct

Reduced reabsorption of Na => increased water loss

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9
Q

What other substances have a diuretic action?

A

Alcohol - inhibits ADH release

Caffeine - increased GFR and decreased Na reabsorption

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10
Q

What are some drugs that act as ADH antagonists?

A

Lithium - diuretic (but not natriuretic), inhibits action of ADH
Tolvaptan - ADH antagonist, used to treat hyponatraemia

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11
Q

What are some generic adverse drug reactions of diuretics?

A

Hypovolaemia and hypotension - activation of RAAS => AKI
Electrolyte disturbance
Metabolic abnormalities
Anaphylaxis

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12
Q

What are some ADRs of thiazides?

A 
Gout 
Hyperglycaemia 
Erectile dysfunction 
Increased LDL and TG 
Hypercalcaemia
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13
Q

What are some ADRs of spironolactone?

A

Hyperkalaemia
Impotence
Painful gynaecomastia

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14
Q

What are some ADRs of furosemide?

A

Ototoxicity
Alkalosis
Increased LDL and TG
Gout

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15
Q

What are some ADRs of bumetanide?

A

Myalgia

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16
Q

What is a potential consequence of interaction of ACE-i and K+ sparing diuretics?

A

Increased hyperkalaemia => cardiac problems

17
Q

What are potential consequences of interactions between aminoglycosides and loop diuretics?

A

Ototoxicity

Nephrotoxicity

18
Q

What is a potential consequence of interaction between digoxin and thiazide/loop diuretics?

A

Hypokalaemia => increased digoxin binding and toxicity

19
Q

What are potential consequences of interactions between β-blockers and thiazide diuretics?

A

Hyperglycaemia
Hyperlipidaemia
Hyperuricaemia

20
Q

What are some potential consequence of interactions between steroids and thiazide/loop diuretics?

A

Hypokalaemia

21
Q

What are some potential consequence of interactions between lithium and thiazide/loop diuretics?

A

Lithium toxicity - thiazide

Reduced lithium levels - loop

22
Q

What are some potential consequences of interaction between carbamazepine and thiazide diuretics?

A

Hyponatraemia

23
Q

How are osmotic diuretics used?

A

Reduce high intracerebral pressure

24
Q

What are loop diuretics used for?

A

Oedema

25
Q

What are thiazide diuretics used for?

A

Hypertension

26
Q

What are potassium sparing diuretics used for?

A

Low potassium when a diuretic is required

27
Q

What are aldosterone antagonist diuretics used for?

A

Heart failure
Ascites
Hypertension
Hyperaldosteronism

28
Q

What are ADH antagonists used for?

A

Hyponatraemia

29
Q

What drugs are potentially nephrotoxic?

A

Aminoglycosides eg gentamicin
IV vancomycin
Aciclovir
NSAIDs

30
Q

What drugs can cause problems with renal dysfunction?

A

ACE-i
Diuretics
NSAIDs

31
Q

What is the effect of NSAIDs on renal perfusion?

A

Inhibits prostaglandins => unable to vasodilate afferent arteriole

Therefore unable to maintain GFR with reduced renal perfusion

32
Q

What is the effects of ACE-i/ARB on renal perfusion?

A

Inhibits Angiotensin II or aldosterone
Therefore unable to vasoconstrict efferent arteriole

Unable to maintain GFR with reduced renal perfusion

33
Q

How is hyperkalaemia managed?

A

Calcium gluconate - protects the heart
Insulin/dextrose - lowers serum K+ by activating Na/K ATPase
Calcium resonium - removes K+ from the body

CPT (21 decks)

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