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2 Renal > Drugs Acting on the Kidney > Flashcards

Drugs Acting on the Kidney Flashcards

1
Q

diuretics act mainly on which ion?

A

Na

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2
Q

another word for vasopressin

A

ADH

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3
Q

main drug class that acts on the kidney?

A

diuretics

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4
Q

what do diuretics do?

A

increase urine flow by inhibiting reabsorption of sodium in the kidney

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5
Q

what causes oedema

A

imbalance between the rate of formation and absorption of interstitial fluid

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6
Q

what forces are affected in oedema?

A

starling forces

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7
Q

what starling forces control movement of water OUT of the capillary?

A

hydrostatic pressure in the capillary

oncotic pressure of the interstitium

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8
Q

which oncotic pressure has the highest pressure and why?

A

capillary oncotic pressure as it has more plasma proteins

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9
Q

oedema will occur if capillary oncotic pressure ___

A

decreases

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10
Q

oedema will occur if hydrostatic pressure in the capillary ___

A

increases

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11
Q

where does protein go in nephrotic syndrome?

A

the filtrate (urine)

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12
Q

what does albumin do?

A

sets the oncotic pressure of the plasma

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13
Q

what happens to the osmotic pressure of the plasma in nephrotic syndrome and why?

A

will decrease as you are losing albumin

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14
Q

what happens when osmotic pressure of the plasma decreases?

A

increased formation of interstitial fluid will occur -> oedema

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15
Q

what effect does increased interstitial fluid have on blood flow?

A

will decrease BV and CO

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16
Q

what effect does decreases blood flow have on RAAS?

A

will upregulate it and cause salt retention

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17
Q

what effect does RAAS have on the capillary hydrostatic pressure?

A

increases it

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18
Q

what effect does RAAS have on plasma oncotic pressure?

A

decreases it further

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19
Q

what effect does increased capillary hydrostatic pressure and decreased plasma oncotic pressure have on the body?

A

oedema

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20
Q

why do you get oedema in ascites?

A

increased capillary hydrostatic pressure in portal vein but have decreased albumin production (lose protein)

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21
Q

what parts of the nephron do thiazide diuretics have an effect on?

A

Na/Cl co-transport in the DISTAL convoluted tubule

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22
Q

carbonic hydrase inhibitors block which process in the nephron?

A

Na/H exchange in proximal and distal convoluted tubules

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23
Q

what 2 conditions are carbonic anhydrase inhibitors mainly used in?

A

glaucoma

altitude sickness

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24
Q

what process in the nephron do loop diuretics block?

A

triple cotransporter (Na/K/Cl) in the thick ascending limb of the loop of henle

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25
Q

main complication of diuretics is…

A

hypokalaemia

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26
Q

what is the main site of action of most diuretics?

A

apical membrane of tubular cells

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27
Q

drug bound protein will not be filtered at the glomerulus T or F

A

T

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28
Q

how do diuretics get into the tubule to be able to work at the apical membrane?

A

if not bound to plasma protein -> glomerular filtration

if bound -> secretion via active transport at proximal tubule

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29
Q

an anion is acidic or basic?

A

acidic

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30
Q

a cation is acidic or basic?

A

basic

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31
Q

loop diuretics and thiazides are acidic or basic?

A

acidic

32
Q

what part of the triple cotransporter do loop diuretics bind to?

A

Cl site

33
Q

how is the triple co-transporter electrically neutral?

A

Cl has 2 negative charges

Na and K have 1 positive charge each

34
Q

loops diuretics cause Ca and Mg ___

A

loss

35
Q

what happens t to the Na that has entered via the triple cotransporter?

A

is used for the Na/K pump

36
Q

what happens to the K that has entered via the triple cotransporter?

A

is used for either:
the Na/K pump
the K/Cl pump

37
Q

what happens to the Cl that has entered via the triple cotransporter?

A

is used for either:
the K/Cl pump
Cl only channel

38
Q

how is digoxin more toxic if a patient is on a loop diuretic?

A

digoxin competes against K+ at the ATPase so if K is low (with diuretic) more digoxin will bind

39
Q

what acid base imbalance can you get with loop diuretics?

A

metabolic alkalosis

40
Q

what site of the Na/Cl carrier do thiazide diuretics bind?

A

Cl part

41
Q

thiazides are used in…

A

mild heart failure
hypertension
severe resistant oedema

42
Q

how do diuretics cause hypokalaemia?

A

diuretic causes inc Na load

more Na reaborbed so more K secreted into urine

43
Q

aldosterone makes more __ channels available

A

ENAC

44
Q

what channels do spirinolactone and epleronone block?

A

ENAC

45
Q

what diuretic can cause hyperkalaemia?

A

ENAC (aldosterone channel) blockers eg spirinolactone

46
Q

when should you give spirinolactone?

A

along with a loop to prevent K loss

47
Q

osmotic diuretics do not have a specific target T or F

A

T

48
Q

presence of mannitol (an osmotic diuretic) ___ the osmolarity of the filtrate

A

increases

49
Q

most iso-osmotic reabsorption of water occurs in…

A

the proximal tubule

50
Q

how do osmotic diuretics enter the nephron?

A

via glomerular filtration

51
Q

name 2 conditions that osmotic diuretics are used in

A

acute hypovolaemic renal failure

acute raised intracranial/ocular pressure

52
Q

depletion of what ion is an adverse effect of osmotic diuretics?

A

Na

53
Q

loss of bicarbonate results in a/an ___ diuresis

A

alkaline

54
Q

why are carbonic anhydrase inhibitors used in glaucoma?

A

suppress formation of aqueous humour to reduce intraocular pressure

55
Q

what are ENAC channels?

A

epithelial Na channels

56
Q

what is neurogenic diabetes insipidus?

A

lack of ADH secretion from posterior pituitary

57
Q

what treats diabetes insipidus?

A

desmopressin

58
Q

what is nephrogenic diabetes insipidus?

A

inabiity of the nephron to respond to vasopresin

59
Q

mutations in what receptor causes nephrogenic diabetes insipidus?

A

V2 receptor gene

60
Q

nicotine ___ ADH secretion

A

enhances

61
Q

what do aquaretics do?

A

act as competitive antagonists of ADH

cause excretion of water only

62
Q

what do V1 receptors do?

A

mediate vasoconstriction

63
Q

what do V2 receptors do?

A

mediate water reabsorption

64
Q

blocking V2 receptors __ plasma Na conc

A

increases

65
Q

aquaretics are used in what conditions?

A

SIADH

66
Q

2 locations of SGLT1 receptors

A

intestine

kidney

67
Q

location of SGLT2 receptors?

A

proximal tubule of kidney

68
Q

which SGLT receptor has a higher affinity for glucose?

A

SGLT1

69
Q

which SGLT receptor has the highest transport capacity?

A

SGLT2

70
Q

main problem of NSAIDs in kidneys?

A

affect the blood supply to the kidney by inhibiting COX

71
Q

what do prostaglandins do in the kidney?

A

control blood supply to (vasodilate) the kidney

72
Q

PGE2 is a prostaglandin mediating blood supply to what area of the kidney?

A

medulla

73
Q

PGI2 is a prostaglandin mediating blood supply to what area of the kidney?

A

glomeruli

74
Q

prostaglandins are sythesised in response to what stimuli?

A 
ischaemia
mechanical trauma
angiotensin 2
ADH
bradykinin
75
Q

what part of the kidney do prostaglandins dilate?

A

afferent arteriole

76
Q

constriction of the efferent arteriole is done by…

A

angiotensin 2

77
Q

what does allopurinol do?

A

inhibits urate synthesis

2 Renal (34 decks)

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