drugs affecting the kidneys W2

Question 1

actions of loop diuretics?

Answer 1

decrease Na+/K+/2CL- in thick ascending limb

Question 2

indications of loop diuretics?

Answer 2

heart & renal failure
liver cirrhosis with ascites

Question 3

adverse effects of loop diuretics?

Answer 3

hyponatraemia, hypokalaemia, metabolic alkalosis
fluid depletion (dehydration, hypovolaemia), incontinence
ototoxicity (hearing/balance probs)

Question 4

actions of thiazide diuretics?

Answer 4

inhibit Na+/Cl- co-transport in distal convoluted tubule
vasodilation

Question 5

indications of thiazide diuretics?

Answer 5

hypertension

Question 6

adverse effects of thiazide diuretics?

Answer 6

hypokalaemia, hyponatraemia, hypomagnesaemia, alkalosis
hyperuricaemia, hyperglycaemia
fluid depletion, incontinence, erectile dysfunction

Question 7

actions of potassium-sparing diuretics?

Answer 7

decrease aldosterone receptor mediated formation of the Na+/K+ exchanger in basolateral membrane of distal tubule
amiloride blocks Na+ channel in luminal membrane

Question 8

indications of potassium-sparing diuretics?

Answer 8

chronic heart failure
liver failure with ascites
resistant hypertension
primary hyperaldosteronism (Conn’s syndrome)

Question 9

adverse effects of potassium-sparing diuretics?

Answer 9

hyperkalaemia
spironolactone oestrogenic effects (gynaecomastia)

Question 10

what is amiloride? what does it have the same action as?

Answer 10

sodium channel blocker (type of potassium-sparing diuretic)
has same action as aldosterone receptor antagonists (spironolactone)

Question 11

actions of osmotic diuretics?

Answer 11

freely filtered but non-absorbed creating an osmotic ‘drag’ that decreases water and Na+ reabsorption in renal tubule

Question 12

indications of osmotic diuretics?

Answer 12

raised ICP due to cerebral oedema
raised intra-ocular pressure

Question 13

adverse effects of osmotic diuretics?

Answer 13

initial fluid overload, hypernatraemia

Question 14

actions of carbonic anhydrase inhibitors?

Answer 14

inhibits carbonic anhydrase in proximal tubular cells
decreased H+ and bicarbonate available for exchange with Na+
mild natriuresis and alkalisation of urine

Question 15

indications of carbonic anhydrase inhibitors?

Answer 15

glaucoma
altitude sickness

Question 16

adverse effects of carbonic anhydrase inhibitors?

Answer 16

metabolic acidosis

Question 17

erythropoietin features

Answer 17

stimulates red cell formation in bone marrow
haemoglobin conc. should be maintained within 100-120g/L

Question 18

vitamin D features

Answer 18

requires hydroxylation in the kidney
patients can be given hydroxylated derivatives to prevent the development of renal osteodystrophy

Question 19

sodium bicarbonate features

Answer 19

corrects acidosis of renal failure

Question 20

SGLT-2 inhibitors features

Answer 20

inhibit at least 90% renal glucose reabsorption
indicated for type 2 diabetes

Question 21

uricosuric drugs features

Answer 21

inhibit uric acid re-absorption in proximal convoluted tubule
indicated for preventing gout

Question 22

3 categories of drugs with adverse effects on the kidneys?

Answer 22

drugs causing a reduction in extracellular volume
drugs with direct effects on renal vasculature
drugs with direct toxic effects

Question 23

what drugs (or drug symptoms) cause dehydration

Answer 23

diuretics
drug-induced diarrhoea
drug-induced vomiting

Question 24

what diuretics cause dehydration

Answer 24

loop diuretics
thiazide diuretics

Question 25

what drugs cause drug induced diarrhoea (leading to dehydration)

Answer 25

laxatives
proton pump inhibitors
antibiotics

Question 26

what causes drug induced vomiting (leading to dehydration)

Answer 26

chemotherapy

Question 27

what drugs alter renal perfusion

Answer 27

drugs suppressing the RAS
NSAIDs

Question 28

what drugs suppress the renin-angiotensin system and how

Answer 28

ACE inhibitors
ARAs (angiotensin receptor antagonists)

block the formation of angiotensin II

Question 29

how do NSAIDs alter renal perfusion

Answer 29

reduce cortical blood flow and glomerular perfusion by block production of vasodilating prostaglandins by cyclo-oxygenase

Question 30

actions of ACE inhibitors?

Answer 30

inhibit angiotensin-converting enzyme

decreased:
->angiotensin 2
->vasopressin
->aldosterone
->BP
->Na+ retention
->K+ excretion

Question 31

indications of ACE inhibitors?

Answer 31

hypertension
chronic heart failure

Question 32

pharmacokinetic effects of renal impairment

Answer 32

reduced plasma clearance
increased drug half-life
drug accumulation after repeated doses

Question 33

drugs that impair renal function?

Answer 33

diuretics
ACE inhibitors
NSAIDs