drugs affecting the kidneys W2 Flashcards
actions of loop diuretics?
decrease Na+/K+/2CL- in thick ascending limb
indications of loop diuretics?
heart & renal failure
liver cirrhosis with ascites
adverse effects of loop diuretics?
hyponatraemia, hypokalaemia, metabolic alkalosis
fluid depletion (dehydration, hypovolaemia), incontinence
ototoxicity (hearing/balance probs)
actions of thiazide diuretics?
inhibit Na+/Cl- co-transport in distal convoluted tubule
vasodilation
indications of thiazide diuretics?
hypertension
adverse effects of thiazide diuretics?
hypokalaemia, hyponatraemia, hypomagnesaemia, alkalosis
hyperuricaemia, hyperglycaemia
fluid depletion, incontinence, erectile dysfunction
actions of potassium-sparing diuretics?
decrease aldosterone receptor mediated formation of the Na+/K+ exchanger in basolateral membrane of distal tubule
amiloride blocks Na+ channel in luminal membrane
indications of potassium-sparing diuretics?
chronic heart failure
liver failure with ascites
resistant hypertension
primary hyperaldosteronism (Conn’s syndrome)
adverse effects of potassium-sparing diuretics?
hyperkalaemia
spironolactone oestrogenic effects (gynaecomastia)
what is amiloride? what does it have the same action as?
sodium channel blocker (type of potassium-sparing diuretic)
has same action as aldosterone receptor antagonists (spironolactone)
actions of osmotic diuretics?
freely filtered but non-absorbed creating an osmotic ‘drag’ that decreases water and Na+ reabsorption in renal tubule
indications of osmotic diuretics?
raised ICP due to cerebral oedema
raised intra-ocular pressure
adverse effects of osmotic diuretics?
initial fluid overload, hypernatraemia
actions of carbonic anhydrase inhibitors?
inhibits carbonic anhydrase in proximal tubular cells
decreased H+ and bicarbonate available for exchange with Na+
mild natriuresis and alkalisation of urine
indications of carbonic anhydrase inhibitors?
glaucoma
altitude sickness
adverse effects of carbonic anhydrase inhibitors?
metabolic acidosis
erythropoietin features
stimulates red cell formation in bone marrow
haemoglobin conc. should be maintained within 100-120g/L
vitamin D features
requires hydroxylation in the kidney
patients can be given hydroxylated derivatives to prevent the development of renal osteodystrophy
sodium bicarbonate features
corrects acidosis of renal failure
SGLT-2 inhibitors features
inhibit at least 90% renal glucose reabsorption
indicated for type 2 diabetes
uricosuric drugs features
inhibit uric acid re-absorption in proximal convoluted tubule
indicated for preventing gout
3 categories of drugs with adverse effects on the kidneys?
drugs causing a reduction in extracellular volume
drugs with direct effects on renal vasculature
drugs with direct toxic effects
what drugs (or drug symptoms) cause dehydration
diuretics
drug-induced diarrhoea
drug-induced vomiting
what diuretics cause dehydration
loop diuretics
thiazide diuretics
what drugs cause drug induced diarrhoea (leading to dehydration)
laxatives
proton pump inhibitors
antibiotics
what causes drug induced vomiting (leading to dehydration)
chemotherapy
what drugs alter renal perfusion
drugs suppressing the RAS
NSAIDs
what drugs suppress the renin-angiotensin system and how
ACE inhibitors
ARAs (angiotensin receptor antagonists)
block the formation of angiotensin II
how do NSAIDs alter renal perfusion
reduce cortical blood flow and glomerular perfusion by block production of vasodilating prostaglandins by cyclo-oxygenase
actions of ACE inhibitors?
inhibit angiotensin-converting enzyme
decreased:
->angiotensin 2
->vasopressin
->aldosterone
->BP
->Na+ retention
->K+ excretion
indications of ACE inhibitors?
hypertension
chronic heart failure
pharmacokinetic effects of renal impairment
reduced plasma clearance
increased drug half-life
drug accumulation after repeated doses
drugs that impair renal function?
diuretics
ACE inhibitors
NSAIDs
