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Pharmacology 1 > drugs that act on the kidney > Flashcards

drugs that act on the kidney Flashcards

1
Q

what is the role of the kidney?

A

to balance salts and fluid in body

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2
Q

describe the path of water through the kidney

A
  • glomerulus
  • proximal tubule
  • loop of henle
  • distal tubule
  • collecting duct
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3
Q

what are diuretics?

A

drugs taht increase the amount of fluid and salts excreted by the kidneys

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4
Q

what are the main uses of diuretics?

A
  • oedema - fluid collection in tissue
  • hypertension - high BP
  • glaucoma - decreases fluid pressure in the eye (intraocular pressure)
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5
Q

how do diuretics help to treat oedema?

A

by increasing urine production → this draws fluid from swollwn areas of tissue thus reducing swelling

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6
Q

how do diuretics help to treat hypertension?

A
  • increase urine production
  • decrease blood volume
  • decrease blood pressure
  • decrease pressure on blood vessels
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7
Q

name three ways in which salts and water move

A
  1. active transport - via pumps
  2. passive transport - via channels
  3. osmosis
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8
Q

name three ‘pumps’ within the body which move salts - what is required for this to occur?

A
  1. sodium/potassium (Na+/K+pump)
  2. sodium/chloride (Cl- pump)
  3. sodium/ potassium / chloride (Na+/K+/ Cl- pump)

* all use energy to move salts

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9
Q

what are channels? and do they require energy?

A

channels are ion selective openings in the cell membrane - no energy required

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10
Q

what is the osmotic effect?

A

where salts go water follows

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11
Q

name the three classes of diuretic

A
  1. thiazide and related diuretics
  2. potassium sparing diuretics
  3. loop diuretics
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12
Q

what is the site of action for thiazide and related duiretics?

A

distal convoluted tubule

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13
Q

what are the clinical uses of thiazide and related diuretics?

A
  1. oedema
  2. hypertension - long term
  3. mild heart failure
  4. liver and kidney disease
  5. steriod/hormone treatment
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14
Q

name two thiazide diuretics

A
  1. bendroflumethazide
  2. cyclopenthiazide (navidrex®)
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15
Q

name four thiazide related diuretics

A
  1. metolazone (metenix®)
  2. chlortalidone (hygroton®)
  3. indapamide (natrilix®)
  4. xipamide (duirexan®)
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16
Q

where are thiazide and related diuretics metabolised and excreted?

A

metabolised - liver

excreted - kidneys

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17
Q

describe the mechanism of action of thiazide and related diuretics

A
  • blocks chloride pump
  • increases excretion of sodium and chloride
  • increases excretion of potassium (due to sodium exchangeof potassium in collecting ducts via ion channels)
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18
Q

what is the potency of thiazide and related diuretics?

A

moderate

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19
Q

what % of filtered sodium is excreted due to thiazide diuretics?

A

5-10%

20
Q

when taking thiazide diuretics how much is the urine flow increased by?

A

from 1ml/per/min to 3ml/per/min

21
Q

how long do thiazide diuretics take to act and what is the duration of action?

A

acts within 1-2hrs

duration of action 24hrs

22
Q

what are the side effects associated with taking thiazide diuretics?

A
  • hypokalemia
  • hypocalcemia
  • hyperuricemia - high uric acid
  • hyperglycemia
23
Q

what is the site of action of loop diuretics?

A

ascending loop of henle

24
Q

what are the clinical uses of loop diuretics?

A
  1. oedema
  2. hypertension
  3. severe heart failure
  4. acute ventricular failure (pulmonary oedema)
25
Q

give three examples of loop diuretics

A
  1. furosemide (lasix®)
  2. bumetanide (burinex®)
  3. torasemide (torem®)
26
Q

where are loop diuretics metabolised and excreted?

A

metabolised - liver

excreted - urine

27
Q

describe the mechanism of action of loop diuretics

A
  • blocks sodium /potassium /chloride pump
  • increases excretion of:
  • sodium
  • chloride
  • potassium - exchange with sodium in collecting ducts
28
Q

what are the side effects of loop diuretics?

A
  • hypokalemia
  • hpocalcemia
  • hpyeruricema
  • hyperglycemia
  • deafness - very high dose IM, IV dosing (8th cranial nerve damage)
29
Q

what % of filtered sodium is excreted when using loop diuretics?

A

very powerful - 30% filtered sodium excreted

30
Q

what is the increase in urine flow when taking loop diuretics?

A

from 1ml/per/min to 8ml/per/min

31
Q

how long do loop diuretics take to act and how long do they work?

A

act within 1hr

work for 6hrs

32
Q

when should loop diuretics be given?

A

upto twice daily (morning and before 4pm)

33
Q

what is the site of action of potassium sparing diuretics?

A

late distal tuble and collecting duct

34
Q

what are the clincal uses of potassium sparing diuretics?

A
  1. oedema - heart failure/live disease
  2. hypertension
  3. hypokalemia - caused by loop or thiazide diuretics
  4. primary hyperaldosteronism (Conn’s syndrome)- use spironolactione only
35
Q

name four potassium sparing diuretics

A
  1. spironolactone (aldactone®)
  2. eplerenone (inspra®)

aldosterone antagonists

  1. amiloride
  2. trimterene (dytac®)

sodium channel blockers

36
Q

where are potassium sparing diuretics metabolised and excreted?

A

metabolised - liver

excreted - urine and bile

37
Q

what is the mechanism of action of potassium sparing diuretics?

A
  • increased sodium and water excretion
  • chloride and calcium also excreted
  • decreased excretion of potassium and H+
38
Q

how much filtered sodium is excreted when using potassium sparing diuretics?

A

fairly weak diuretic - 5% of filtered sodium excreted

39
Q

what are the side effects of using potassium sparing diuretics?

A

hyperkalaemia - low potassium diet required

close monitoring of electrolyte levels - especially with ACE inhibitors, angiotensin receptor antagonists and beta adrenoceptor anatagonists

40
Q

what is the site of action for antidiuretic drugs?

A

collecting tubules

41
Q

what are the clinical uses of antidiuretics?

A

central diabetes insipidus (lack of ant-diuretic hormone

42
Q

what is the mechanism of action of antidiuretics?

A
  • released from posterior pituitary gland
  • increases no. of water channels in V2 receptors
  • increases passive reabsorption of water
43
Q

name two antidiuretic drugs

A
  1. vasopressin
  2. desmopressin
44
Q

describe the action, administeration and use of vasopressin

A
  • very short acting
  • injection/infusion only
  • increases blood pressure (V1 receptors in smooth muscle)
45
Q

describe the action, administeration and use of desmopressin

A
  • longer duration of action
  • nasal spray or tablets
  • no effect on blood pressure (V2 receptors - selective)

*dose needs to be balanced to avoid H2O intoxication

46
Q

what information must be gathered before and during administeration of diuretics?

A
  • patient history - allergies, meds, organ impairment
  • administer in morning
  • check urine output
  • monitor weight
  • monitor serum electrolytes
  • check oedema/congestion is reducing
  • check BP - hypotension
  • diet - rich/low in potassium and low in sodium

Pharmacology 1 (11 decks)

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