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Pharmacology > Drugs that act on the Kidneys > Flashcards

Drugs that act on the Kidneys Flashcards

0
Q

Within the nephron, what order do you find the following:

Distal Tubule, Collecting Duct, Proximal Tubule, Loop of Henle, Glomerulus

A

Glomerulus - Proximal Tubule - Loop of Henle - Distal Tubule - Collecting Duct

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1
Q

What organ’s job is to balance salts and fluid within the body?

A

The Kidney

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2
Q

What type of drug increases the amount of fluid and salts excreted by the kidney?

A

Diuretics

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3
Q

What drug is used to sort out oedema, hypertension and glaucoma?

A

Diuretics

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4
Q

Diuretics increase urine production. How does this help get rid of oedema?

A

It draws away more fluid from the swollen areas in the tissue.

This reduces swelling and the area returns to normal.

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5
Q

Diuretics increase the volume of urine produced.

What 3 things do they decrease in order to treat hypertension?

A

Blood Volume
Pressure on blood vessels
Blood Pressure

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6
Q

What are the 3 ways salts and water move around between cells etc in the body?

A

Active Transport = Pumps
Passive Transport = Channels
Osmosis

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7
Q

Pumps move salts using energy.

Name the 3 pumps that do this:

A

Sodium/Potassium Pump
Sodium/Chloride Pump
Sodium/Potassium/Chloride Pump

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8
Q

What is the name for openings in the cell membrane, that are ion selective and allow salts to move through (no energy required)?

A

Channels

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9
Q

What does ion selective mean?

A

This is where only certain ions are allowed through, whether this may be sodium, potassium or chloride

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10
Q

What is osmotic effect?

A

Water follows salt

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11
Q

What are the 3 main classes of diuretic?

A

Thiazide and related
Loop
Potassium Sparing

These work on slightly different parts of the nephron

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12
Q

Which diuretic acts on the distal convoluted tubule?

A

Thiazide and Related Diuretics

D in thiazide = distal

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13
Q

Which class of diuretic is used to treat oedema within MILD heart failure, liver and kidney disease or steroid/hormone treatment, and for LONG TERM hypertension?

A

Thiazide Diuretics

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14
Q

What are bendroflumethazide, metolazone and indapamide examples of?

A

Thiazide Diuretics

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15
Q

Which 2 types of diuretic are metabolised by the liver and excreted only in the urine?

A

Thiazide and Loop diuretics

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16
Q

Which class of diuretic blocks the chloride pump, increases the excretion of sodium chloride and then increases the excretion of potassium?

A

Thiazide

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17
Q

What is the mechanism of action for thiazide diuretics?

A

Blocks the chloride pump, increases the excretion of sodium chloride and then increases the excretion of potassium.

IDE = Thiazide

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18
Q

When thiazide diuretics block the chloride pump, why does this also increase the excretion of sodium and potassium?

A

Chloride is negatively charged and sodium and potassium are positively charged.
As the chloride is being excreted the cells want to balance out.

19
Q

When should thiazide diuretics be taken? Why (think of how long it takes for them to act)?

A

In the morning. They act within 1-2hours (rapidly), so this stops the patient being up all night.

20
Q

What are the side effects of thiazide diuretics?

4 Hs and 2 cautions

A

Hypokalaemia, Hypocalcemia, Hyperuricemia, Hyperglycemia
(low potassium, low calcium, high uric acid and high sugar)

Caution with patients w/ arrhythmias, diabetes, on lithium, NSAIDS or pregnant/breastfeeding

21
Q

Where do loop diuretics act?

A

The ASCENDING loop of Henle

22
Q

Which diuretic is used for oedema resulting from SEVERE heart failure or acute ventricular failure (pulmonary oedema), and hypertension?

A

Loop Diuretics - loop = Loop of Henle

Potent = severe stuff = loopy?

23
Q

What are furosemide and bumetanide examples of?

A

Loop diuretics

FUROSEMIDE AND BUMETANIDE

24
Q

What is the mechanism of action for loop diuretics?

A

They block the sodium/potassium/chloride pump increasing the excretion of all 3.
Makes sense - severe and loopy = big pump
More urine and hardly any ions reabsorbed

25
Q

When should powerful loop diuretics be administered? Why?

A

Morning and before 4pm.

Twice daily - act very fast but not for as long. Don’t want to be up all night

26
Q

Which diuretic has side effects of hypokalaemia, hyponatraemia, hypervolemia and deafness?
(also caution should be taken for patients with Arrhythmias, diabetes, taking lithium and pregnant

A

Loop Diuretics

Deafness = 8th cranial nerve damage from I.M or I.V admin

27
Q

What is the site of action for potassium sparing diuretics?

A

The distal tubule and collecting duct

things on the end - late
Sparing - being nice comes last

28
Q

Which diuretic is used for oedema resulting from heart failure and liver disease, hypertension and hypokalemia alongside other diuretic types?

A

Potassium Sparing

29
Q

Which specific diuretic is used for primary hyperaldosteronism (Conn’s Syndrome)?

A

Spirolactone

30
Q

Spirolactone, amiloride (a sodium channel blocker) and eplerenone (an aldosterone antagonist) are examples of what?

A

Potassium Sparing Diuretics

31
Q

Which diuretic is metabolised by the liver and excreted in both urine and bile?

A

Potassium Sparing

32
Q

What is the general mechanism of action for potassium sparing diuretics?
How does spironolactone do this?

A

It increases sodium and water excretion along with chloride and calcium, however it decreases the excretion of potassium and hydrogen.

Spironolactone blocks the aldosterone receptor. It blocks sodium being reabsorbed thus increasing urine/water - and lessens the sodium potassium pump so that potassium is not pumped out

33
Q

Which class of diuretic is fairly week?

A

Potassium Sparing Diuretics

34
Q

Which diuretic has possible side effects of hyperkalaemia (requiring a low potassium diet) and the requirement for close monitoring of electrolyte levels - especially for people also taking ACE inhibitors, angiotensin receptor antagonists and B antagonists?

A

Potassium Sparing Diuretics

35
Q

What diuretic is a patient likely to be taking if we need to monitor their electrolyte levels?
(Particularly if taking ACE inhibitors, SARTANS, B antagonists)?

A

Potassium Sparing Diuretics

36
Q

What is the site of action for anti-diuretics?

A

The Collecting Tubule

Right at the end - anti

37
Q

What are anti-diuretics used for?

A

To treat Central Diabetes Insipidus (the lack of ADH/anti-diuretic hormone)

38
Q

What type drug is used to treat Central Diabetes Insipidus? What is this?

A

Anti-diuretics - a lack of anti-diuretic hormone

39
Q

What are vasopressin and desmopressin examples of?

A

Anti-diuretics

Pressin = pressin for a wee

40
Q

What is the mechanism of action of anti-diuretics?

A

They increase the number of water channels by V2 receptors, which increases passive reabsorption of water

41
Q

Anti-diuretics increase water channels, thus increasing the passive reabsorption of water. What receptors do they act on?

A

V2

42
Q

Which anti-diuretic has a short duration of action, is administered by injection/infusion and also increases blood pressure due to binding to V1 receptors?

A

Vasopressin

43
Q

Which anti-diuretic has a longer duration of action, is administered as a nasal spray or tablets and is V2 selective so does not affect blood pressure?

A

Desmopressin

44
Q

What do you need to ensure is balanced when dosing anti-diuretics?

A

Want to make sure there is enough urine production to prevent water intoxication

Pharmacology (13 decks)

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