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module 104 - theme 3 > drugs which affect the kidney > Flashcards

drugs which affect the kidney Flashcards

1
Q

what are diuretics?

A

a drug that increases the excretion of both fluids and solutes

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2
Q

what does a natriuretic do?

A

increases Na+ excretion

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3
Q

what does a kaliuretic do?

A

increases K+ excretion

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4
Q

what are the 2 ways in which most diuretics increase excretion of Na+ and water by the kidneys?

A

1) they reduce reabsorption of Na+ from the filtrate

2) increase water loss is secondary to Na+ excretion

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5
Q

what are aquaretic agents?

A

new diuretics that increase urine excretion without increasing Na+ excretion

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6
Q

what are the 2 modes of action of diuretics?

A

1) direct action of the cells of the nephron

2) modification of content of the filtrate

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7
Q

what are the 2 major applications of diuretic agents?

A

1) reduce circulating fluid volume

2) removal of excess body fluid (oedema)

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8
Q

what are possible of side effects of diuretics due to actions they have on the kidneys?

A
  • hypertension
  • chronic heart failure
  • liver cirrhosis
  • renal disease
  • premenstrual oedema
  • toxic oedema
  • increase elimination of drugs
  • rapid weight loss
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9
Q

what are other side effects of diuretics?

A
  • glaucoma

- epilepsy

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10
Q

where do carbonic anhydrases act?

A

proximal tubule

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11
Q

where do osmotic diuretics act?

A

proximal tubule, descending loop of Henle

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12
Q

where do loop diuretics act?

A

ascending loop of Henle

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13
Q

where do thiazides and thiazide-like diuretics act?

A

early distal tubule

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14
Q

what are the 2 types potassium sparing diuretics?

A
  • aldosterone antagonists

- non-aldosterone antagonists

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15
Q

where do potassium sparing diuretics act?

A

late distal tubule, early collecting duct

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16
Q

what are the most effective diuretics?

A

loop diuretics

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17
Q

how do loop diuretics work?

A

they inhibit the Na+/K+/2Cl- transporters (NKCC2) in the thick ascending limb of the loop of Henle which reduces reabsorption of Na+, K+ and Cl-

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18
Q

what can a single dose of loop diuretics do to the urine volume?

A

increase urine volume from 200 to 1,200ml over 3 hours

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19
Q

what are the clinical uses of loop diuretics?

A
  • acute pulmonary oedema
  • chronic heart failure
  • cirrhosis of liver
  • resistance hypertension
  • nephrotic syndrome
  • acute kidney injury
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20
Q

what are the unwanted effects of loop diuretics?

A
  • dehydration
  • K+ loss leading to low plasma K+
  • metabolic alkalosis
  • hypokalaemia can potentiate effects of cardiac glycosides
  • deafness
21
Q

how does sodium-potassium exchange change due to loop diuretics?

A
  • loop diuretics cause increased Na+ delivery to distal tubule
  • this is exchanged for K+ in the DT which is excreted in the urine
  • this K+ loss contributes to hypokalaemia associated with loop diuretics
22
Q

how do thiazide diuretics work?

A
  • act in the distal tubule to inhibit the apical Na+/Cl- co-transporter
  • cause moderate but sustained Na+ excretion with increased water excretion
23
Q

how long do thiazide diuretics work?

A

up to 24 hours

24
Q

what are the clinical uses for thiazide diuretics?

A
  • hypertension
  • oedema
  • mild heart failure
25
Q

what are the unwanted effects of thiazide diuretics?

A
  • plasma K+ depletion
  • metabolic acidosis
  • increased plasma uric acid: gout
  • hyperglycaemia
  • increased plasma cholesterol
  • male impotence (reversible)
26
Q

what is currently the preferred diuretic for resistance hypertension and why?

A
  • indapamide

- lower incidence of unwanted effects

27
Q

what are the symptoms of mild hypokalaemia?

A

fatigue, drowsiness, dizziness, muscle weakness

28
Q

what are the symptoms of severe hypokalaemia?

A

abnormal heart rhythm, muscle paralysis, death

29
Q

how do potassium sparing diuretics work?

A

act on distal tubules to inhibit Na+ reabsorption but K+ isn’t secreted into the distal tubule

30
Q

what is spironolactone metabolised to?

A

canrenone

31
Q

what is canrenone?

A

a competitive antagonist of aldosterone

32
Q

how does spironolactone work?

A

reduces Na+ channel formation and its absorption from distal tubule

33
Q

what are the clinical uses of spironolactone?

A
  • heart failure

- oedema

34
Q

what are the unwanted effects of spironolactone?

A
  • hyperkalaemia
  • metabolic acidosis
  • GI upsets
  • gymaecomastia, menstrual disorder, testicular atrophy

*eplernone produces less unwanted effects

35
Q

how do triamterene and amiloride work?

A
  • weak diuretic: act on distal tubule to inhibit Na+ reabsorption and decrease K+ excretion
  • block luminal Na+ channel by which aldosterone produces its main effects
36
Q

what are the main unwanted effects of triamterene and amiloride?

A
  • hyperkalaemia
  • metabolic acidosis
  • GI upsets
  • skin rashes
37
Q

what are the 2 main reasons diuretics are used in combination?

A

1) to increase diuretic effect

2) to avoid the unwanted effects of hypokalaemia

38
Q

what is the best combination of diuretics to use to avoid hypokalaemia?

A

use loop diuretics or thiazides with potassium sparing diuretics

39
Q

what is the main example of a carbonic anhydrase inhibitor?

A

azetozolamide

40
Q

how do carbonic anhydrase inhibitors work?

A
  • ## blocks sodium bicarbonate reabsorption in the proximal tubule
41
Q

what are carbonic anhydrase inhibitors used to treat?

A
  • glaucoma

- epilepsy

42
Q

what are the unwanted effects of carbonic anhydrase inhibitors?

A
  • metabolic acidosis

- enhances renal stone formation

43
Q

what is the main example of an osmotic diuretic?

A

mannitol

44
Q

what are the clinical uses of osmotic diuretics?

A
  • treatment of raised inter cranial pressure
  • treatment of intraoccular pressure
  • cause osmotic diarrhoea if given orally
  • can treat acute renal failure
45
Q

what is the unwanted effector osmotic directs?

A

increased plasma volume

46
Q

what volume of urine does ADH usually maintain?

A

1.5L/day

47
Q

what happens with toxicity of ADH antagonists?

A

1) diabetes insipidus
2) renal failure
3) Li+ can cause tremors, mental confusion, cardiotoxcicity, thyroid dysfunction and leukocytosis
4) demeclocylcine shouldn’t be used in patients with liver disease

48
Q

what are the 2 non-selective agents used in potential ADH antagonists?

A
  • lithium

- demeclocyline

49
Q

how doe Xanthines work?

A
  • produce weak diuretic effect by increasing cardiac output
  • possible also some vasodilation of the glomerular afferent arteriole
  • results in increased renal and glomerular blood flow which increases glomerular filtration rate and urine output

module 104 - theme 3 (13 decks)

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