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104: Theme 3 - 304 - Renal > Drugs Which Affect the Kidney > Flashcards

Drugs Which Affect the Kidney Flashcards

1
Q

What are two modes of action for diuretics?

A
  • Direct action on the cells of the nephron ( more common)
  • Modification of content of the filtrate
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2
Q

List 4 situations which you would use diuretics?

A
  • hypertension
  • CHF
  • liver cirrhosis
  • renal disease
  • premenstrual oedema
  • toxic oedema
  • increase the elimination of drugs
  • rapid weight loss (abuse)
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3
Q

What are the 5 classes of diuretic agents?

A
  • Carbonic anhydrase inhibitor
  • Osmotic diuretic
  • Loop diuretics
  • Thiazide and Thiazide-like diuretics
  • Potassium-sparring diuretics: (Non-) Aldosterone antagonists
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4
Q

Where is the main site of action for the class of diuretics: carbonic anhydrase inhibitors

A
  • the proximal tubule
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5
Q

Where is the main site of action for the class of diuretics: Osmotic diuretics

A
  • Proximal tubule
  • Descending Loop of Henle

(water permeable parts of the nephron)

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6
Q

Where is the main site of action for the class of diuretics: Loop diuretics?

A
  • Ascending Loop of Henle
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7
Q

Where is the main site of action for the class of diuretics: Thiazide and Thiazide-like diuretics?

A
  • Early distal tubule
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8
Q

Where is the main site of action for the class of diuretics: Potassium-sparing diuretics

A
  • Late distal tubule
  • Early collecting tubule (duct)
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9
Q

Describe the action of Loop Directs

A
  • Inhibits the action of NKCC2 in the thick ascending Loop of Henle
  • Na+, K+ and Cl- not reabsorbed from the tubule
  • reduced Na+ reabsorption leads to rapid and significant diuresis
  • the osmotic gradient isn’t created in the medulla –> less water being reabsorbed from descending limb of LOH
  • urine output from 200 to 1200 ml in 3 hours
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10
Q

When would use of Loop diuretics be clinically indicated?

A
  • Acute pulmonary oedema
  • Chronic Heart Failure
  • Cirrhosis of the liver
  • Resistant hypertension
  • reduced urine production (oliguria)*
  • Nephrotic syndrome
  • Acute kidney syndrome
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11
Q

What are the unwanted effects of Loop diuretics?

A
  • Dehydration
  • Hypokalaemia: K+ loss leading to low plasma K+
  • Metabolic alkalosis: due to H+ loss in urine
  • Hypokalaemia can potentiate the effects of cardiac glycosides (increase output force of the heart and increase HR acts on Na/K pump)
  • Deafness: when used with aminoglycoside antibiotics
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12
Q

Describe the action of Thiazide diuretics

A
  • Inhibit the Na/Cl co-transporter in the distal tubule
  • cause moderate but sustained Na+ secretion with increased water excretion
  • well-absorbed from GI tract and long duration of action: up to 24h
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13
Q

Give examples of thiazide and thiazide-like diuretics and their indications?

A
  • Bendroflumethiazide: useful for mild/moderate heart failure
  • Chlortalidone: preferred for ascites due to cirrhosis of stable patients; oedema due to nephrotic syndrome

Thiazide-like diuretics

  • Indapamide: preferred for hypertension
  • Metolazone: good combined with loop diuretics, good for Oedema
  • Xipamide: lowers BP with less side effects, good for Oedema
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14
Q

What are the unwanted effects of Thiazide diuretics and what drug is used for the least unwanted effects?

A
  • Plasma K+ depletion
  • Metabolic alkalosis: due to urinary H+ loss
  • Increased plasma uric acid- gout
  • Hyperglycaemia
  • Increased plasma cholesterol (with long term use)
  • Male impotence (reversible)

Indapamide

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15
Q

What are the symptoms and clinical features Mild Hypokalemia?

A
  • Loop Diuretics and Thiazide diuretics
  • fatigue
  • drowsiness
  • dizziness
  • muscle weakness
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16
Q

What are the symptoms and clinical features Severe Hypokalemia?

A
  • abnormal heart rhythm
  • muscle paralysis
  • death
17
Q

Describe the action of Potassium-Sparing diuretics: Aldosterone antagonists

A
  • aldosterone antagonist in the distal tubule
  • used short-term fro Heart failure and Oedema
  • Spironolactone (or Epleronone) is metabolised to canrenone (active form)
  • acts as a competitive inhibitor for aldosterone receptor
  • reduce Na+ channel formation and its absorption from the distal tubule
  • limited diuretic action, takes several days to take effect as its affecting the protein expression on distal tubular cells
18
Q

What are the unwanted effects of the Potassium-sparing diuretic drug Spironolactone?

A
  • Hyperkalaemia: needs regularly monitoring
  • Metabolic acidosis (increased plasma H+)
  • GI upsets (peptic ulceration)
  • Gynaecomastia, menstrual disorders, testicular atrophy
  • Eplerenone produces less unwanted effects than spironolactone
19
Q

What is the use of Triamterene and Amiloride?

A
  • weak diuretics best used in combination with potassium depleting-diuretics to limit hypokalaemia
  • blocks luminal Na+ channel which aldosterone acts on to produce its main effect
20
Q

What is the main unwanted effect of Potassium-sparing diuretics Triamterene and Amiloride?

A
  • hyperkalaemia
  • metabolic acidosis
  • GI disturbance
  • skin rashes
21
Q

What diuretic combinations can be used to avoid hypokalemia?

A

Loop diuretics with spironolactone

  • Lasilactone®: furosemide + spironolactone

Loop diuretics with amiloride or triamterene

  • Co-amilofruse: furosemide + amiloride

Thiazides with spironolactone

  • Co-flumactone: hydroflumethiazide + spironolactone

Thiazides with amiloride or triamterene

  • Co-amilozide: hydrochlorothiazide + amiloride

Diuretics containing K+

22
Q

Describe the action and indicated use of the diuretic type: Carbonic Anhydrase Inhibitors

  • what are the unwanted effects
A
  • Blocks NaHCO3 reabsorption in the Proximal tubule
  • weak diuresis

Used for:

  • glaucoma (reduces intraocular pressure)
  • epilepsy (reduces volume and pressure of CSF)

Unwanted effects:

  • metabolic acidosis (due to excretion of HCO3-)
  • enhances renal stone formation (alkaline urine)
23
Q

Describe the action and indicated use of Osmotic diuretics.

  • give an example
  • what are the unwanted effects?
A
  • Mannitol
  • non-absorbable solute undergoes glomerular filtration
  • excreted within 30-60min
  • diuresis begins within 30-60 mins and persists for 6-8h

Used for:

  • cerebral oedema
  • glaucoma (eye thing)
  • osmotic diarrhoea if given orally
  • acute renal failure

Unwanted effects:

increases plasma volume can’t be used in those with hypertension

104: Theme 3 - 304 - Renal (5 decks)

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