Kidney Drugs

Question 1

Types of kidney drugs

Answer 1

Diuretics
RAS drugs (ACE I, AT1/Renin antagonists)
ADH analogues
Weak acid/base transporter
Altering urine pH

Question 2

Diuretic types

Answer 2

Osmotic e.g. mannitol
CA inhibitors
Loop diuretic
Thiazide diuretic
K sparing

Question 3

Osmotic diuretic MOA

Answer 3

Mannitol, HMW compounds filtered but not reabsorbed, water enters due to osmosis and diuresis occurs but weak diuretic

Question 4

Osmotic diuretic used in

Answer 4

Cerebral oedema

Raised intra-ocular pressure

Question 5

CA inhibitor MOA

Answer 5

Acetazolamide increases Na bicarb excretion and water accompanies it but weak diuretic

Question 6

CA inhibitor used in

Answer 6

Glaucoma, Acute mountain sickness, urinary alkalisation treatments

Question 7

CA inhibitor SE

Answer 7

Hyperchloremic metabolic acidosis

Question 8

Loop diuretic MOA

Answer 8

Furosemide inhibits NKCC in TAL of loop of Henle

Question 9

Loop diuretic SE

Answer 9

metabolic alkalosis due to reduced plasma volume and inc HCO3 conc
increased Ca/Mg excretion
Gout (furosemide competes with transporter for uric acid removal)
Overuse can cause deafness if very high doses given intravenously

Question 10

Loop diuretic uses

Answer 10

Pulmonary oedema due to LV failure

Used in heart attack to remove fluid

Question 11

Thiazide MOA

Answer 11

Bendroflumethiazide/metolazone inhibit NaCl symporter in dct

Question 12

Thiazide uses

Answer 12

Hypertension
Oedema in mild CHF
Nephrogenic diabetes insipidus (possibly because creates mild hypovolaemia, stimulates compensation)

Question 13

Thiazide SE

Answer 13

Hypokalaemia
Hyperuricaemia
Glucose Tolerance
Increased plasma cholesterol for 6 months

Question 14

K sparing diuretic MOA

Answer 14

spironolactone antagonises aldosterone on K/Na exchanger on basolateral membrane of distal tubule, amiloride/triamterene blocks Na absorption on luminal side

Question 15

K sparing uses

Answer 15

Can be given with thiazide/loop to spare K

Spironolactone in Conn’s disease (1˚ hyperaldosteronism), liver disease with ascites, severe heart failure

Question 16

K sparing SE

Answer 16

Hyperkalaemia especially with ACE inhibitors

Question 17

Where is ACE found

Answer 17

All epithelial cells, so high density in lungs

Question 18

Beta blockers MOA

Answer 18

Atenolol inhibits renin release (beta 1 receptor)

Question 19

ACE inhibitors MOA

Answer 19

Ramapril, captopril, enalapril (prodrug) inhibit ACE

Question 20

AT-1 inhibitors MOA

Answer 20

Losartan/candesartan/valsartan antagonise angiotensin II at AT-1 receptor

Question 21

Renin inhibitors MOA

Answer 21

Aliskiren inhibits renin directly preventing conversion of angiotensinogen to angiotensin

Question 22

ACE inhibitor uses

Answer 22

anti-hypertension
chronic heart failure
Myocardial infarction with heart failure

Question 23

ACE inhibitor SE

Answer 23

Transient hypotension with first dose, especially with dehydration/diuretic use
Hyperkalaemia
Bradykinin cough

Question 24

ADH analogue MOA

Answer 24

Desmopressin is an ADH analogue causing less vasoconstriction (acts on V1 receptors), Felypressin has more vasoconstrictor than diuretic activity

Question 25

ADH analogue administration

Answer 25

Nasal spray/drops, not oral as it’s a peptide so digested

Question 26

Iodothalamic acid use

Answer 26

Given IV, secreted into urine to show urinary tract under X-ray

Question 27

Probenecid use

Answer 27

Blocks secretion of drugs to maintain high levels in blood

Blocks urate reabsorption so used to treat gout by increasing uric acid excretion

Question 28

Acidification of urine pH

Answer 28

Ascorbic acid/ammonium chloride which dissociates to ammonia (converted to urea) and HCl

Question 29

Alkalinisation of urine

Answer 29

potassium citrate used, dissociates to form potassium and bicarbonate anion (base), alkaline forces diuresis