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Year 1: Patho/Pharm > Kidney PHARM > Flashcards

Kidney PHARM Flashcards

1
Q

Function of the Kidney

A
  1. Control extracellular fluid volume and composition
  2. acid-base balance
  3. excrete wastes (metabolites, drugs)
  4. Hormones
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2
Q

Indication
Diuretics

A
  1. Hypertension
  2. Fluid volume overload
    - heart failure
    - kidney failure
    - cirrhosis
  3. prevent kidney failure
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3
Q

% electrolyte reabsorption
Different parts of nephron

A
  1. Proximal convoluted tubule
    - 65% sodium reabsorption
    - 100% potassium and bicarb reabsorption
  2. Loop of henle
    - 20% sodium reabsorption
  3. early distal convoluted tubule
    - 10% sodium reabsorption
  4. late distal convoluted tubule
    - 1-5% sodium reabsorption

*water follows
Strongest diuretics act earliest in the nephron

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4
Q

3 basic functions of the nephron

A
  1. Filter
  2. reabsorption
  3. secretion

Filter
- non selective
- glomerular filtration membrane
- water, electrolytes, a.a., glucose, medication, waste

Reabsorption
- selective
- electrolytes, water, glucose, a.a

Secretion
- selective
- Active process using pumps
- waste, metabolites, glucose, potassium, sodium, etc.

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5
Q

Diuretic, action site on nephron, % blockage

A

Mannitol
- proximal convoluted tubule
- 65% sodium/chloride blockage

Loop diuretics
- thick ascending loop of henle
- 20% sodium/chloride blockage
Ex. furosemide

Thiazide diuretics
-Early distal convoluted tubule
- 10% sodium/chloride/potassium blockage

Potassium Sparing Diuretics
- late distal convoluted tubule
- 1-5% sodium/chloride blockage
- Ex. spironolactone/triamterene

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6
Q

MOA Diuretics

A

Blockage passive absorption of water through blocking sodium/chloride reabsorption

*water passively follows sodium reabsorption

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7
Q

AE Diuretics

A

Excess diuresis
- hypovolemia
- low blood pressure
- dehydration

Excess sodium/chloride blockage
- Hyponatremia
- hypokalemia
- digoxin and lithium toxicity

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8
Q

Classification of Diuretics

A
  1. Loop diuretics
    Ascending thick limb of henle
    Ex. furosemide
    20% block Na/Cl reabsorption
  2. Thiazide diuretics
    early distal convoluted tubule
    Ex. hydrochlorothiazide
    10% block Na/Cl reabsorption
  3. Potassium sparing diuretics
    late distal convoluted tubule
    Ex. spironolactone (aldosterone antagonists)
    Ex. triamterene (non-aldosterone antagonists)
  4. Mannitol
    Proximal convoluted tubule
    65% sodium/chloride blockage
    strongest diuretic
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9
Q

Examples
Loop diuretics

A

Furosemide
Torsemide
Ethancrynic acid
Bumetadine

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10
Q

MOA
Loop Diuretics

A

Prevention sodium/chloride reabsorption in ascending loop of henle (20% blockage)
Prevents passive reabsorption of water
Promotes diuresis

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11
Q

SE
Loop Diuretics

A

Excessive diuresis and dehydration
- thirsty, oliguria, dry mouth, weight loss

Hypotension
- diuresis
- vascular smooth muscle relaxation

Ototoxicity
- furosemide reversible
- ethancrynic acid irreversible

Dyslipidemia
- increase LDL, cholesterol, TG (bad)
- decrease HDL

Hyperglycemia
- increase glucose reabsorption

Hyperuremia
- increase urea reabsorption

Electrolyte imbalances
- Hyponatremia
- Hypochloremia
- Hypokalemia (distal convoluted tubule, reabsorbs sodium, excretes potassium)

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12
Q

Drug interactions
Loop diuretics

A

Digoxin toxicity
- hypokalemia -> dysrhythmias

Lithium toxicity
- increase reabsorption

NSAIDS
- nephrotoxicity

Ototoxic drugs
- ototoxicity and hearing loss
- Ex. aminoglycoside antibiotics
- Ex. misoprostol

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13
Q

Contraindications
Loop diuretics

A
  • Hyponatremia
  • Hypochloremia
  • Hypokalemia
  • Caution: diabetics, dyslipidemia, gout, lithium, digoxin (heart failure), ototoxic drugs, NSAIDs, anti-hypertensives
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14
Q

Therapeutic monitoring
Loop diuretics

A

Weight (water loss)
electrolytes (sodium, chloride, potassium)
S&S hypokalemia
Blood pressure
Heart rate

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15
Q

S&S hypokalemia

A
  • muscle weakness
  • palpitations / dysrhythmias
  • numbness, tingling
  • constipation
  • nausea, vomiting
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16
Q

PRN potassium prescriptions
Loop diuretics

A

Potassium rich diet:
potatoes, spinach, tomatoes, bananas, nuts

potassium suppliment

potassium sparing diuretics
spironolactone
triamterene

17
Q

MOA
Thiazide diuretics

A

Block sodium, chloride, potassium (and water) reabsorption in the early distal convoluted tubule (10%)

*not effective if GFR < 15mL/min

18
Q

Indications
Thiazide Diuretics

A

Hypertension

Fluid volume overload (kidney, heart, liver)

19
Q

SE
Thiazide diuretics

A

Dehydration
- weight loss, thirsty, oliguria, dry mouth

Hypotension
- Caution: anti-hypertensives

Hyperglycemia
- increase glucose reabsorption
- Caution: diabetes

Hyperuricemia
- increase urea reabsorption
- Caution: gout

Electrolyte imbalances
- hyponatremia, hypochloremia, hypokalemia
- Caution: lithium, digoxin, heart failure

Dyslipidemia

20
Q

Drug interactions and caution
Thiazide Diuretics

A

Digoxin toxicity

Lithium toxicity

Caution: diabetes, gout, heart failure

eGFR < 15mL/min (not effective)

21
Q

Patient monitoring
Thiazide diuretics

A

Weight
blood pressure, heart rate
S&S hypokalemia
edema

22
Q

Example
Thiazide diuretics

A

Hydrochlorothiazide
Chlorothiazide
methyclothiazide
indapamide

23
Q

Indication
Potassium sparing diuretics

A

Adjunct prescription with other diuretics (loop diuretics, thiazide diuretics) to counteract potassium loss

Minimal effect on fluid volume (5%)

Cardio protective effects aldosterone antagonists

24
Q

Examples
Potassium sparing diuretics

A
  1. aldosterone antagonists
    - sprionolactone
    -epilerone
  2. non-aldosterone antagonists
    - triamterene
    - amiloride
25
Q

MOA
Spironolactone
MRA (mineralcorticoid receptor antagonist)

A

Acts in late distal convoluted tubule - prevents action of aldosterone - prevents synthesis of Na/K pumps (1-2 days for onset, lifetime of cell)

Result potassium absorption, sodium excretion

26
Q

SE
Spironolactone

A

Adrongenergic: hirsituism, deep voice, decreased libido, impotence, gynecomastia

Teratogenic: fetus

Hyperkalemia: caution with RAAS inhibitors (ACE inhibitors, ARBs, renin inhibitors), caution with potassium supplements, potassium rich diet

Tumorgenic: rats

27
Q

Cardiovascular benefit of
Spironolactone

A

Blocks aldosterone effect on heart
prevention mortality
decreases cardiac and blood vessel remodelling by blocking aldosterone

Prevents absorption of water which decreases after load and cardiac work

28
Q

Monitoring
Potassium sparing diuretics

A

Serum potassium

signs of hyperkalemia

avoidance potassium supplements, potassium rich foods,

RAAS inhibitors
D/C potassium sparing diuretic 2-3 days before you start ACEi

29
Q

Contraindication
Potassium sparing diuretics

A

potassium supplements, potassium rich foods

hyperkalemia

pregnancy

30
Q

MOA
Triamterene / amiloride

A

Directly block Na reabsorption
Promote potassium reabsorption, promote diuresis
location distal convoluted tubule

31
Q

SE
Triamterene / amiloride

A

Hyperkalemia
- nausea, vomiting, diarrhea
- numbness, tingling, weakness
- palpitations

Amiloride - blood dyscrasia, tingling, vomiting, leg cramps

32
Q

S&S
Hyponatremia

A

SALT LOSS

Stupor/coma
Anorexia
Lethargy
Tendon reflexes decrease
Limp muscles
Orthostatic hypotension
Seizures
Stomach cramping

*wet noodle

Year 1: Patho/Pharm (45 decks)

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