Manipulating kidney function Flashcards

1
Q

main kidney functions

A

Excretion of nitrogenous waste products and xenobiotics
Regulation of water, electrolyte, mineral and acid-base balance
Production or activation of hormones (calcitriol – active
vitamin D3; erythropoietin)

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2
Q

diuretic mechanism of action

A

direct action on the nephron
Inhibit sodium chloride reabsorption to incr salt and water excretion
Counter-act salt and water retention in heart failure
Activate renin secretion

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3
Q

loop diuretics

A

Act on ascending Loop of Henle from tubule side
Heavily plasma protein bound – reach site of action by PCT secretion
most efficacious of the clinically available diuretics
pulmonary venodilator action when given intravenously

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4
Q

thiazide diuretics

A

Act on the early distal tubule (DCT)
Bind to the Cl- site of the Na+/Cl- co-transporter
Less efficacious than loop diuretics
anti-hypertensive effects include vascular action

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5
Q

thiazide diuretics - drugs

A

Chlorothiazide and hydrochlorthiazide

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6
Q

loop diuretics - drug

A

Furosemide

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7
Q

Potassium sparing diuretics

A

Act on the collecting tubule to inhibit the action of aldosterone
used to prevent potassium loss
Potential adverse effect – hyperkalaemia

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8
Q

Potassium sparing diuretics - Spironolactone

A

competitive antagonist of aldosterone
hyperkalaemia is less of a risk
can help in heart disease

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9
Q

Potassium sparing diuretics - Triamterene and amiloride

A

non-competitive inhibitors of aldosterone

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10
Q

General adverse effects of diuretics

A

Hypokalaemia - Furosemide
Hypomagnesaemia - Thiazides
Hyperkalaemia - K+ sparing diuretics
Hyponatraemia - All diuretics – poor prognosis
Hypochloraemic metabolic alkalosis - Furosemide and thiazides

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11
Q

drug interactions

A

Diuretics are synergistic with vasodilator drugs
Reduce the dose once congestion resolves
Renal prostaglandins are natriuretic (salt losing)
NSAIDs exacerbate salt and water retention in heart failure, reducing efficacy of diuretics + COX-1 and COX-2 inhibition

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