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Renal > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What are diuretics role

A
  • inhibit the reabsorption of sodium

- increase urine flow

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2
Q

Thiazide diuretics can be used for what?

A
  • hypertension
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3
Q

Define oedema

A
  • imbalance between the formation and absorption of interstitial fluid
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4
Q

Name some conditions which cause oedema?

A
  • nephrotic syndrome
  • congestive heart failure
  • hepatic cirrhosis with ascites
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5
Q

Nephrotic syndrome is a disorder of?

A
  • glomerular filtration
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6
Q

Proteins in the urine causes what to the oncotic pressure of plasma?

A
  • decreases
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7
Q

Blood volume decrease due to proteinuria activates what system?

A
  • RAAS
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8
Q

How does congestive heart failure arise

A
  • from reduced cardiac output and renal hypoperfusion
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9
Q

How does hepatic cirrhosis cause ascites

A
  • increased pressure in hepatic portal vein
  • decreased albumin
  • loss of fluid into peritoneal cavity
  • activation of RAAS
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10
Q

Main sites of reabsorption of sodium

A
  • proximal convoluted tubule
  • thick ascending limb of loop of henle
  • early distal convoluted tubule
  • collecting tubule
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11
Q

What do carbonic anhydrase inhibitors block?

A
  • Na+/H+ exchange
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12
Q

What do loop diuretics block?

A
  • triple transporter

- Na+/K+/Cl-

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13
Q

What do thiazide diuretics block

A
  • Na+/Cl-
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14
Q

What do potassium sparing diuretics block?

A
  • Na+/K+ exchange
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15
Q

Diuretics must enter the ____ to work

A
  • filtrate
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16
Q

How do diuretics enter the filtrate

A
  • glomerular filtration
  • OATs (acidic drugs)
  • OCTs (basic drugs)
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17
Q

What transports acidic diuretic drugs

A
  • organic anion transporters
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18
Q

What transports basic diuretic drugs

A
  • organic cation transporters
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19
Q

Drug interactions of OATs

A
  • diuretics
  • simvastain
  • penicillin
  • nsaids
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20
Q

Drug interactions of OCTs

A
  • diuretics
  • atropine
  • metformin
  • morphine
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21
Q

Overall affect of loop diuretics

A
  • decrease tonicity of medullary interstium
  • prevent dilution of filtrate
  • increase Na+ load in distal nephron
  • increase Ca2+and Mg2+ excretion
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22
Q

Medical side effects of loop diuretics

A
  • hypocalcaemia
  • hypomagnesia
  • hyperuricaemia
  • loss of hearing
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23
Q

Main loop diuretics used

A
  • furosemide

- bumetanide

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24
Q

Where are loop diuretics absorbed?

A
  • absorbed from the GI tract
  • bind to plasma proteins
  • enter by OAT
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25
Q

Indications for loop diuretics

A
  • pulmonary oedema
  • chronic heart failure
  • nephrotic syndrome
  • increased urine volume in acute kidney failure
  • to reduce hypercalcaemia
26
Q

Contraindications of loop diuretics?

A
  • severe hypovolaemia or dehydration

- avoid in gout

27
Q

Name a thiazide diuretic

A
  • bendrolumethiazide
28
Q

Explain how thiazide diuretics work

A
  • act at early distal convoluted tubule
  • block Na+/cl- co transporter
  • absorbed by OAT transporters
  • promote reabsorption of Cli-
29
Q

Name a thiazide diuretic like drug

A
  • chlortalidone

- indapamide

30
Q

What are some uses for thiazide diuretics

A
  • mild heart failure
  • hypertension
  • severe resistant oedema
  • renal stone disease
  • nephrogenic diabetes insipidus
31
Q

Why might thiazide diuretics be used in renal stones

A
  • promote reabsorption of cl-

- reduce cl- in urine

32
Q

Contraindications of thiazide diuretics

A
  • hypokalaemia
33
Q

Adverse effects of thiazide diuretics

A
  • hypokalaemia
  • metabolic acidosis
  • hypomagnesaemia
  • erectile dysfunction
34
Q

Explain hypokalaemia as a result of diuretics

A
  • increased Na+ load
  • charge seperation
  • increased driving force on K+
  • K+ secretion
  • K+ washed away
35
Q

Name 2 different types of potassium sparing diuretics?

A
  • spironolactone / eplerenone

- amilodride

36
Q

Explain how spironolactone works

A
  • competes against aldosterone
  • increases Sodium excretion
  • decreases K+ excretion
37
Q

Explain how amilodride works

A
  • blocks Na+ channel
  • increases Na+ excretion
  • increases k+ reabsorption
38
Q

How does amiloride enter the kidney

A
  • octs
39
Q

when should the use of potassium sparing diuretics be avoided

A
  • severe renal impairment
  • hyperkalaemia
  • Addisons
40
Q

Usage of potassium sparing diuretics?

A
  • heart failure
  • Conns
  • resistant hypertension
41
Q

What are given in conjunction with potassium sparing diuretics?

A
  • thiazide or loop diuretics

- potassium sparing have a modest diuresis

42
Q

Which diuretic enter the cells via a oct?

A
  • Amiloride hydrochloride

- Na+ blocker

43
Q

What diuretics can cause hyperkalaemia?

A
  • potassium sparing diuretics
44
Q

What diuretics can cause hypokalaemia?

A
  • thiazide and loop diuretics
45
Q

Name an osmotic diuretic

A
  • Mannitol

- given iv

46
Q

Affect of osmotic diuretics

A
  • suppress movement of water

- reduce reabsorption of sodium

47
Q

How do osmotic diuretic enter the cell?

A
  • glomerular filtration
  • increases osmolarity of filtrate
  • reduces reabsorption of sodium
48
Q

When are osmotic diuretics used?

A
  • prevention of acute hypovolaemic renal failure

- treatment of raised intracranial pressure

49
Q

Adverse effects of osmotic diuretics?

A
  • transient expansion of blood volume

- hyponatraemia

50
Q

Name a carbonic anhydrase inhibitors?

A
  • acetazolamide
51
Q

What traditional diuretic is no longer used as a diuretic?

A
  • carbonic anhydrase inhibitors
52
Q

How do carbonic anhydrase inhibitors work?

A
  • increased excretion of HC03, Na+, k+ and H2O
53
Q

Carbonic anhydrase inhibitors can be used for?

A
  • glaucoma
  • prophylaxis for altitude sickness
  • infantile epilepsy
54
Q

Carbonic anhydrase inhibitors cause a what pH?

A
  • Metabolic acidosis

- excretion of bicarbonate

55
Q

Affect of carbonic anhydrase inhibitors on the urine?

A
  • alkalinising

- can be used for renal stones

56
Q

Affect of aldosterone

A
  • secretion from zona glomerulosa
  • increased activity of sodium channels
  • enhanced tubular Na+ reabsorption
57
Q

How does Vasopressin work

A
  • increased aquaporin 4

- enhanced H2O reabsoprtion

58
Q

Treatment of diabetes insipidus

A
  • desmopressin (synthetic analogue of vasopressin)
59
Q

What drugs may cause secondary vasopressin inhibition?

A
  • lithium
  • demeclocycline
  • vaptans
60
Q

What do vaptans block?

A
  • block V1 and V2

- blocks ADH effect

61
Q

Uses of vaptans

A
  • SIADH

- polycystic kidney disease

Renal (14 decks)

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