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renal > pharmacology > Flashcards

pharmacology Flashcards

1
Q

how do diuretics increase urine outflow

A

by inhibiting the resorption of electrolytes at various sites in the nephron

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2
Q

when do diuretics enhance secretion of salt and water

A

in an increase of interstitial fluid causing tissue swelling

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3
Q

what conditions causes oedema

A
  • nephrotic syndrome
  • congestive heart failure
  • hepatic cirrhosis with ascites
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4
Q

how do diuretics enter the filtrate

A

by either:

  • glomerular filtration
  • secretion via transport process in the proximal tubule
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5
Q

what are the two transport systems

A
  • the organic anion transporters

- the organic cation transporters

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6
Q

what do organic anion transporters transport

A

acidic drugs

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7
Q

what do organic cation transporters transport

A

basic drugs

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8
Q

where do organic anions enter the cell

A

the basolateral membrane

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9
Q

where do organic anions enter the lumen

A

apical membrane

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10
Q

where do organic cations enter the cell

A

basolateral membrane

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11
Q

where do organic cations enter the lumen

A

at the apical membrane

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12
Q

what do loop diuretics do

A

inhibit the Na/K/2Cl transporter by binding to the Cl site

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13
Q

where are loop diuretics absorbed

A

in the GI tract

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14
Q

clinical indications of loop diuretics

A

to reduce salt and water overload associated with:

  • chronic heart failure
  • chronic kidney failure
  • hepatic cirrhosis with ascites
  • nephrotic syndrome

to increase urine volume in acute kidney failure
to treat hypertension
to reduce acute hypercalcaemia

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15
Q

contraindications of loop diuretics

A
  • severe hypovolaemia or dehydration
  • severe hypokalaemia and/or hyponatraemia
  • hepatic encephalopathy
  • gout
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16
Q

side effects of loop diuretics

A
  • causing low electrolyte states
  • hypovolaemia and hypotension
  • hyperuricaemia
  • dose-related loss of hearing
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17
Q

what do thiazide diuretics do

A

inhibit the Na/Cl carrier by binding to the Cl site

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18
Q

which mechanism do thiazide diuretics enter the nephron by

A

the OAT mechanism

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19
Q

clinical indications for thiazide diuretics

A
  • mild heart failure
  • hypertension
  • severe resistent oedema
  • renal stones
  • nephrogenic diabetes insipidus
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20
Q

contraindications for thiazide diuretics

A
  • hypokalaemia
  • hyponatraemia
  • gout
21
Q

adverse effects of thiazide diuretics

A
  • hypokalaemia
  • metabolic acidosis
  • hypovolaemia and hypotension
  • hypomagneasmia
  • hyperuricaemia
  • erectile dysfunction
  • impaired glucose tolerance
22
Q

what type of drugs are amiloride, triamterene, spironolactone and eplerenone

A

potassium sparing diuretics

23
Q

what do amiloride and triamterene do

A

block the apical sodium channel and decrease sodium reabsorption

24
Q

what do spironolactone and eplerenone do

A

compete with aldosterone for binding to intracellular receptors

25
Q

what happens if potassium sparing diuretics are given alone

A

they cause hyperkalaemia

26
Q

what are aldosterone antagonists used for (spironolactone)

A
  • heart failure
  • primary hyperaldosteronism
  • resistant essential hypertension
  • secondary hyperaldosteronism
27
Q

contraindications of potassium sparing diuretics

A
  • severe renal impairment
  • hyperkalaemia
  • addisons disease
28
Q

what do osmotic diuretics do

A

increase the osmolality of the filtrate, opposing the absorption of water in parts of the nephron that are freely permeable to water

29
Q

where is the major site of action of osmotic diuretics

A

the proximal tubule

30
Q

clinical uses of osmotic diuretics

A
  • prevention of acute hypovolaemia renal failure to maintain urine flow
  • urgent treatment of acutely raised intracranial and intraocular pressure
31
Q

adverse effects of osmotic diuretics

A

transient expansion of blood volume and hyponatraemia

32
Q

what do carbonic anhydrase inhibitors do

A

increase excretion of HCO3 with Na, K and H2O, alkalinising the urine

33
Q

what are carbonic anhydrase inhibitors used for

A
  • glaucoma and following eye surgery
  • prophylaxis of altitude sickness
  • infantile epilepsy
34
Q

what can alkalinising the urine be useful in

A
  • relief of dysuria
  • prevention of crystallization of weak acids
  • enhancing the excretion of weak acids
35
Q

what happens at the kidneys when aldosterone is secreted from the adrenal cortex

A

enhanced tubular sodium reabsorption and salt retention

36
Q

what happens at the kidneys when vasopressin is secreted from the posterior pituitary

A

enhanced water reabsorption

37
Q

what causes neurogenic diabetes insipidus

A

lack of vasopressin secretion from the posterior pituitary

38
Q

what causes nephrogenic diabetes insipidus

A

inability of the nephron to respond to vasopressin

39
Q

what can the act of vasopressin on the kidney be inhibited by

A
  • lithium
  • demeclocycline
  • vaptans
40
Q

what is Tolvaptan used in

A

SIADH to correct hyponatraemia

41
Q

where is SGLT1 found

A

kidneys and intestine

42
Q

where is SGLT2 found

A

proximal tubule of the kidneys

43
Q

what does inhibition of SGLT2 result in

A

glucosuria

44
Q

what do SGLT2 inhibitors cause

A
  • excretion of glucose
  • decreases in HbA1c
  • weight loss
45
Q

what prostaglandins are synthesised by the kidneys

A

PGE2

PGI2

46
Q

how do prostaglandins affect GFR

A
  • a direct vasodilator effect upon the afferent arteriole
  • releasing renin leading to increased levels of angiotensin II that vasoconstricts the efferent arteriole - filtration pressure increases
47
Q

what is the ‘triple whammy’ (three drugs that combined could have detrimental effects)

A

ACEI (or ARB), diuretic and NSAID

48
Q

what do uricosuric agents do

A

used in treatment of gout by blocking reabsorption of urate in the proximal tubule

49
Q

side effect of diuretics

A

gout

renal (28 decks)

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