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renal > pharmacology > Flashcards

pharmacology Flashcards

1
Q

where is blood filtered in the kidney?

A

glomerulus

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2
Q

what is natiuresis?

A

the process of excretion of sodium in the urine

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3
Q

what increases sodium excretion?

A

ventricular and atrial natriuretic peptides as well as calcitonin

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4
Q

what conserves sodium?

A

chemicals such as aldosterone

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5
Q

where is K appearing in the urine secreted from?

A

the collecting duct

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6
Q

where is filtered potassium reabsorbed?

A

the proximal tubule and the loop of henle

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7
Q

how is potassium transported into cells in the collecting duct?

A

via the N/K ATPase on the basolateral membrane

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8
Q

what are diuretics?

A

drugs that ↑ the volume of urine produced by promoting the excretion of Na+, Cl-, HCO3 and water from the kidneys.

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9
Q

what is the impact of diuretics?

A

↑ urine flow, altered pH and altered ionic composition of blood and urine

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10
Q

when are diuretics used?

A

treatment of oedema and hypertension

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11
Q

what are the different classes of diuretics?

A

Osmotic diuretics
Carbonic anhydrase inhibitors
Loop diuretics
Thiazide diuretics
Potassium sparing diuretics

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12
Q

where do osmotic diuretics act?

A

proximal tubules
loop of henle
collecting duct

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13
Q

what is the mechanism of osmotic diuretics?

A

inhibition of water and Na reabsorption

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14
Q

where do carbonic anhydrase inhibitors act?

A

the proximal tubules

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15
Q

what is the mechanism of carbonic anhydrase inhibitors?

A

inhibition of bicarbonate reabsorption

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16
Q

where do loop diuretics act?

A

loop of henle (thick ascending limb)

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17
Q

what is the mechanism of loop diuretics?

A

inhibition of Na, K and Cl

18
Q

where do thiazides act?

A

early distal tubule

19
Q

what is the mechanism of thiazides?

A

inhibition of Na and Cl cotransport

20
Q

where do K sparing diuretics act?

A

late distal tubule
collecting duct

21
Q

what is the mechanism of K sparing diuretics?

A

inhibition of Na reabsorption and K secretion

22
Q

what are some examples of osmotic diuretics?

A

mannitol, isosorbide, glycerine and urea

23
Q

what is the result of osmotic diuresis?

A

blood volume deacreased and a large volume of dilute urine produced

24
Q

what does mannitol do?

A

diuresis in the prevention of acute renal failure
excretion of toxic substances
reduce IOP and ICP and cerebral oedema

25
Q

what are the adverse effects of osmotic diuresis?

A

cardiovascular toxicity immediately after injection
contraindicated in patients with HF

26
Q

what are some examples of carbonic anhydrase inhibitors?

A

Acetazolamide, Methazolamide

27
Q

what is the function of carbonic anhydrase in the proximal collecting tubule?

A

anhydrase plays a major role in acid/base balance
ultimately leads to no Na or bicarbonate reabsorption

28
Q

what are some indications for carbonic anhydrase inhibitors?

A

raised IOP in open angle glaucoma
ocular hypertension when monotherapy is inadequate

29
Q

what are some side affects of carbonic anhydrase inhibitors?

A

metabolic acidosis
renal stones
renal potassium wasting

30
Q

which binding site do loop diuretics act upon?

A

the chloride binding site, directly inhibiting the carrier

31
Q

what are the indications for loop diuretics?

A

water imbalances associated with congestive HF, KF and pulmonary oedema
in patients with a high BP and less than 50% kidney function

32
Q

how do loop diuretics interact with other medications?

A

hypokalaemia associated with loop diuretics increases the risk of digoxin toxicity ( a med prescribed for congestive HF)
corticosteroids can also cause hypokalaemia
aminoglycosides can increase the risk of kidney damage
NSAIDs can reduce the effect of loop diuretics

33
Q

what are some examples of thiazide diuretics?

A

hydrochlorothiazide, bendroflumethiazide

34
Q

what are thiazide diuretics used to treat?

A

high BP
congestive HF
oedema
cirrhosis

35
Q

what ion do thiazides increase reabsorption of?

A

Ca reabsorption at the distal tubule

36
Q

what are the contraindications of thiazide diuretics?

A

hypotension
gout
renal failure
lithium therapy
hypokalaemia
may worsen diabetes
they reduce the clearance of uric acid, hence the gout contraindication

37
Q

why can thiazides and loop diuretics lead to digoxin toxicity?

A

Hypokalaemia resulting from loop diuretics and thiazides will potentiate the effect digoxin, thus increasing the risk of cardiac arrythmias

38
Q

how does digoxin work?

A

Digoxin is an inhibitor of the Na+/K+ ATPase pump and binds to the alpha subunit.
This causes an increase in intracellular Na+

39
Q

which diuretics are potassium sparing?

A

aldosterone antagonists (eg spironolactone)
sodium channel inhibitors (eg amiloride)

40
Q

what are the side affects of potassium sparing diuretics?

A

hyperkalaemia
use with caution with meds that increase K, eg. ACEi

41
Q

which drugs reduce the efficacy of thiazides?

A

NSAIDs

42
Q

what does pharmacodynamics mean?

A

effects of drug on the body

renal (22 decks)

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