pharmacology Flashcards
site of action of osmotic diuretics
PT, loop of henle and collecting duct
MOA of osmotic diuretics
inhibition of water and Na+ reabsorption
site of action of carbonic anhydrase inhibitors
proximal tubules
MOA of carbonic anhydrase inhibitors
proximal tubules
MOA of carbonic anhydrase inhibitors
inhibition of bicarbonate reabsorption
site of action of loop diuretics
thick ascending limb of the loop of henle
MOA of loop diuretic
inhibition of Na+, K+ and Cl-
site of action of thiazide diuretics
early distal convoluted tubule
MOA of thiazide diuretics
inhibition of Na+ Cl- co-transport
site of action of K+ sparing diuretics
late DCT and collecting duct
MOA of K+ sparing diuretics
inhibition of Na+ reabsorption and K+ secretion
what is the role of the tubules in the nephron
reabsorption and secretion of substances and the formation of urine
what is the role of the collecting duct
transfers urine to the medullary collecting duct
where does the medullary collecting duct empty into
renal papillae in the renal pelvis
what are the components of urinary excretion
filtration - reabsorption + secretion
where is blood filtered in the nephron and how is this achieved
the glomerulus
passive transport of substances under pressure (due to blood pressure)
what happens in reabsorption in the nephron
solutes and water are removed from tubular fluid and transported into the blood
what happens in secretion in the nephron
solutes and water are removed from tubular fluid and transported into the blood
how does secretion occur in the nephron
active transport
what is natriuresis
the process of excretion of sodium in the urine
what 3 substances promote natriuresis
VNP and ANP, calcitonin
what substance inhibits natriuresis
aldosterone
what is an important drug interaction to remember for loop diuretics
greater risk of digoxin toxicity due to hypokalaemia
name a type of drug that reduces the efficacy of thiazides
NSAIDs
name one type of drug that needs to be used with caution with potassium-sparing diuretics
ACE inhibitors
name an osmotic diuretic
mannitol
how do osmotic diuretics need to be given
IV infusion
clinical indications for osmotic diuretics
prevention of AKI in conditions of reduced renal perfusion
urgent treatment of intracranial and intraocular pressure
name a condition that can cause reduced renal perfusion
rhabdomyolysis
name 3 adverse effects of osmotic diuretics
transient expansion of blood volume
hyponatraemia
pulmonary oedema
name a carbonic anhydrase inhibitor
acetazolamide
what is the ending of a CA-I
zolamide
where to carbonic anhydrase inhibitors act
proximal convoluted tubule of the nephron
what is the MOA of CA-Is
reduces HCO3- reabsorption
name an adverse effect of CAI’s
metabolic acidosis
name 2 loop diuretics
furosemide and bumetanide
name some indications for thiazide diuretics
hypertension, heart failure, oedema, nephrotic syndrome
name some contraindications for thiazide diuretics
hypotension, gout, renal failure, hypokalaemia
what are the 2 main types of K+ sparing diuretics and give examples
aldosterone antagonists: spironolactone
Na+ channel inhibitors: amiloride
what makes adverse drug reactions more likely
polypharm, drugs with narrow therapeutic index, multimorbidity, frailty
name some drugs with a narrow (<2) therapeutic index
warfarin, lithium, digoxin, carbamazepine, levothyroxine
what classification is used for ADRs
ABCDEF
what is a type A adverse drug reaction
augmented pharmacological effects - dose dependent and predictable
which type of adverse drug reaction has the highest mortality/morbidity
type B - bizarre
what are type C adverse drug reactions
chronic effects which result from prolonged therapy
type B ADR from chloramphenicol
bone marrow aplasia
type B ADR from halothane
hepatic necrosis
how can we prevent type C ADRs
drug therapy monitoring
name 3 examples of type C ADRs
- Cushing’s disease from steroid therapy
- Diabetes from beta blockers
- hypertension from NSAIDs
what are type D ADRs
delayed effects, often many years after stopping the drug
give an example of a type D ADR
secondary malignancy post chemotherapy
what are type E ADRs
end of treatment effects, can be due to abrupt withdrawal or rebound effects
what are type F ADRs
failure of therapy
what does it mean if a medication has a black triangle
still on a list of medicines subject to additional monitoring
how often to black triangle medications get reviewed
every 2 years
what is used to report adverse drug reactions
yellow card scheme
