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Alan's lecture - Pharmacology > Pharmacology of diuretics > Flashcards

Pharmacology of diuretics Flashcards

1
Q

What do volume sensors regulate and what are they used to control?

A
  • Vascular tone (to control organ perfusion)

- Renal Na excretion (to control total fluid volume)

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2
Q

Where are the low and high pressure sensors located?

A
  • Low pressure sensors located in the pulmonary vasculature

- High pressure sensor located in the atria

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3
Q

How does the body monitor pressure changes?

A
  • By using pressure sensors
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4
Q

In the kidneys the water follows the Na. TRUE OR FALSE?

A

TRUE

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5
Q

What happens when the pulmonary vasculature is activated?

A

It actiaves the PNS, CNS which actiavtes

  • Renal sympathetic nerves
  • Renin-angiotensin aldosterone axis
  • Pituitary release vasopressin
  • Causes constriction and cardiac output
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6
Q

What do sensors that dectect high pressure changes excrete in response to this high pressure?

A
  • Natriuteric peptides
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7
Q

What does Natriuteric peptides cause?

A
  • Vasodilation and causes Na to be excreted from the kidney
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8
Q

How much urine does an adult excrete per day?

A
  • 180ml
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9
Q

Urine output is 1-2 L for an adult. TRUE OR FALSE?

A

TRUE

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10
Q

ACE inhibitors (RAAS), AT receptors antagonists can be used as a therapeutic strategy for volume regulation. TRUE OR FALSE?

A

TRUE

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11
Q

What is vasopressin and where is it secreted from and in response to what?

A

An anti-diuretic hormone ADH

Secreted by the pituitary in response to low blood volume

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12
Q

What are the receptors are used by vasopressin?

A

-GPCR (V1 (smooth muscle) and V2 (collecting duct)

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13
Q

V1 (smooth smuscle) in vasopressin causes an increase in calcium levels which leads to vasoconstriction. TRUE OR FALSE?

A

TRUE

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14
Q

V2 (Collecting duct) in vasopressin increases aquaporin 2 which leads to an increase in water reabsorption. TRUE OR FALSE?

A

TRUE

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15
Q

What is desmopressin and what is it indicated for?

A
  • A synthetic agonist with low affitnity for V1 (no vasoconstriction)
  • Indicated for diabetes insipidus
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16
Q

What is diabetes insipidus and how can it be treated?

A
  • It is excess dilute urine due to the lack of vasopressin secretion from pituitary
  • treatment - nasal spray which lasts 4-6 hours
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17
Q

What occurs in the renal sympathetic nervous system?

A
  • Induces B1 receptors which leads to an increase in renin production juxtaglomerular cells, this stimulates the afferent arteriole to constrict whuch decreases glomerular pressure and therefore decreasing GFR
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18
Q

What are some of the clinical uses of diuretics?

A
  • Oedema
  • Hypertension
  • Hypercalcemia
  • Renal failure
  • Diabetes insipidus
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19
Q

What is oedema?

A
  • Increase in interstitial fluid in any organ e.g pulmonary oedema, causes severe breathlessness
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20
Q

What occurs in nephrotic syndrome (oedema)?

A
  • Renal damage causes an increase in permeability of glomerular basement membrane which leads to proteinuria and a decrease in protein in plasma leading to an increased fluid, this leads to ankle and legs swelling
21
Q

What occurs in heart failure (oedema)?

A
  • decreased cardiac output triggers kidney to respond as if hypovolemia, causing increased salt and fluid retention
22
Q

what occurs in hepatic cirrhosis (oedema)?

A

Portal vein flow obstructed which leads to fluid escape into the peritoneal cavity

23
Q

Carbonic anhydrase inhibitors are rarely used as diuretics. TRUE OR FALSE?

A

TRUE

24
Q

With Carbonic anhydrase inhibitors, there is a potential for rapid development of tolerance. TRUE OR FALSE?

A

TRUE

25
Q

What are carbonic anhydrase inhbitors used to treat?

A

Glaucoma

26
Q

Loop diuretics are the most efficacious diuretics. TRUE OR FALSE?

A

TRUE

27
Q

What are the indications for loop diuretics?

A
  • For the treatment of oedema commonly after heart failure/acute p.o (i.v admin)
  • Hypertension (used as last resort)
  • hypercalceamia (hyperparathyroidism)
  • hyperkaleamia (resulting from renal insufficiency/drugs causing K retention)
  • Hyponatraemia
28
Q

What are the names of loop diuretic drugs?

A
  • Furosimide
  • Bumetanide
  • Torasemide
29
Q

What is the half life of furosimide and how is it cleared?

A
  • 1hr (variable absorption i.v or i.m)

- clearedd by the kidneys

30
Q

What is the half life of bumetanide and Torasemide and how are they cleared?

A
  • bumetanide - 1.5hr (well absorbed p.o)/cleared hepatic metabolism
  • Torasemide - 3hr (well absorbed p.o)/cleared by hepatic metabolism
31
Q

Bumetadine is a not potential advanatge if patient’s renal function is impaired. TRUE OR FALSE?

A

FALSE

32
Q

What are some of the ADR’s of Loop diuretics?

A
  • Greater risk of ADR with furosemide in renal disease
  • Hypokalaemia (arrythmia, muscle weakness,metabolic alkilosis)
  • Hypotension
  • Hypocalcaemia and hypomagnesaemia
  • Hyperuricaemia and gout
  • Ototoxicity
33
Q

Names thiazide and thiazide like diuretic drugs and their half life?

A
  • Bendroflumethiazide - 6hr
  • Indapamide (lowers bp at dose where no eefct on diuresis) - 16hr
  • Metolazone - 4hr (preferred in advanced renal failure)
  • Chlortalidone
34
Q

What are some of the indications for thiazide and thiazide like diuretics?

A
  • Mild oedema
  • Hypertension
  • Diabetes insipidus
35
Q

What are some of the ADR’s for Thiazide and thiazide like diuretics?

A
  • Hypokalaemia
  • Nocturia
  • Hypotension
  • Hyponatremia
  • Hypomagnesaemia
  • Decreased ca excretion
36
Q

How is hypokalaemia classified and with which type of diuretics is it most common with and why?

A

<3.5 mM serum K+

- thiazide diuretics because of longer half life

37
Q

What are some treatments for hypokalaemia?

A
  • K+ sparing diuretics
  • K+ supplement
  • Diet - bananas
38
Q

What can hypokalaemia cause?

A
  • Arrhythmia
  • Encephalopathy
  • Diabetes mellitus because reduced insulin secretion
  • Fatigue and lethargy
39
Q

Potassium sparing diurtics are often used in combination with loop diuretics or with thiazides to counteract K+ loss. TRUE OR FALSE?

A

TRUE

40
Q

What are potassium sparing diuretics particularly used for?

A
  • Conserving potassium if loop diuretic or thiazide are used
  • Concomitant digoxin therapy
  • Secondary hyperaldosteronism
  • Elderly
41
Q

potassium sparing diuretics are not used on their own to treat oedema. TRUE OR FALSE?

A

TRUE

42
Q

Spirinolactone has a slow onset of effect because of mechanism of action. TRUE OR FALSE?

A

TRUE

43
Q

What are the ADR’s for potassium sparing diuretics?

A
  • Hyperkalemia
  • Metabolic acidosis
  • Spirinolactone also inhibits androgen receptor (a related steroid receptor)
44
Q

What is metabolic alkalosis and what arethe symptoms?

A
  • Increased alkalinity (loop and thiazide diuretics cause H+ loss)
  • Tremor, muscle twitching, numbness, possible coma
45
Q

What is metabolic acidosis and what are its symptoms?

A
  • Increased blood acidity (K+ sparing diuretics inhibit H+ loss)
  • Rapid breathing, confusion, may lead to shock or death
46
Q

loop and thiazide diuretics cause H+ loss
K+ sparing diuretics inhibit H+ loss
Are these statements TRUE OR FALSE?

A

TRUE

47
Q

How does Mannitol (osmotic diuretic) work?

A
  • It undergoes glomerular filtration, it is not reabsorbed in renal tubule, this leads to a decrease in osmotic gradient in descending limb of loop of henle, less water is reabsorbed which leads to more diuresis
48
Q

What are the indications for osmotic diuretics (mannitol) and ADR’s?

A
  • emergency use - cerebral oedema

- ADR - heart failure/ hypokalaemia

Alan's lecture - Pharmacology (16 decks)

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