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BS - Renal System > Pharmacology of the Kidney > Flashcards

Pharmacology of the Kidney Flashcards

1
Q

When do the kidneys release renin?

A

When blood pressure drops

The kidneys secrete renin to retain salt and water to increase BP

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2
Q

What is the role of renin?

A

It converts angiotensinogen into angiotensin I

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3
Q

What happens to angiotensin I?

A

It is converted into angiotensin II by ACE

Angiotensin II is a potent vasoconstrictor

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4
Q

How does angiotensin II affect the adrenal gland?

A

It binds to an angiotensin II receptor and causes aldosterone release

Aldosterone increases sodium retention

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5
Q

How do ACE inhibitors work?

Why is a cough a common side effect?

A

They block ACE which converts AngI to AngII in the lungs

In some people, ACEi will block breakdown of bradykinin which causes a cough

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6
Q

Where do ARBs work?

A

On the adrenal gland and the surface of blood vessels

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7
Q

Where do beta blockers work?

A

They work on the kidney to inhibit renin release

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8
Q

What is the role of aldosterone?

A

It stimulates sodium uptake and potassium loss

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9
Q

What are the roles of the macula densa and juxtaglomerular apparatus in the cortex?

A

They sense changes in the concentration of Na+ and Cl- and the osmolality

They trigger the release of renin when there is a change

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10
Q

Where are granular cells found and what is their role?

A

They line the afferent arteriole leading to the glomerulus

They contain renin

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11
Q

When do granular cells release renin?

What stimulates this?

A

They release renin when triggered by macula densa cells

This is triggered by decreased pressure

e.g. blood loss, hypotension, stress, vomiting, anaesthetics

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12
Q

How do anaesthetics affect the kidneys during surgery?

A

Anaesthetics reduce the blood pressure

This leads to the kidneys being underperfused during surgery

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13
Q

What will stimulate renin secretion from the granular cells?

A
  1. pressure changes in afferent arteriole
  2. sympathetic tone
  3. macula densa sensing changes in Cl- and osmotic concentration
  4. local prostaglandin and nitric oxide release
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14
Q

Where do ACEis work?

What actions do they result in?

A

They work on the efferent arteriole

They inhibit the vasoconstrictive effect of AngII by:

  1. modulating intraglomerular pressure
  2. increasing Na+ and water excretion
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15
Q

When may ACEi be prescribed?

A
  1. hypertension
  2. cardiac failure
  3. chronic kidney disease - to reduce intra-renal pressure
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16
Q

What are the side effects of ACEi?

A
  1. hypotension

2. hyperkalaemia

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17
Q

What are examples of ACEi?

A

Ramipril and Lisinopril

“pril” ending

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18
Q

When should women not be prescribed ACEi?

A

If they are planning on becoming pregnant

They cause foetal abnormalities

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19
Q

Why do ARBs and ACEi cause hyperkalaemia?

A

They inhibit the action of aldosterone

Aldosterone leads to K+ excretion

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20
Q

What is the role of ARBs?

Where do they work?

A

They inhibit the vasoconstrictive effect of AngII

They work on the efferent arteriole

They modulate intraglomerular pressure and increase Na+ and water excretion

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21
Q

When may ARBs be prescribed?

A
  1. hypertension
  2. cardiac failure
  3. chronic kidney disease

They are only prescribed if a patient does not respond well to an ACEi

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22
Q

What are the side effects of ARBs?

A
  1. hypotension

2. Hyperkalaemia due to inhibition of aldosterone

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23
Q

What are examples of ARBs?

A

Valsartan and Irbesartan

“sartan” ending

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24
Q

What is an example of an osmotic diuretic?

Where does it act?

A

Mannitol

Acts at the Bowman’s capsule to modify the contents of the filtrate

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25
Q

Where to loop diuretics work?

What are examples?

A

They work on the Na+K+Cl- transporter to inhibit the reuptake of ions and water

e.g. furosemide and bumetanide

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26
Q

Why are loop diuretics used to relieve an oedema?

A

They block the reuptake of Na+, K+, Cl- and water

This leads to diuresis - the loss of salt and water in urine

This relieves the fluid build-up in a patient

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27
Q

What is an example of a carbonic anhydrase inhibitor?

How do they work?

A

Acetazolamide

They inhibit Na+ reabsorption in the distal and proximal convoluted tubules

This is because there is no H+ to exchange with Na+

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28
Q

What is the role of thiazides?

A

They block the uptake of sodium in the distal convoluted tubule

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29
Q

How do amiloride and spironolactone work?

A

They block the effects of aldosterone

This prevents sodium reabsorption and loss of K+ in urine

30
Q

When may loop diuretics be prescribed?

A
  1. chronic kidney disease
  2. nephrotic syndrome
  3. hypertension
  4. cardiac failure
  5. liver failure (ascites)
31
Q

What are the side effects of loop diuretics?

A
  1. hypovolaemia

2. hypokalaemia

32
Q

What may loop diuretics often be prescribed alongside?

A

Potassium-sparing diuretics

This prevents hypokalaemia

33
Q

What is the action of thiazides?

A

They inhibit sodium uptake

This leads to the removal of sodium and water

34
Q

When are thiazides prescribed?

A
  1. chronic kidney disease
  2. nephrotic syndrome
  3. hypertension
  4. cardiac failure

They are a weak diuretic and are also used as an antihypertensive

35
Q

What are the side effects of thiazides?

A
  1. hypovolaemia

2. hyponatremia

36
Q

What is the action of spironolactone?

A

It inhibits aldosterone

This prevents sodium reabsorption in exchange for potassium

37
Q

What type of diuretic is spironolactone?

A

Potassium-sparing

38
Q

When may spironolactone be prescribed?

A
  1. cardiac failure

2. liver cirrhosis - ascites

39
Q

What are the side effects of spironolactone?

A
  1. hyperkalaemia
40
Q

What is the action of amiloride?

A

It inhibits sodium reabsorption in exchange for potassium

This leads to the removal of sodium and water

41
Q

When may amiloride be prescribed?

A

Alongside a loop diuretic to prevent hypokalaemia

It is a potassium-sparing diuretic

42
Q

What are the side effects of amiloride?

A

Hyperkalaemia

43
Q

Why can calcium and phosphate not be absorbed if the kidneys are not functioning properly?

A

The kidneys activate vitamin D

Vitamin D is needed for Ca2+ and phosphate absorption

44
Q

What happens to vitamin D analogues when they enter the body?

A

They are hydroxylated by the liver to an active form

45
Q

What is the action of vitamin D analogues?

A

They increase the uptake of calcium and phosphate from the gut

46
Q

What are the side effects of vitamin D analogues?

A
  1. hypercalcaemia

2. hyperphosphataemia

47
Q

What is an example of a vitamin D analogue?

A

Alpha calcidol

48
Q

When is erthyropoietin usually released from the kidneys?

A

It is produced by cells in the interstitium

Secretion is stimulated by hypoxia as it stimulates erythropoiesis

49
Q

When may erythropoietin be administered to a patient?

How is it administered

A

When eGFR < 15 in CKD patients that have developed anaemia

Administered through subcutaneous injection

50
Q

What are the side effects of erythropoietin?

A
  1. hypertension

2. pure red cell aplasia

51
Q

Why is hypertension as a result of erythropoietin dangerous?

A

You want to keep Hb levels slightly lower than normal

Hypertension can lead to a stroke if Hb levels are brought back to normal

52
Q

What is meant by pure red blood cell aplasia?

A

Antibodies develop to the Epo

RBC levels will not rise despite administering Epo

53
Q

In patients with CKD, or at risk of AKI, why are some drugs potentially harmful to the kidneys?

A

There is an increased reliance on the intra-renal haemodynamics to maintain perfusion pressure

54
Q

What is meant by intra-renal haemodynamics?

A

Blood flows into the glomerulus via an afferent arteriole and out through an efferent arteriole

There is a pressure gradient which allows ultrafiltrate to form

This pressure is regulated at all times

55
Q

How does reduced renal perfusion affect intra-renal haemodynamics?

A

Reduced transglomerular pressure

Reduced GFR

56
Q

How do prostaglandins affect intra-renal haemodynamics?

A

They cause vasodilation of the afferent arteriole

This increases renal perfusion

57
Q

Why are NSAIDs potentially harmful to the kidneys?

A

They inhibit prostaglandins

This impairs vasodilation of the afferent arteriole, leading to a reduced renal perfusion

58
Q

How does activation of the renin-angiotensin system restore GFR?

A

It causes efferent arteriolar vasoconstriction

This increases transglomerular pressure and restores GFR

59
Q

How may ACEi and ARBs affect intra-renal haemodynamics?

A

They inhibit efferent arteriolar vasoconstriction

This decreases transglomerular pressure

This leads to a decreased GFR

60
Q

What types of penicillins are excreted by the kidneys?

A

ALL penicillins except for flucloxacillin

61
Q

Why should a reduced dose of penicillin be given in patients with CKD or AKI?

A

It the penicillin accumulates this can lead to CNS side effects

This includes seizures and hypoxic brain injury

62
Q

What are examples of opioid analgesics?

Why does a reduced dose need to be given in patients with CKD and AKI?

A

Morphine, pethidine, codeine

Accumulation of active metabolites can lead to CNS side effects and respiratory depression

63
Q

What opiates are preferred in people with reduced kidney function?

A

Opiates with minimal renal excretion

  1. fentanyl
  2. oxycodone
  3. hydromorphone
64
Q

In someone with reduced kidney function, why should digoxin be avoided?

A

It can accumulate and lead to:

  1. bradycardia
  2. visual disturbances
  3. mental confusion

it also aggravates hyperkalaemia

65
Q

Under what conditions is digoxin used in patients with reduced kidney function?

A

A reduced dose is used and the drug level is monitored

66
Q

Under what conditions are hypoglycaemic agents used in patients with reduced kidney function?

A
  1. avoid longer acting agents
  2. reduced dose
  3. monitoring of blood glucose levels as they may accumulate and lead to hypoglycaemia
67
Q

What may metformin lead to in patients with reduced kidney function?

A

Lactic acidosis

Accumulation also leads to hypoglycaemia

68
Q

When should metformin not be given to patients with reduced kidney function?

A

When GFR < 30 ml/min

69
Q

What type of Chinese herbal medicine should be avoided?

A

Herbal medicines containing aristocholic acid

This is implicated in interstitial nephritis

70
Q

What is Cat’s Claw?

What is the problem with using this herbal remedy?

A

It has anti-inflammatory properties

It is implicated in causing AKI and hypotension with antihypertensives

BS - Renal System (8 decks)

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