Pharmacology of the Kidney Flashcards
what does aldosterone stimulate
sodium uptake
potassium excretion
where does renin come from and what does it do
from the kidney and stimulates angiotensiogen release from the kidney
where is angiotensin 1 converted to angiotensin 2
by ACE in the lungs
what does AG2 do
stimulate aldosterone and vasoconstriction
what type of drugs block renin release from the kidneys
beta blockers
what stimulates the kidney to release renin
pressure changes in afferent arteriole
sympathetic tone
macula densa chloride or osmotic concentration changes
local prostaglandin and NO release
what is the role of ACEi and where does it cat
inhibits vasoconstriction effect of AG2
acts on efferent arteriole
modulates intraglomerular pressure
increases sodium and water excretion
what are the indications of ACEi
hypertension
cardiac failure
CKD - reduces the intra renal pressure
what are the side effects of ACEi
hypotension - risk of AKI
hyperkalaemia - inhibits action of aldosterone
give two examples of ACEi
ramipril
lisinopril
what is the role of ARBs and what does it act on
inhibits vasoconstriction effect of AG2 on the receptor
acts on efferent arteriole
modulates intraglomerular oressure increases sodium and water excretion
what are the indications fo ARBs
hypertension
cardiac failure
CKD
what are the side effects of ARBs
hypotension
hyperkalaemia - inhibits action of aldosterone
what are two examples of ARBs
valsartan
irbesartan
where do osmotic diuretics work and what is an example
mannitol on the bowman capsule - modifies what is filtered
what is acetazolamide and where would it work
carbonic anhydrase inhibitor which works on both DCT and PCT to cause more Na+ excretion and water excretion
what is spironolactone and what does it do
inhibits aldosterone which stops Na reabsorption in the DCT
where do thiazides work
on the DCT to stops sodium reabsorption
give two examples of loop diuretics
furosemide
bumetanide
what does amiloride do
stops Na absorption in the DCT
what is the action of loop diuretics and when would you use them
inhibits uptake of water sodium potassium and chloride
CKD
nephrotic syndrome
hypertension
cardiac failure
what are the side effects of loop diuretics
hypovolaemia
hypokalaemia
when would you use thiazides
CKD
nephrotic syndrome
hypertension
cardiac failure
what conditions would you use sprionlactone
cardiac failure or liver cirrhosis - ascites
what are the side effects of sprionolactone
hyperkalamiea
when would you use amiloride and what are the side effects
to prevent hypokalaemia
but can cause hyperkalaemia
give an example of Vit D analogue and what it does
alpha calcidol which is hydrolxyted by the liver to active from - increases calcium uptake from the gut and phosphate
what are the side effects of VIT D analogues
hypercalcaemia
hyperphosphateaemia
what is EPO released from
produced buy cells in the interstitium of the kidney
when is EPO required
when eGFR is lower than 15
what are the side effects of EPO
hypertension
pure red cell aplasia
when should you be careful about administering drugs to patients
with CKD or at risk of AKI
when do prostaglandins to in the nephron
vasodilator afferent arteriole
how can you stop prostoglandins affect on the nephron
use NSAIDS to inhibit PG release - ibuprofen, naproxen
how do ARBs and ACEi affect the kidney
inhibit efferent arteriole vasoconstriction
decreases transglomerular pressure
decreases GFR
which penicillin is not excreted by the kidney
flucloxacillin
which opiates have the least amount of removal from the kidney
fentanyl
oxycodone
hydromorphone
what is the danger of accumulation of active metabolites of opioids
increased incidence of CNS side effects and reparatory depression
what can an accumulation of digoxin lead to
bradycardia
visual disturbances
mental confusion
hyperkalaemia
what can accumulation of metaformin lead to
lactic acidosis
hypoglycaemia
when should metaformin be avoided
when GFR is less than 30 ml / min
what are cats claws and what can they induce
anti-inflammatory properties
causes AKI and hypotension
