Renal

Question 1

Give examples of synthetic insulin:

Answer 1

Novorapid
Glargone
Humalog mix

Question 2

What are the four types of insulin?

Answer 2

A. Rapid acting insulin (Novorapid):

1. Reaches circulation within 15 minutes after injection
2. Peaks 30 to 90 minutes later
3. Lasts for up to 5 hours

B. Short acting

1. Reaches circulation 3&\ mins after injection
2. Peaks 2 - 4 hours later
3. Lasts for up to 4 to 8 hours

C. Intermediate acting

1. Reaches circulation in 2 - 6 hours
2. Peaks 4 - 14 hours later
3. Lasts for up to 20 hours

D. Long acting (Glargine)

1. Reaches circulation in 6 to 14 hours
2. Minimal peak
3. Lasts for up to 24 hours

Question 3

What is the mechanism of action of insulin?

Answer 3

Insulin increases cellular uptake of glucose
It stimulates glycogenesis, encourages DNA synthesis and promotes release of growth hormone
Several types of exogenous insulin:

• Short acting: Novorapid
• Long acting: Glargine
• Fast-acting and Intermediate-acting mix: Humalog Mix

Question 4

When is insulin prescribed?

Answer 4

Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Hyperkalaemia (in conjunction with dextrose)

Question 5

What are side effects of insulin administration?

Answer 5

Side effects:
Hypoglycaemia
Sweats / shakes / tachycardia / headache / weakness / fatigue (typically symptoms of hypoglycaemia)
Oedema
Injection site reactions

Question 6

Give examples of loop diuretics:

Answer 6

Furosemide
Bumetanide
Torasemide

Question 7

What is the mechanism of action of loop diuretics?

Answer 7

Na/Ct’/K symporter antagonists
Act on the thick ascending loop of Henle
Increases secretion of Na, K, Cl and water

Question 8

When are loop diuretics prescribed?

Answer 8

Hypertension
Hyperkalaemia
Heart faílure
Cirrhosis of liver (Fluid retention)
Nephrotic syndrome

Question 9

What are side effects of loop diuretics?

Answer 9

Hypokalaemia, hypovolaemia, hyperuricaemia (increased rate reabsorption)
Metabolic acidosis
Abdominal pain
Ototoxicity

Question 10

Give examples of thiazide diuretics:

Answer 10

Bendroflumethazide
Indapamide
Chlortalidone

Question 11

What is the mechanism of action of thiazide diuretics?

Answer 11

Inhibit Na/Cl’ transporter at the distal convoluted tubule and collecting duct
Increases Na, Cl and water excretion

Question 12

When would thiazide diuretics be prescribed?

Answer 12

In hypertension or oedema of cardiac/renal/hepatic or iatrogenic origin

Question 13

What are side effects of thiazide diuretics?

Answer 13

Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hypercalcaemia
Hyperuricaemia
Reduced glucose tolerance
Hypersensitivity reactions - rashes, pneumonitis (less common)