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Drugs > Renal Drugs > Flashcards

Renal Drugs Flashcards

1
Q

Thiazide Diuretics

Example(s) of drugs:

A

Bendroflumethazide
Indapamide
Chlortalidone

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2
Q

Thiazide Diuretics

Mechanism of action:

A

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

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3
Q

Thiazide Diuretics

Indication(s):

A

Hypertension
Oedema of cardiac / renal / hepatic / iatrogenic origin

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4
Q

Thiazide Diuretics

Side effects:

A
  • Hypokalaemia
  • Hypomagnesaemia
  • Hyponatraemia
  • Hypercalcaemia
  • Hyperuricaemia
  • Reduced glucose tolerance
  • Hypersensitivity reactions – rashes, pneumonitis (less common)
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5
Q

Thiazide Diuretics

Important pharmacokinetics / pharmacodynamics:

A
  • Produces diuresis quickly within 1-2 hours
  • NSAIDs reduces efficacy of thiazide diuretics
  • Note that urinary symptoms are less common with the lower doses used for the treatment of hypertension.
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6
Q

Thiazide Diuretics

Patient information:

A
  • Urinary frequency usually not affected
  • Report if sudden rash
  • Make aware of risk of electrolyte imbalance
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7
Q

Loop Diuretics

Example(s) of drugs:

A
  • Furosemide
  • Bumetanide
  • Torasemide
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8
Q

Loop Diuretics

Mechanism of action:

A
  • Na+/Cl-/K+ symporter antagonists
  • Act on the thick ascending loop of Henle
  • Increase secretion of Na+, K+, Cl- and water
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9
Q

Loop Diuretics

Indication(s):

A
  • Hypertension
  • Hyperkalaemia
  • Heart failure
  • Cirrhosis of liver (fluid retention)
  • Nephrotic syndrome
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10
Q

Loop Diuretics

Side effects:

A
  • Hypokalaemia, hypovolaemia, hyperuricaemia (increased urate reabsorption)
  • Metabolic acidosis
  • Abdominal pain
  • Ototoxicity
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11
Q

Loop Diuretics

Side effects:

A
  • Hypokalaemia, hypovolaemia, hyperuricaemia (increased urate reabsorption)
  • Metabolic acidosis
  • Abdominal pain
  • Ototoxicity
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12
Q

Loop Diuretics

Important pharmacokinetics / pharmacodynamics:

A
  • 60% absorbed in patients with normal renal function
  • Renal and hepatic excretion – increased half life for patients with renal or hepatic disease
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13
Q

Loop Diuretics

Patient information:

A
  • Avoid excess alcohol
  • Urinary frequency increases
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14
Q

Insulin

Example(s) of drugs:

A

Novorapid
Glargine
Humalog Mix

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15
Q

Insulin

Mechanism of action:

A
  • 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
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16
Q

Insulin

Indication(s):

A
  • Type 1 Diabetes Mellitus
  • Type 2 Diabetes Mellitus
  • Hyperkalaemia (in conjunction with dextrose)
17
Q

Insulin

Side effects:

A
  • Hypoglycaemia
  • Sweats / shakes / tachycardia / headache / weakness / fatigue (typically symptoms of hypoglycaemia)
  • Oedema
  • Injection site reactions
18
Q

Insulin

Important pharmacokinetics / pharmacodynamics:

A
  • Patients are given varying types of insulin combinations based on their activities and preferences
  • Given subcutaneously and short acting insulin (actrapid) can be given intravenously.
19
Q

Insulin

Patient information:

A
  • Only in the form of injection
  • Compliance important
  • Never skip meals while on insulin
20
Q

Insulin

Other information:

A

Four types of insulin based on onset of action, peak time and the duration of action.

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 30 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
21
Q

Osmotic diuretic:

Example of drug

A

Mannitol

22
Q

Osmotic diuretic site of action

A

Proximal convoluted tubules and descending LOH

23
Q

Osmotic diuretic

Indication

A
  • raised intracranial pressure
  • raised intraocular pressure (glaucoma)
24
Q

Osmotic diuretic mechanism of action

A
  • freely filtered at the the glomerulus
  • but only partiallify reasbsorped
  • Passive water reabsorption is reduced by the presence of this non-reabsorbable solute within the tubule lumen
  • net effect is increased water loss, with a relatively smaller loss of sodium
25
Q

Osmotic diuretic:

Contra-indications

A

Congestive heart failure, pulmonary oedema

26
Q

Osmotic diuretic:

Side effects

A

Chills, fever

27
Q

Potassium sparing diuretic

example

A

Spironolactone, amiloride

28
Q

Potassium diuretic site of action

A

Late distal tubule and collecting ducts

29
Q

Two classes of potassium sparing diuretics

A
  • Sodium-channel blockers - amiloride
    • block sodium reabsoprtion by the principals cells and this reducing the potential difference across the cell and reducing K+ secretion. Secretion of H+ from the intercalated cells is also decreased
  • Aldosterone antagonists - eg spironolactone
    • competitive antagonist at aldosterone receptors and thus reduces Na+ reabsorption and therefore K+ and H+ secretion. The degree of diuresis depends on aldosterone levels
30
Q

Potassium Sparing diuretic Indications

A
  • in conjuncton with other diuretics (thiazides, loops) in managing heart failure or hypertension, to aintain normal serum potassium levels
  • aldosterone antagonists are used in the treatment of hyperaldosteronis, which can be primary (Conns) or secondary (as a result of CHF, liver disease or nephrotic syndrome)
31
Q

Potassium sparing diuretics

Contraindication

A

Dont give with ACE inhibitors as risk of hyperkalaemia

32
Q

Potassium sparing diuretics

Adverse effects

A
  • hyperkalaemia
  • hyponatremia
  • aldosterone agonists - gynaecomastia
33
Q
A

Drugs (8 decks)

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