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Renal drugs Flashcards

1
Q

What is nephrotic syndrome?

A

A disorder of glomerular filtration, allowing large protein (mainly albumin) to appear in the urine (proteinuria).

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2
Q

Why is fluid retained in congestive heart failure?

A

Cardiac output goes down therefore get activation of RAAS.

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3
Q

How does Hepatic Cirrhosis With Ascites occur?

A

Increased pressure in the hepatic portal vein, combined with decreased production of albumin, causes loss of fluid into the peritoneal cavity and oedema (ascites)

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4
Q

At what 4 points in the nephron can Na be reabsorbed?

A

Proximal tubule
Ascending limb of loop of Henle
Distal tubule
Collecting duct

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5
Q

What five mechanisms exist for Na reabsorption?

A 
Na diffusion
Na/H exchange
NaKCl triple transporter
NaCl cotransporter
NaK exchanger
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6
Q

Where do most diuretics work?

A

Apical/luminal membrane

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7
Q

How do diuretics get into the filtrate?

A

Filtration

Secretion into proximal tubule

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8
Q

What two transport processes exist for secretion of diuretics into the proximal tubule?

A

Organic anion transporters (OATs)

Organic cation transporters (OCTs)

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9
Q

What type of drugs to OATs secrete?

A

Acidic (loop and thiazide)

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10
Q

What type of drugs to OCTs secrete?

A

Basic (triamterene and amiloride)

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11
Q

How do loop and thiazide diuretics cause hypokalemia?

A

Less K reab as less Na reab in proximal tubule and LoH

Increased Na reab in distal tubule loses K via NaK exchanger.

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12
Q

What are the two forms of DI?

A

Neurogenic diabetes insipidus

Nephrogenic diabetes insipidus

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13
Q

What is the etiology of Neurogenic diabetes insipidus?

A

Don’t produce ADH from post pit

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14
Q

What is the etiology of Nephrogenic diabetes insipidus?

A

Nephrons can’t respond to ADH

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15
Q

How do you treat Neurogenic diabetes insipidus?

A

Give desmopressin

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16
Q

What treatment id there for Nephrogenic diabetes insipidus?

A

None

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17
Q

What are the 4 categories of diuretic?

A

Loop
Thiazide
Potassium sparing
Osmotic

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18
Q

How do loop diuretics work?

A

Inhibit NaKCl triple transporter in the ascending LoH

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19
Q

Where do loop diuretics work?

A

Ascending LoH

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20
Q

How are loop diuretics transported in the blood?

A

Plasma bound

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21
Q

In addition to Na, K and Cl loss what other effects can loop diuretics have?

A

Vasodilation

Ca and Mg loss

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22
Q

Give two examples of loop diuretics

A

Furosemide

Bumetanide

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23
Q

What are some indications for starting a loop diuretic?

A 
Acute pulmonary oedema
Chronic heart failure
Chronic kidney failure
Nephrotic syndrome 
Increase urine volume in acute kidney failure
Reduce acute hypercalcaemia 
Hypertension
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24
Q

What are some contraindications of loop diuretics?

A 
Severe hypovolaemia/dehydration
Severe hypokalaemia 
Severe hyponatraemia
Hepatic encephalopathy
Gout
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25
What are some side effects of loop diuretics?
``` Hypokalaemia Metabolic alkalosis Hypocalcaemia Hypomagnesaemia Hypotension Hyperuricaemia Dose-related loss of hearing ```
26
How do thiazide diuretics work?
Inhibit the NaCl cotransporter in the distal tubule
27
Where do thiazide diuretics work?
Distal tubule
28
In addition to Na and K loss what other effects do thiazide diuretics have?
Vasodilation | Ca retention
29
Give some examples of thiazide diuretics
Bendroflumethiazide Chlortalidone Indapamide Metolazone
30
What are the indications for starting a thiazide diuretic?
``` Mild heart failure Hypertension Severe resistant oedema Renal stone disease Nephrogenic diabetes insipidus ```
31
What are some contraindications for starting thiazide diuretics?
Hypokalaemia Hyponatraemia Gout
32
What are some side effects of thiazide diuretics?
``` Hypokalaemia Metabolic alkalosis Hypotension Hypomagnaesmia Hyperuricaemia Erectile dysfunction Impaired glucose tolerance in diabetics ```
33
Where do all K sparing diuretics work?
Late distal and collecting tubule
34
Through which two mechanism can K sparing diuretics work?
Block the apical sodium channel and decrease Na+ reab therefore reduce K excretion. Compete with aldosterone for binding to intracellular receptors preventing its translocation of Na channels.
35
Which two K sparing diuretics work by blocking the apical Na channel?
Amiloride and Triamterene
36
Which two K sparing diuretics work by blocking aldosterone?
Spironolactone and Eplerenone
37
What are the indications for starting a K sparing diuretic?
Use in combo with diuretics causing hypokalemia Use in combo with loop and thiazide as it blocks RAAS they activate Heart failure Primary hyperaldosteronism (Conn’s syndrome) Resistant essential hypertension Secondary hyperaldosteronism (due to hepatic cirrhosis with ascites)
38
What are the contraindications for starting a K sparing diuretic?
Severe renal impairment Hyperkalemia Addison’s disease
39
Give an example of an osmotic diuretic?
Mannitol
40
How is mannitol given?
IV
41
How do osmotic diuretics work?
Freely filtered but not reabsorbed so increase osmolarity of filtrate drawing water back and stopping Na reab.
42
What are the indications for starting an osmotic diuretic?
Prevention of acute hypovolaemic renal failure to maintain urine flow Urgent treatment of acutely raised intracranial and intraocular pressure
43
Why are osmotic diuretics used for intracranial/ocular pressure?
Does not enter the eye, or brain, but increased plasma osmolality extracts water from these compartments.
44
What are some side effects of osmotic diuretics?
Transient expansion of blood volume Hyponatraemia Hyperglycaemia
45
What drugs can inhibit ADH receptors?
Li Demeclocycline ‘Aquaretics’ or ‘Vaptans’
46
How do ‘Aquaretics’ or ‘Vaptans’ work?
Inhibit ADHR
47
What do ‘Aquaretics’ or ‘Vaptans’ do?
Excretion of water without accompanying Na+ and thus raises plasma Na+ concentration.
48
What are some indications for ‘Aquaretics’ or ‘Vaptans’?
Hypervolaemic hyponatraemia | SIADH
49
Which two SLGTs are found in the kidney?
SLGT1 and 2
50
Where is SLGT1 found in the kidney?
DIstal tubule
51
Where is SLGT2 found in the kidney?
Proximal tubule
52
How much of the glucose in the urine does SLGT2 absorb?
90%
53
How does SLGT2 work?
Facilitative transporter requiring Na
54
Compare SLGT1 and 2
SLGT1: 2Na:1Glucose, High affinity/low capacity SLGT2: 1Na:1Glucose, Low affinity/high capacity
55
What do uricosuric drugs do?
Inhibit urate absorption
56
Give some examples of uricosuric drugs.
Probenecid | Sulfinpyrazole
57
What kind of drugs modify urine pH?
Carbonic Anhydrase Inhibitors
58
Give an example of a CA inhibitor
Acetazolamide
59
What effects do CA inhibitors have?
Excretion of HCO3- with Na+, K+ and H2O | Alkalize urine
60
What are some indications for starting CA inhibitors?
``` Glaucoma and following eye surgery Prophylaxis of altitude sickness Relief of dysuria Prevention of the crystallization of weak acids Enhancing the excretion of weak acids ```
61
Which prostaglandins are synthesized by the kidneys?
PGE2- Medulla | PGI2 (prostacyclin)- Glomeruli
62
What physiological effects do prostaglandins have on the kidney?
Vasodilators | Na excretion
63
Under normal conditions how much of an effect do have on renal blood flow (RBF), or glomerular filtration rate (GFR)?
Very little
64
When are prostaglandins important to the kidneys?
conditions of vasoconstriction, or decreased effective arterial blood volume, where they cause compensatory vasodilation.
65
What are prostaglandins synthesized in response to?
``` Ischaemia Mechanical trauma Angiotensin II ADH Bradykinin ```
66
What can inhibit prostaglandins synthesis?
NSAIDs

Renal (13 decks)

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