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Renal > Renal drugs > Flashcards

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
Q

What are some side effects of loop diuretics?

A 
Hypokalaemia
Metabolic alkalosis 
Hypocalcaemia
Hypomagnesaemia
Hypotension
Hyperuricaemia
Dose-related loss of hearing
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26
Q

How do thiazide diuretics work?

A

Inhibit the NaCl cotransporter in the distal tubule

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27
Q

Where do thiazide diuretics work?

A

Distal tubule

28
Q

In addition to Na and K loss what other effects do thiazide diuretics have?

A

Vasodilation

Ca retention

29
Q

Give some examples of thiazide diuretics

A

Bendroflumethiazide
Chlortalidone
Indapamide
Metolazone

30
Q

What are the indications for starting a thiazide diuretic?

A 
Mild heart failure
Hypertension
Severe resistant oedema 
Renal stone disease 
Nephrogenic diabetes insipidus
31
Q

What are some contraindications for starting thiazide diuretics?

A

Hypokalaemia
Hyponatraemia
Gout

32
Q

What are some side effects of thiazide diuretics?

A 
Hypokalaemia
Metabolic alkalosis
Hypotension
Hypomagnaesmia
Hyperuricaemia
Erectile dysfunction
Impaired glucose tolerance in diabetics
33
Q

Where do all K sparing diuretics work?

A

Late distal and collecting tubule

34
Q

Through which two mechanism can K sparing diuretics work?

A

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
Q

Which two K sparing diuretics work by blocking the apical Na channel?

A

Amiloride and Triamterene

36
Q

Which two K sparing diuretics work by blocking aldosterone?

A

Spironolactone and Eplerenone

37
Q

What are the indications for starting a K sparing diuretic?

A

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
Q

What are the contraindications for starting a K sparing diuretic?

A

Severe renal impairment
Hyperkalemia
Addison’s disease

39
Q

Give an example of an osmotic diuretic?

40
Q

How is mannitol given?

41
Q

How do osmotic diuretics work?

A

Freely filtered but not reabsorbed so increase osmolarity of filtrate drawing water back and stopping Na reab.

42
Q

What are the indications for starting an osmotic diuretic?

A

Prevention of acute hypovolaemic renal failure to maintain urine flow
Urgent treatment of acutely raised intracranial and intraocular pressure

43
Q

Why are osmotic diuretics used for intracranial/ocular pressure?

A

Does not enter the eye, or brain, but increased plasma osmolality extracts water from these compartments.

44
Q

What are some side effects of osmotic diuretics?

A

Transient expansion of blood volume
Hyponatraemia
Hyperglycaemia

45
Q

What drugs can inhibit ADH receptors?

A

Li
Demeclocycline
‘Aquaretics’ or ‘Vaptans’

46
Q

How do ‘Aquaretics’ or ‘Vaptans’ work?

A

Inhibit ADHR

47
Q

What do ‘Aquaretics’ or ‘Vaptans’ do?

A

Excretion of water without accompanying Na+ and thus raises plasma Na+ concentration.

48
Q

What are some indications for ‘Aquaretics’ or ‘Vaptans’?

A

Hypervolaemic hyponatraemia

SIADH

49
Q

Which two SLGTs are found in the kidney?

A

SLGT1 and 2

50
Q

Where is SLGT1 found in the kidney?

A

DIstal tubule

51
Q

Where is SLGT2 found in the kidney?

A

Proximal tubule

52
Q

How much of the glucose in the urine does SLGT2 absorb?

53
Q

How does SLGT2 work?

A

Facilitative transporter requiring Na

54
Q

Compare SLGT1 and 2

A

SLGT1: 2Na:1Glucose, High affinity/low capacity
SLGT2: 1Na:1Glucose, Low affinity/high capacity

55
Q

What do uricosuric drugs do?

A

Inhibit urate absorption

56
Q

Give some examples of uricosuric drugs.

A

Probenecid

Sulfinpyrazole

57
Q

What kind of drugs modify urine pH?

A

Carbonic Anhydrase Inhibitors

58
Q

Give an example of a CA inhibitor

A

Acetazolamide

59
Q

What effects do CA inhibitors have?

A

Excretion of HCO3- with Na+, K+ and H2O

Alkalize urine

60
Q

What are some indications for starting CA inhibitors?

A 
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
Q

Which prostaglandins are synthesized by the kidneys?

A

PGE2- Medulla

PGI2 (prostacyclin)- Glomeruli

62
Q

What physiological effects do prostaglandins have on the kidney?

A

Vasodilators

Na excretion

63
Q

Under normal conditions how much of an effect do have on renal blood flow (RBF), or glomerular filtration rate (GFR)?

A

Very little

64
Q

When are prostaglandins important to the kidneys?

A

conditions of vasoconstriction, or decreased effective arterial blood volume, where they cause compensatory vasodilation.

65
Q

What are prostaglandins synthesized in response to?

A 
Ischaemia
Mechanical trauma
Angiotensin II
ADH
Bradykinin
66
Q

What can inhibit prostaglandins synthesis?

Renal (13 decks)

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