Renal Drugs

Question 1

what are some examples of thiazide diuretics?

Answer 1

Bendroflumethazide
Indapamide
Chlortalidone

Question 2

what is the MoA for thiazide diuretics?

Answer 2

Inhibit Na+/Cl- transporter at the distal convoluted tubule and collecting duct

Increases Na+, Cl- and water excretion

Question 3

What are the indications for thiazide diuretics?

Answer 3

hypertension

oedema of cardiac, renal, hepatic, iatrogenic origin

Question 4

list some side effects of thiazide diuretics:

Answer 4

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

Question 5

what is important clinically regarding pharmacokinetics/dynamics for thiazide diuretics?

Answer 5

Produces diuresis quickly within 1-2 hours

NSAIDs reduces efficacy of thiazide diuretics

Question 6

What info needs to be given to patient before starting a thiazide diuretic?

Answer 6

Urinary frequency usually not affected
Report if sudden rash
Make aware of risk of electrolyte imbalance

Question 7

what are some examples of Loop Diuretics?

Answer 7

Furosemide
Bumetanide
Torasemide

Question 8

what is the MoA for loop diuretics?

Answer 8

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

Question 9

what are the indications for a loop diuretic?

Answer 9

Hypertension
Hyperkalaemia
Heart failure
Cirrhosis of liver (fluid retention)
Nephrotic syndrome

Question 10

list some side effects of a loop diuretic?

Answer 10

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

Ototoxicity

Question 11

what is important clinically regarding pharmacokinetics/dynamics for loop diuretics?

Answer 11

60% absorbed in patients with normal renal function

Renal and hepatic excretion – increased half life for patients with renal or hepatic disease

Question 12

What info needs to be given to patient before starting a loop diuretic?

Answer 12

Avoid excess alcohol

Urinary frequency increases

Question 13

what are some examples of insulin?

Answer 13

Novorapid
Glargine
Humalog Mix

Question 14

what is the MoA of insulin?

Answer 14

Insulin increases cellular uptake of glucose.
It stimulates glycogenesis, encourages DNA synthesis and promotes release of GH.
Several types of exogenous insulin:
Short acting: Novorapid
Long acting: Glargine
Fast-acting and Intermediate-acting mix: Humalog Mix

Question 15

what are the indications for insulin?

Answer 15

T1DM
T2DM
Hyperkalaemia

Question 16

what are the side effects of insulin?

Answer 16

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

Question 17

what is important clinically regarding pharmacokinetics/dynamics for insulin?

Answer 17

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.

Question 18

What info needs to be given to patient before starting insulin?

Answer 18

Only in the form of injection
Compliance important
Never skip meals while on insulin

Question 19

When does rapid acting insulin (Novorapid) reach circulation & peak and how long does it last?

Answer 19

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

Question 20

When does short acting insulin reach circulation & peak and how long does it last?

Answer 20

Reaches circulation 30 mins after injection
Peaks 2 – 4 hours later
Lasts for up to 4 to 8 hours

Question 21

When does intermediate acting insulin reach circulation & peak and how long does it last?

Answer 21

Reaches circulation in 2 – 6 hours
Peaks 4 – 14 hours later
Lasts for up to 20 hours

Question 22

When does long acting insulin (Glargine) reach circulation & peak and how long does it last?

Answer 22

Reaches circulation in 6 to 14 hours
Minimal peak
Lasts for up to 24 hours