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renal pharmacology 1 Flashcards

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1
Q

function of kidneys - 3

A

excretion of drugs/ metabolites from body via filtration

maintain volume, pH, electrolytes of extracellular fluid

respond to environmental factors like dietary changes

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2
Q

renal system contains left and right kidney which is linked to ___ via __ and __ linked to __ and __. tubes called ___ feed into bladder, allowing for eventual excretion of urine via ___

A

circulatory system

renal veins

arteries

aorta

inferior vena cava

ureters

urethra

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3
Q

the kidney recieves ___ of cardiac output

A

1/4

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4
Q

in the avg adult, kidneys filter ___ a day leading to excretion of ___ per 24hr

A

120L

1.5L

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5
Q

nephron

A

functional unit of kidney

filtration, reabsorption, secretion

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6
Q

the nephron’s filtrate does not contain ___

A

protein

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7
Q

the nephron’s filtrate does not contain protein unless - 2

A

suffering kidney disease (albumin in filtrate)

infection (bacterial cells can contain protein)

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8
Q

in the nephron, the glomerulus is fixed to the ___, which leads to the ___, which then leads on to the ___, which is surrounded by a capillary network. That feeds into the ____ that then links to the collecting duct.

A

bowman’s capsule

proximal convoluted tubule

loop of Henle

distal convoluted tubule

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9
Q

podocytes

A

cells with fingerlike projections that wrap around glomerular capillaries, inc sa to aid filtration

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10
Q

the renal tubule’s ascending limb is impermeable to ____ due to thickness and tight junctions

A

water

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11
Q

water loss is regulated by 3 hormones -

A

antidiuretic hormone

aldosterone

renin indirectly

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12
Q

___% of water reaches the collecting ducts

A

10, most reabsorbed in nephron before then

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13
Q

conditions pertaining to kidney function - many but 6

A

hypertension

lupus

diabetes

anorexia nervosa

chronic heart failure

kidney disease

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14
Q

hypertension

A

long term medical condition

blood pressure is elevated in arteries

water retention in response to high Na+ conc

often caused by stress or underlying condition e.g. kidney disease, high salt diet, obesity

often asymptomatic

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15
Q

hypertension is a major risk factor for - 2

A

stroke and heart disease

e.g. myocardial infarction, inschaemic stroke

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16
Q

what is vasopressin also known as

A

antidiuretic hormone (ADH)

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17
Q

where is vasopressin secreted

A

by pituitary gland

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18
Q

where does vasopressin act

A

on collection tube in nephron to stimulate water conservation by kidneys

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19
Q

how does vasopressin stimulate water consertation by kidneys

A

binds to V2 receptors on collecting duct

inc Gs, inc cAMP inc aquaporin expression on apical membrane causing osmosis of water into circulatory system from filtrate

inc permeability to water

inc water reabsorption from filtrate into bloodstream

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20
Q

clinical applications of vasopressin - 4

A

diabetes insipidus

septic shock

post surgery stomach conditions

during abdominal x rays

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21
Q

what drugs inhibit vasopressin - 4

A

ethanol

lithium

demeclocycline (inhibits vasopressin secretion by tumours)

grapefruit juice

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22
Q

drugs that inhibit vasopressin secretion can cause

A

nephrogenic diabetes insipidus

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23
Q

nephrogenic diabetes insipidus

A

failure of renal collecting ducts to respond to vasopressin

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24
Q

vasopressin secretion is enhanced by the drug

A

nicotine

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25
what is a diuretic
main drug class that alters renal function prevent body from absorbing sodium e.g. sodium and alcohol
26
what are diuretics prescribed for - 6
hypertension pulmonary oedema overdose/ poisioning chronic heart failure liver disease kidney disease
27
what do diuretics do
inc excretion of salt sodium chloride or sodium bicarbonate and water decrease reabsorption of sodium ions and usually chloride ions inc the frequency of urination
28
diuretics admin when
in the morning
29
direct acting diuretics - 4
loop thiazide/ thiazide/like potassium sparing carbonic anhydrase inhibitors
30
direct acting diuretics act
directly on the cells of the nephron
31
direct diuretics act from within ___ and are secreted into the ___ to reach the site of action
tubular lumen proximal tubule
32
indirect acting diuretics
osmotic diuretics modify filtrate contents instead
33
where do direct acting diuretics target nephron
depends varied on drug type as diff sites have different levels of sodium reabsorption from urine to blood
34
which diuretics are the most powerful
loop diuretics
35
where are loop diuretics absorbed
gi tract
36
how much filtered Na+ loop diuretics excreted
15-25%
37
where are loop diuretics site of action
loop of Henle on ascending limb
38
loop diuretic side effects - 4
excessive urine flow - excessive Na+ and water loss leading to hypovolaemia (low blood vol) and hypotension (low blood pressure) hypokalaemia (K+ loss) leading to inc risk of drug toxicity esp to digoxin for heart failure dose related hearing loss at high conc caused by impaired ion transport by membrane in inner ear idiosyncratic allergic reactions e.g. rashes
39
clinical applications of loop diuretics - 5
hypertension chronic heart failure cirrhosis of liver nephrotic syndrome renal failure (dietary salt restriction)
40
example of loop diuretics - 2
furosemide bumetanide
41
loop diuretics mechanism of action
inhibit Na+/K+/2CL- co-transporter reducing Na+ reuptake into blood from filtrate/urine leads to excretion of Na+ and H2O
42
bartter syndrome type 1
rare autosomal recessive disorder of Na+/K+/2Cl- co-transporter, lacking in function, so similar to diuretic effect
43
thiazide and thiazide-like diuretics act on
distal convoluted tubule
44
thiazide and thiazide-like diuretics admin
oral, best absorbed this way
45
thiazide and thiazide-like diuretics clinical applications - 5
uncomplicated hypertension (if comp use hoop) reduce heart attack/ stroke risk severe resistant oedema prevent recurrent stone formation nephrogenic diabetes insipidus
46
thiazide and thiazide-like diuretics examples - 3
bendoflumethiazide hydrochlorothiazide chlortalidone
47
thiazide and thiazide-like diuretics mechanism of action
inhibit sodium and chloride ion co transporters, so excreted into urine with more water dec blood volume cause vasodilator effect to reduce blood pressure and inc volume reduce calcium ion excretion
48
loop vs thiazide and thiazide-like diuretics advantage of thiazide and thiazide-like diuretics
thiazide and thiazide-like diuretics facilitate calcium reabsorption so better for older patients at risk of osteoporosis
49
side effects of thiazide and thiazide-like diuretics -5
inc urinary freq erectile dysfunction inhibited insulin secretion so impaired glucose tolerance by activation of potassium ATP channels hyponatraemia - abnormal levels of sodium in blood idiosyncratic reactions like rashes
50
coadministration of loop and thiazide diuretic effect
synergistic effect loop delivers greater fraction of filtered Na+ to site of action of thiazide in distal tubule
51
what are potassium sparing diuretics also called
aldosterone antagonists
52
potassium sparing diuretics are __ when used alone
weak as act on collecting tubule/duct where little sodium reabsorption
53
potassium sparing diuretics act on
collecting tubule and duct
54
potassium sparing diuretics clinical applications -5
hypertension heart failure - prolong survival conn's syndrome low renin hypertension prevent hypokalaemia (caused by other diuretics)
55
potassium sparing diuretics examples - 2
spironolactone eplerenone
56
what is aldosterone
hormone that conserves Na+ in kidney, salivary glands, sweat glands, colon influences blood pressure as retains Na+
57
where is aldosterone secreted
adrenal glands on top of each kidney
58
potassium sparing diuretics mechanism of action
block distal Na+/K+ exchange competes with aldosterone for intracellular receptor, inhibiting distal Na+ retention and K+ excretion
59
at distal site, __% filtered Na+ is reabsorbed
2
60
spironolactone has a plasma half life of
10 min
61
spironolactone's active metabolite is
canrenone
62
canrenone has a plasma half life of
16 hr
63
eplerenone has a ___ half life than canrenone
shorter (has no active metabolites)
64
side effects of potassium sparing diuretics - 3
hyperkalaemia - so avoid K+ supplements, can cause cardiac arrest GI upset spironolactone/ canrenon act on progesterone and androgen receptors too, could cause gynaecomastia (men develop breast tissue) and menstrual disorders in women
65
carbonic anhydrase inhibitors have a ___ diuretic effect
limited so not rly used
66
carbonic anhydrase inhibitors ____ excretion of bicarbonate, K+, Na+, water leading an ___ flow of ___ urine
increase increased alkaline
67
carbonic anhydrase inhibitors diuretic example
acetazolamide
68
carbonic anhydrase inhibitors diuretic clinical applications - 3
prev used as diuretic glaucoma infantile epilepsy - anticonvulsant
69
indirect acting diuretics are __ __ by the nephron, so are pharmacologically __
not reabsorbed inert
70
osmotic diuretic is a type of _____
carbonic anhydrase inhibitor diuretic
71
osmotic diuretics ___ volume of H2O excreted by changing composition of fluid passively, act on __ __ parts of nephron
inc water permeable
72
example of osmotic diuretic
mannitol - sweetener in diabetic food, also forces urine prod in people with sudden kidney failure
73
patient - female aged 83, hypertension, mild osteoporosis. what would u px
thiazide which inhibit calcium ion excretion loop too powerful for elderly, may be vulnerable to hypotension or hypovolaemia
74
patient - male aged 56, hypertension, renal failure
loop as helps with renal failure, others too weak
75
patient - male aged 76, furosemide (loop) for hypertension, has hypokalaemia
potassium-sparing diuretic to help trear hypokalaemia
76
patient - female aged 37, hypertension, BMI=26.9, no other conditions
lifestyle changes, too young so try first e.g weight loss, dec stress
77
The kidneys play a significant role in regulating blood pressure through mechanisms such as the
renin-angiotensin-aldosterone system (RAAS)
78
carbonic anydrase inhibitor mechanism of action
inhibit carbonic anhydrase in proximal conxoluted tubule reduces reabsorption of bicarbonate, sodium, water inc bicarbonoate excretion mild diuretic effect
79
excessive diuretic use can cause
metabolic alkalosis
80
diuretic resistance
can be developed in patients with nephrotic syndrome e.g. hypoalbunemia in nephrotic syndrome dec plasma protein binding of loop, dec efficacy
81
overcoming diuretic resistance
maybe facilitate loop delivery by iv albumin is severe hypoalbuminemia
82
what is conn's syndrome
excess aldosterone hormone production from adrenal glands
83
lupus
a chronic autoimmune disease that causes the body's immune system to attack healthy tissues e.g. in kidney
84
anorexia nervosa
inc rate of acute kidney injury and chronic kidney disease, electrolyte abnormalities
85
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) case study
pt had fatigue, lethargy hyponatremia (low plasma sodium ion conc) final diagnosis/ cause - drug induced SIADH due to carbamazepine therapy personalised med - see prior history

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