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342 > renal pharmacology 1 > Flashcards

renal pharmacology 1 Flashcards

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
Q

what is a diuretic

A

main drug class that alters renal function

prevent body from absorbing sodium

e.g. sodium and alcohol

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26
Q

what are diuretics prescribed for - 6

A

hypertension

pulmonary oedema

overdose/ poisioning

chronic heart failure

liver disease

kidney disease

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27
Q

what do diuretics do

A

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

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28
Q

diuretics admin when

A

in the morning

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29
Q

direct acting diuretics - 4

A

loop

thiazide/ thiazide/like

potassium sparing

carbonic anhydrase inhibitors

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30
Q

direct acting diuretics act

A

directly on the cells of the nephron

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31
Q

direct diuretics act from within ___ and are secreted into the ___ to reach the site of action

A

tubular lumen

proximal tubule

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32
Q

indirect acting diuretics

A

osmotic diuretics

modify filtrate contents instead

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33
Q

where do direct acting diuretics target nephron

A

depends varied on drug type

as diff sites have different levels of sodium reabsorption from urine to blood

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34
Q

which diuretics are the most powerful

A

loop diuretics

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35
Q

where are loop diuretics absorbed

A

gi tract

36
Q

how much filtered Na+ loop diuretics excreted

A

15-25%

37
Q

where are loop diuretics site of action

A

loop of Henle on ascending limb

38
Q

loop diuretic side effects - 4

A

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
Q

clinical applications of loop diuretics - 5

A

hypertension

chronic heart failure

cirrhosis of liver

nephrotic syndrome

renal failure

(dietary salt restriction)

40
Q

example of loop diuretics - 2

A

furosemide

bumetanide

41
Q

loop diuretics mechanism of action

A

inhibit Na+/K+/2CL- co-transporter

reducing Na+ reuptake into blood from filtrate/urine

leads to excretion of Na+ and H2O

42
Q

bartter syndrome type 1

A

rare autosomal recessive disorder of Na+/K+/2Cl- co-transporter, lacking in function, so similar to diuretic effect

43
Q

thiazide and thiazide-like diuretics act on

A

distal convoluted tubule

44
Q

thiazide and thiazide-like diuretics admin

A

oral, best absorbed this way

45
Q

thiazide and thiazide-like diuretics clinical applications - 5

A

uncomplicated hypertension (if comp use hoop)

reduce heart attack/ stroke risk

severe resistant oedema

prevent recurrent stone formation

nephrogenic diabetes insipidus

46
Q

thiazide and thiazide-like diuretics examples - 3

A

bendoflumethiazide

hydrochlorothiazide

chlortalidone

47
Q

thiazide and thiazide-like diuretics mechanism of action

A

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
Q

loop vs thiazide and thiazide-like diuretics advantage of thiazide and thiazide-like diuretics

A

thiazide and thiazide-like diuretics facilitate calcium reabsorption so better for older patients at risk of osteoporosis

49
Q

side effects of thiazide and thiazide-like diuretics -5

A

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
Q

coadministration of loop and thiazide diuretic effect

A

synergistic effect

loop delivers greater fraction of filtered Na+ to site of action of thiazide in distal tubule

51
Q

what are potassium sparing diuretics also called

A

aldosterone antagonists

52
Q

potassium sparing diuretics are __ when used alone

A

weak

as act on collecting tubule/duct where little sodium reabsorption

53
Q

potassium sparing diuretics act on

A

collecting tubule and duct

54
Q

potassium sparing diuretics clinical applications -5

A

hypertension

heart failure - prolong survival

conn’s syndrome

low renin hypertension

prevent hypokalaemia (caused by other diuretics)

55
Q

potassium sparing diuretics examples - 2

A

spironolactone

eplerenone

56
Q

what is aldosterone

A

hormone that conserves Na+ in kidney, salivary glands, sweat glands, colon

influences blood pressure as retains Na+

57
Q

where is aldosterone secreted

A

adrenal glands on top of each kidney

58
Q

potassium sparing diuretics mechanism of action

A

block distal Na+/K+ exchange

competes with aldosterone for intracellular receptor, inhibiting distal Na+ retention and K+ excretion

59
Q

at distal site, __% filtered Na+ is reabsorbed

A

2

60
Q

spironolactone has a plasma half life of

A

10 min

61
Q

spironolactone’s active metabolite is

A

canrenone

62
Q

canrenone has a plasma half life of

A

16 hr

63
Q

eplerenone has a ___ half life than canrenone

A

shorter

(has no active metabolites)

64
Q

side effects of potassium sparing diuretics - 3

A

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
Q

carbonic anhydrase inhibitors have a ___ diuretic effect

A

limited so not rly used

66
Q

carbonic anhydrase inhibitors ____ excretion of bicarbonate, K+, Na+, water leading an ___ flow of ___ urine

A

increase
increased
alkaline

67
Q

carbonic anhydrase inhibitors diuretic example

A

acetazolamide

68
Q

carbonic anhydrase inhibitors diuretic clinical applications - 3

A

prev used as diuretic

glaucoma

infantile epilepsy - anticonvulsant

69
Q

indirect acting diuretics are __ __ by the nephron, so are pharmacologically __

A

not reabsorbed

inert

70
Q

osmotic diuretic is a type of _____

A

carbonic anhydrase inhibitor diuretic

71
Q

osmotic diuretics ___ volume of H2O excreted by changing composition of fluid passively, act on __ __ parts of nephron

A

inc

water permeable

72
Q

example of osmotic diuretic

A

mannitol - sweetener in diabetic food, also forces urine prod in people with sudden kidney failure

73
Q

patient - female aged 83, hypertension, mild osteoporosis. what would u px

A

thiazide which inhibit calcium ion excretion

loop too powerful for elderly, may be vulnerable to hypotension or hypovolaemia

74
Q

patient - male aged 56, hypertension, renal failure

A

loop as helps with renal failure, others too weak

75
Q

patient - male aged 76, furosemide (loop) for hypertension, has hypokalaemia

A

potassium-sparing diuretic to help trear hypokalaemia

76
Q

patient - female aged 37, hypertension, BMI=26.9, no other conditions

A

lifestyle changes, too young so try first e.g weight loss, dec stress

77
Q

The kidneys play a significant role in regulating blood pressure through mechanisms such as the

A

renin-angiotensin-aldosterone system (RAAS)

78
Q

carbonic anydrase inhibitor mechanism of action

A

inhibit carbonic anhydrase in proximal conxoluted tubule

reduces reabsorption of bicarbonate, sodium, water

inc bicarbonoate excretion

mild diuretic effect

79
Q

excessive diuretic use can cause

A

metabolic alkalosis

80
Q

diuretic resistance

A

can be developed in patients with nephrotic syndrome e.g. hypoalbunemia in nephrotic syndrome dec plasma protein binding of loop, dec efficacy

81
Q

overcoming diuretic resistance

A

maybe facilitate loop delivery by iv albumin is severe hypoalbuminemia

82
Q

what is conn’s syndrome

A

excess aldosterone hormone production from adrenal glands

83
Q

lupus

A

a chronic autoimmune disease that causes the body’s immune system to attack healthy tissues e.g. in kidney

84
Q

anorexia nervosa

A

inc rate of acute kidney injury and chronic kidney disease, electrolyte abnormalities

85
Q

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) case study

A

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

342 (21 decks)

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