Renal Pharmacology Flashcards
What are diuretics.
Diuretics are drugs which increase the excretion of salts (manly NaCl) and water by the kidney.
Diuretics cause reduction in preload/after-load leading to increase heart rate/cardiac output and decreased SVR/SV.
Diuretics cause a reduction in preload leading to increase cardiac output and decreased systemic vascular resistance.
Administrations diuretics
Better to take it in morning to prevent nocturia.
Give example of loop diuretic
Frusemide
Bumentanide.
Indication for loop diuretics
Oedema.
Resistant oedema.
Resistant hypertension.
Loop diuretics act on what part of the renal tubules.
Ascending loop of henle.
Mechanism of action
Loop diuretics
Blocks Na+, K+, 2Cl- ion by action on NKCC2 co-transporter in the thick ascending loop of henle.
Loop diuretics block NKCC2 at the thin ascending loop of henle.
(a) True
(b) False.
(b) False.
When combined with loop diuretics increases the risk of ototoxicity.
(a) Vancomycin
(b) MAOIs
(c) Anti-diabetics
(d) Digoxin
(e) Lithium
(f)Theophylline.
(a)Vancomycin
When combined with loop diuretics increases the risk of ototoxicity and nephrotoxicity.
(a) Ramipril
(b) Amikacin
(c) Anti-diabetics
(d) Digoxin
(e) Lithium
(f)Vancomycin
(b) Amikacin
When combined with loop diuretic causes enhanced hypotensive effects.
(a) Ramipril
(b) Amikacin
(c) Anti-diabetics
(d) Digoxin
(e) Lithium
(f)Theophylline.
(f) theophylline.
When combined with loop diuretic causes enhanced hypo magnesia
(a) Ramipril
(b) Risperidone
(c) Proton pump inhibitor
(d) Digoxin
(e) Lithium
(f)Theophylline.
(c) Proton Pump inhibitor
When loop diuretics and digoxin are combined what is the likely event that will cause dig toxicity.
(a) Hypokalemia
(b) Hyponatremia
(c) hyperkalemia
(d)Hypernatremia
(a) Hypokalemia
Give the name of the drug that leads to QT prolongation exacerbated by hypokalemia when combined with loop diuretics.
Lithium.
Digoxin.
Administration of loop diuretics
In the morning and early afternoon (for BD) to avoid nocturia.
Loop diuretics Monitoring: when and what.
At start and after 5-7 days for patient on ACE-I, elderly or CKD:
Electrolytes: potassium
eGFR/serum creatinine
When dose titration: electrolytes, renal function, blood pressure and recheck 5-7 days.
Adverse effects associated with loop diuretics.
Counselling of loop diuretics.
Body is overloaded with water so we are trying to reduce it. It will make you pass more in the loo more often.
Contraindications and cautions of loop diuretics.
Contraindications:
Hypovolemia
Dehydration
Severe hypokalaemia or severe hyponatraemia.
Addisons disease
Caution:
Older people susceptible to adverse effects.
Give example thiazide diuretic
Indapamide
Bendroflumethiazide
Mechanism of Indapamide and its effect both short term and long term.
Blocks Na+, Cl- co-transport in the distal convoluted tubule, reduces plasma volume, venous return, cardiac output. Also reduces total peripheral resistance by unknown mechanism.
Which diuretic cause total peripheral resistance decrease.
a. Spironolactone
b. Amiloride
c. Indapamide
d. Frusemide
(c) Indapamide
Indication for thiazide-like diuretics.
Indapamide is recommended by NICE for essential hypertension.
Bendroflumethiazide: Oedema + Specialist advise with hypertension.
Adverse effects associated with thiazide diuretics
Hypokalemia, hyperglycaemia, hyperuricaemia, erectile dysfunction, hyponatremia.
