Renal Pharmacology

Question 1

What are diuretics.

Answer 1

Diuretics are drugs which increase the excretion of salts (manly NaCl) and water by the kidney.

Question 2

Diuretics cause reduction in preload/after-load leading to increase heart rate/cardiac output and decreased SVR/SV.

Answer 2

Diuretics cause a reduction in preload leading to increase cardiac output and decreased systemic vascular resistance.

Question 3

Administrations diuretics

Answer 3

Better to take it in morning to prevent nocturia.

Question 4

Give example of loop diuretic

Answer 4

Frusemide
Bumentanide.

Question 5

Indication for loop diuretics

Answer 5

Oedema.
Resistant oedema.
Resistant hypertension.

Question 6

Loop diuretics act on what part of the renal tubules.

Answer 6

Ascending loop of henle.

Question 7

Mechanism of action
Loop diuretics

Answer 7

Blocks Na+, K+, 2Cl- ion by action on NKCC2 co-transporter in the thick ascending loop of henle.

Question 8

Loop diuretics block NKCC2 at the thin ascending loop of henle.
(a) True
(b) False.

Answer 8

(b) False.

Question 9

When combined with loop diuretics increases the risk of ototoxicity.
(a) Vancomycin
(b) MAOIs
(c) Anti-diabetics
(d) Digoxin
(e) Lithium
(f)Theophylline.

Answer 9

(a)Vancomycin

Question 10

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

Answer 10

(b) Amikacin

Question 11

When combined with loop diuretic causes enhanced hypotensive effects.
(a) Ramipril
(b) Amikacin
(c) Anti-diabetics
(d) Digoxin
(e) Lithium
(f)Theophylline.

Answer 11

(f) theophylline.

Question 12

When combined with loop diuretic causes enhanced hypo magnesia
(a) Ramipril
(b) Risperidone
(c) Proton pump inhibitor
(d) Digoxin
(e) Lithium
(f)Theophylline.

Answer 12

(c) Proton Pump inhibitor

Question 13

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

Answer 13

(a) Hypokalemia

Question 14

Give the name of the drug that leads to QT prolongation exacerbated by hypokalemia when combined with loop diuretics.

Answer 14

Lithium.
Digoxin.

Question 15

Administration of loop diuretics

Answer 15

In the morning and early afternoon (for BD) to avoid nocturia.

Question 16

Loop diuretics Monitoring: when and what.

Answer 16

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.

Question 17

Adverse effects associated with loop diuretics.

Answer 17

Question 18

Counselling of loop diuretics.

Answer 18

Body is overloaded with water so we are trying to reduce it. It will make you pass more in the loo more often.

Question 19

Contraindications and cautions of loop diuretics.

Answer 19

Contraindications:
Hypovolemia
Dehydration
Severe hypokalaemia or severe hyponatraemia.
Addisons disease
Caution:
Older people susceptible to adverse effects.

Question 20

Give example thiazide diuretic

Answer 20

Indapamide
Bendroflumethiazide

Question 21

Mechanism of Indapamide and its effect both short term and long term.

Answer 21

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.

Question 22

Which diuretic cause total peripheral resistance decrease.
a. Spironolactone
b. Amiloride
c. Indapamide
d. Frusemide

Answer 22

(c) Indapamide

Question 23

Indication for thiazide-like diuretics.

Answer 23

Indapamide is recommended by NICE for essential hypertension.

Bendroflumethiazide: Oedema + Specialist advise with hypertension.

Question 24

Adverse effects associated with thiazide diuretics

Answer 24

Hypokalemia, hyperglycaemia, hyperuricaemia, erectile dysfunction, hyponatremia.

Question 25

Indapamide is cleared by: kidney or liver.

Answer 25

Kidney.

Question 26

Interactions to be MINDFUL with when using Indapamide/Bendroflumethiazide

Answer 26

Digoxin: hypokalaemia potentiate dig toxicity.
Lithium: hyponatremia potentiate lithium toxicity.

Question 27

Counselling for thiazide diuretics.

Answer 27

Tell patients it is a water pill that increase water loss improving their symptoms.

Question 28

Why does thiazide-like and loop diuretics cause hypokalemia and metabolic alkalosis.

Answer 28

Thiazides and loop diuretics increases Na+ and fluid to the collecting tubule and this increases Na+ uptake couple with K+ and H+ secretion into the tubule.
This increases the chances of hypokalaemia and metabolic acidosis.

Question 29

Give an example of potassium-sparing diuretic.

Answer 29

Amiloride
Spironolactone
Eplerenone.

Question 30

What is meant by potassium sparing diuretic.

Answer 30

Helps eliminate sodium and water from the body while retaining potassium at the same time.

Question 31

Where do K+ sparing diuretics work in the renal tubules.

Answer 31

Collecting ducts.

Question 32

What is the mechanism of Amiloride

Answer 32

Inhibits sodium reabsorption in the distal convoluted tubule and collecting ducts at sodium channels.