Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sem 2 Year 2 > Renal physiology and pharmacology > Flashcards

Renal physiology and pharmacology Flashcards

1
Q

What are the functions of the kidney?

A

Filtration of blood
Detoxification
Regulation of blood pressure
Regulation of blood pH
Regulation of haematopoiesis (produces erthyropoietin)
Activates Vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the slit diaphragm?

A

Gaps between podocytes which wrap around the blood vessels in the kidneys
Smaller molecules could pass through these gaps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the biggest hole size in the slit diaphragm?

A

Size of albumin molecule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is high pressure needed to push blood into the filtrate?

A

Pushing molecules through filter- only about 3% of the total area is slit so there is major resistance
Thermodynamics- need pressure to stop water from flowing back to the area with greater ion concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are efferent and afferent arterioles?

A

Efferent= drains blood from kidney
Afferent= applies blood to kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens when afferent and efferent arterioles are restricted?

A

Afferent= blood pressure in glomerular capillaries drops and thus filtration rate drops
Efferent= blood pressure in capillaries rises and filtration rate rises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are stuck molecules removed from the filter in the kidney?

A

Small molecules that get stuck in the filters are brought in pinocytosis (phagocytosis of small molecules)
Mesangial cells are constantly recycling the glomerular basement membrane so that large molecules which are stuck are moved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What was the structure of the glomerulous membrane?

A

GBM= glomerular basement membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are the parts of the glomerular membrane cleaned?

A

Endothelial cells= cleaned by blood flow and phagocytes
Podocytes= cleaned by pinocytosis
Basement membrane= renewed by mesangial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What was the glomerulus?

A

The glomerulus, the filtering unit of the kidney, is a specialized bundle of capillaries that are uniquely situated between two resistance vessels
Alot of branching that comes together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the space in which the glomerulus sits?

A

Bowman’s capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the renal corpsule?

A

Glomerulus structure and Bowman’s capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How many renal corpsules do humans have?

A

50,000-1,000,000 per kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Barker hypothesis?

A

Barker hypothesis- number of nephrons follows mother’s amino acid nutrition
Nutrition restriction (especially lack of protein) during foetal life may lead to having as little as 100,000 nephrons. May be adaptive so the foetus loses less proteins. The consequence is high blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do high levels of plasma creatinine indictate?

A

Indicative of kidney problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does the glomerular filtration rate compare with levels of creatinine in the plasma?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does the amount of creatinine in the urine tell us?

A

The amount filtered, as it is not reabsorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the equasion for the clearance rate of a substance that is not reabsorbed in the kidney?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the options for those who have severe chornic filtration conditions?

A

Dialysis or transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the nephron divided into?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the differences in proximal and distal tubules?

A

Proximal have microvilli, distal tubules do not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where in the nephron are tight junctions leaky?

A

The proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the common plasma membrane transporter in the proximal tubule?

A

Na+ K+ ATPase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the different solute recovery channels in the nephron?

A

Primary active transporters- require energy ( Na+ K+ ATPase and H+ ATPase)
Solute carrier proteins- co-transporters powered by established concentration gradients
Aquaporins
Ion channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What does Na+ K+ ATPase do?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is sodium recovered in the proximal tubule?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Where is potassium recovered?

A

Occurs in the loop of henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How is potassium recovered?

A

Sodium can co transport Cl and K, sodium can enter due to the gradient causes by NaK ATPase
There is also regulated leakage of potassium in the renal outer medullary K channel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Where does amino acid recovery occur?

A

The proximal tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How are amino acids recovered?

A

Brought in with Na+ that can be brought in due to concentration gradient caused by Na+ K+ ATPase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Where does glucose recovery occur?

A

Mostly in the proximal tubule, a little in the loop of Henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How is glucose recovered?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is indicative of diabetes mellitus and why?

A

Glucose in the urine- glucose recovery from kidneys can become saturated and no more can be taken up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Where does phosphate recovery occur?

A

Proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How is phosphate (PO4 2-) recovered?

A

Co transported with sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How is bicarbonate recovered?

A

Calcium anhydrase converts it to H2O and CO2
CO2 diffuses through cell and re joins with water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Where does bicarbonate reuptake occur?

A

Proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How does bicarbonate reuptake not affect acid base?

A

Bicarbonate is re absorbed
H+ is recycled and goes round and round in the pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What happens if there is left over protons after bicarbonate has been re absorbed?

A

Bonds to ammonia (NH3) or hydrogen phosphate (HPO4 2-) and is excreted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Where does the ammonia come from that excess protons can bind to?

A

Glutamine in the cell can be broken down to NH3 and bicarbonate
Useful as more H+ excreted and more bicarbonate, so pH rises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How can protons be brought back to the body or excreted by themselves?

A

Type A and type B cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How is water reuptaken?

A

Via aquaporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How are calcium ions recovered?

A
  • Calcium recovery is driven by osmosis once the urine has become more concentrated
  • Calcium ions can cross tight junctions directly, down the concentration gradient into the body
  • With ions removed water will have moved back into the body, meaning the concentration of calcium ions is greater in the body and they can flow down the concentration gradient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How are proteins re-uptaken in the proximal tubule?

A

Takes place using receptors such as megalin, which are huge and bring in proteins via endocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How do organic cation and anion transporters work?

A

Cation= Allows passive movement down gradient
Anions= push into the cell and drift out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What organic transporter is dangerous and why?

A

Anions= since they push in, concentrations can increase and cause toxicity and renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What drug can block the uptake of organic ions into the cell and why is it useful?

A

Probenecid- this is useful as it means small dose of a drug e.g. penecillin will be excreted slower and have greater effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are examples of organic cations and anions?

A

Cations= dopamine, antihistamines, morphine
Anions= cyclic peptides, prostaglandins, methotrexate, penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the summary of what occurs in the proximal lumen?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Are tight junctions in the loop of henle leaky?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the structure of the loop of henle and what is absorbed where?

A

Cells in the thin descending limb have lots of aquaporins but little ion transport.
The other way round in the ascending limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How is water reabsorbed in the loop of Henle?

A

There is an uptake of ions in the ascending limb that creates a hypertonic area where water travelling in the descending limb is pulled towards out of the filtrate
Water is drawn towards the hypertonic area due to the anatomic structure of the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How are ions reabsorbed in the loop of henle?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How much water is reabsorbed in the loop of Henle?

A

10% of filtered water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Where in the loop of Henle is water diluted and where is not?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How is the hypertonic region stopped from being swept away by blood flow in the tissues?

A
  • Salty parts are kept away from corpsules
  • Also the blood vessels emerging from the glomerulus go on to form a secondary capillary system- the vasa recta
  • Where counter current exchange takes place
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What occurs in the distal tubule?

A

More recovery of ions, no water transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What occurs after the distal tubule?

A

The collecting duct, which also passes through the hypertonic zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How does body re absorb water in the collecting duct?

A

Via aquaporins
Collecting duct cells choose where the aquaporins are located

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What else is recovered in the collecting duct in small amounts?

A

The duct can also choose to leak urea back in the body, to add to the hypertonicity. It is not enough to cause toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the basic anatomy of the kidney?

A

There is renal pyramids connected by collective tissue that drain into the kidney pelvis (bowl)
There is seperation between normal and hypertonic zones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Why are the kidneys are particularly sensitive to ischaemia?

A

The long runs of parallel arteries and vein and arterioles and venules means there is countercurrent exchange of oxygen, so that much gets shunted from artery to vein before the blood enters the kidneys. This means the kidneys are particularly sensitive to ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What occurs in low renal oxygen levels?

A

Erythropoietin is released and more RBC made in bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What detects blood pressure in the nephron?

A
  • There is direct pressure sensing in the afferent arteriole- the myogenic mechanism
  • There is also tubuloglomerular feedback which measures the concentration of salt in the nephron to work out how fast urine is flowing through and if it has enough time to be absorbed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How is blood controlled in individual nephrons?

A

The end of the distal tubule make contact with the arterioles entering the glomerulus- known as the macula densa and feedback can occur that way

66
Q

How does the macula densa cells detect and stop elevated glomerular blood pressure?q

A
67
Q

What are the two reasons why too much NaCl remains in the distal tubule?

A

There has been a high salt intake OR
Glomerular pressure is too high and so salt is not absorbed

68
Q

Where is renin released?

A

Juxtaglomerular cells

69
Q

What inhibits the release of renin?

A

Signalling from macula dense (when there is high salt in the distal tubule) and or elevated glomerular blood pressure

70
Q

How does the renin-angiotensin-aldosterone system work?

A
71
Q

How does angiotensin II cause an increase of Na re-absorbsion?

A

Affects proximal convoluted tubule
Up regulates the Na+/H+ exchanger through a secondary messenger system

72
Q

How does aldosterone cause an increase of Na re-absorbsion?

A

Effects the collecting duct
Drives gene expression of Na+/K+ ATPase channels

73
Q

How does aldosterone cause less K+ uptake

A

Regulates gene expression so more H+ channels are transcribed and less activity of H+/K+ channels

74
Q

What kidney cells does aldosterone effect?

A

Principle cells (Na+ absorbsion)
Intercalated cells (H+ excretion)

75
Q

What causes AVP to be released from pituitary gland?

A

Aldosterone

76
Q

What is the effect of AVP?

A

AVP drives the transport of aquaporins from storage into the membrane, thus allowing for more uptake of water in the collecting duct

77
Q

What happens to the kidneys during the fight or flight response?

A

Renal nerves have a fight or flight sympathetic response; they secrete noradrenalin which constricts both vessels serving glomerulus so reduces flow (so there is more blood to pump around muscles). Also directly promotes renin release

78
Q

What causes more sodium loss in the kidneys?

A

Atrial natruietic peptide from the heart blocks the Na+ reuptake channel in the collecting ducts and causes more sodium loss

79
Q

What happens when there is low blood calcium?

A
  • The parathyroid releases PTH which acts on the kidney
  • PTH inhibits phosphate re uptake, as they tend to go in opposite directions of travel
  • They also bind to receptors which drive the production of calcium channels and also the exit channel. Need Vit D for these
  • Causes increased Calcium recovery and decreased PO4 2- recovery
80
Q

What happens if there is a fall in intracellular pH?

A
  • If there is a fall in intracellular pH, apicial Na+/H+ exchangers can detect this and can become more actived
  • This causes more H+ to be excreted
81
Q

Where does regulation of potassium occur?

A

There is little regulation of K in the proximal tubule, the excretion and absorbsion regulation occurs in the collecting duct
Absorption by intercalated cells is occurring constantly, excretion by principle cells is regulated

82
Q

What happens to the K+ removal system in chronic K+ deprivation and in high K+ diets?

A

In chronic K+ deprivation the K+ system gets degraded and channels are removed from the membrane
Opposite in high K+ diet

83
Q

What happens to potassium in alkalosis?

A

H+ pumping by intercalated cells is reduced, so there is LESS K+ intake
Can lead to hypokalaemia

84
Q

What happens to potassium in acidosis?

A

There is increased H+ outpumping via a H+/K+ channel, so more potassium uptaken.
Can lead to hyperkalaemia

85
Q

What do diruetics do?

A

Increase the amount of water and salts lost from the body

86
Q

What is the mechanism of action of loop diruetics?

A

Blocks a channel (Cl-/K+/Na+) that stops salt being moved into the interstitium and thus the salty area is less salty and there is less osmolarity drive to bring the water back into the body

87
Q

What is a common loop diruetic in Scotland?

A

Furosemide

88
Q

What are the side effects of loop diuretics?

A
  • They result in the loss of Na+, K+ and Cl- because of failure to recover in the LoH. Loss of essential electrolytes
  • Can result in the hypercalcuria (in collecting duct some Ca recovery was dependant on the pull of water)
  • More Na getting to the collecting duct means more uptatke there and more K+ loss
89
Q

What are diruetics main effects on blood pressure?

A

The main effect on blood pressure is not due to fluid loss but due to the urine being unusually salty- the macula densa and juxtaglomerular apparatus will detect this and stop producing renin

90
Q

How do thiazide diuretics work?

A

They block the Na+/Cl- co-transporter in the distal tubule

91
Q

How do potassium sparing diruetics work?

A

They block the Na channel- weaker than loop diruetics
Do not have the vice of driving patients into hypokalkaemia

92
Q

What are examples of potassium sparing diuretics?

A

Amiloride
Spironolactone

93
Q

What is the action of spironolactone?

A

Blocks aldosterone, which causes transcription of the Na channel

94
Q

What is a common side effect of spironolactone?

A

Drives mammilary growth in men

95
Q

What is the mechanism of action of carbonic anhydrase inhibitors?

A
  • Also is carbonic anhydrase inhibitors (causes more bicarbonate to not be recovered, so there is less of a drive to pull water back in as urine is more osmolaric.
  • Messes with pH
96
Q

Where do the different diuretics act?

A
97
Q

What is Bartter’s syndrome?

A

Causes impaired action of the SLC12A2 which stops Cl-, K+ and Na+ from entering at the loop of Henle
Makes medulla less salty and less water is drawn in
Causes loss of Na+, K+, H2O and hypercalcuria

98
Q

What is Gitelman’s syndrome?

A

Impaired action of the sodium and chloride uptake channels
Causes loss of Na, K, H2O but hypocalcuria
Loss of K+ because thiazide diuretics act on the distal tubule, and so there is more Na+ left in the collecting duct as it has not been uptaken and is swapped for K+

99
Q

What syndrome mimics a thiazide diuretic?

A

Gitelman’s syndrome

100
Q

What is Liddle’s syndrome?

A

Makes sodium intake channels very active
Causes volume expansion in the body and hypertension

101
Q

What can Liddle’s syndrome be treated with?

A

Amiloride

102
Q

What is pseudohypoaldosteronism?

A

Causes underactivation of sodium channel
Causes Na+ loss, K+ retention and high aldosteronism
Aldosterone is trying to correct the problem, but cannot due to a non-functioning sodium channel. Symptoms mimic lack of aldosterone

103
Q

What does inactivating mutations of aquaporins 2 cause?

A

Nephrogenic diabetes insipidus

104
Q

What is Addison’s disease?

A

Destruction of the adrenal glands, causes lowered/no aldosterone production
This causes loss of Na+, hyper K+, hypervolaemia
Same renal result as treatment with spirnololactone

105
Q

What is psychogenic polydipsia?

A

Causes whole body hypo-osmolarity
Compulsive water drinking

106
Q

What is renal angenesis?

A

Where both (bilateral) or one (unilateral) kidneys are missing
Bilateral is rare and not compatible with life if there is no medical intervention

107
Q

What is Potter’s facies?

A

Flat nose, flat chin and ears against head
Caused by bilateral renal angenesis

108
Q

Why does Potter’s facies occur?

A

Normally foetus develops in amniotic fluid so pressure from mother is not pushing on foetus- when no fluid face is flatter

109
Q

What is congenital cystic disease?

A

Problems in the cells ability to measure pressure of urine- cells may put transporters on wrong side of cell
Cysts fill with fluids and crush healthy kidney cells

110
Q

What is supernumerary ureter?

A
  • When there is more an one ureter. If they unite before or at the bladder is not too serious.
  • If joins below the bladder there will be continous dribbles of urine and make it easier for infections to get into the kidney
111
Q

What is Pelvic kidney?

A

When the kidney ends up in the pelvis. If there is two pelvic kidneys they fuse together to form a horseshoe kidney

112
Q

What is hypospadias?

A

Incomplete migration of the urethral groove from the base of the penis to the tip

113
Q

What is the cloaca?

A

Common exit of rectal, vaginal and urethral opening. It is seperated by folds

114
Q

What are the congenital abnormalities of cloacal development?

A
  • Rectovaginal fistula
  • Rectoprostatic fistula
  • Rectoclocal canal (rectum, vagina and urethra unite inside body)
115
Q

How is the female reproductive and urology area created?

A
  • Indifferent gonad develops into an ovary
  • Upper Mullerian ducts become fallopian tubes
  • Mullerian ducts converge & fuse to become the uterovaginal canal
  • Neprhic ducts and mesoneprhos degenerates
  • Uterovaginal canal forms uterus and upper part of vagina. (Lower part from urogenital sinus)
  • The urethra ends within the vulva and does not run to end of the clitoris
116
Q

How is the male reproductive and urology area created?

A
  • Indifferent gonad develops testis cords
  • Testis cords connect to some mesonephric tubules (->epidydymis)
  • Mullerian duct regresses
  • Distal neprhic duct sprouts seminal vesicles – the part of the nephric duct distal to this is the ejaculatory duct
  • Urethra sprouts prostate and bulbourethral glands.
  • Urethra runs along the penis and opens at its end
117
Q

How is the renal system created in a foetus?

A
  • Urogenital system forms from the urogenital ridge (parallel to vertebral column) and nephrogenic cord
  • The mesonephros is an area in the thoracic area in the nephrogenic cord. Has a mesonephric duct connected to tubules
  • The metanephros forms around week 5- connects to ureter and forms lots and lots of branches
118
Q

What would be the effect on the kidneys and the whole body of having a renal arterial stenosis?

A

Causes low blood pressure in that kidney; activation of the the RAAS system. Ischaemia will also cause a GFR decrease
Leads to hypetension, increased risk of stroke and MI
Other kidney- will be affected by hypertension, causing glomerular disease and scarring and proteinuria

119
Q

Why can those who are experiancing kidney failure become anaemic?

A

Because the kidneys produce erythropoitein

120
Q

What are the rates of renal blood flow, glomerular filtration rate and urine output per min?

A

Renal blood flow= 1.25L/ min
Glomerular filtration rate= 100mL/min
Urine output= 1mL/min

121
Q

Where does vasopressin act?

A

The collecting duct

122
Q

Where is the majority of salt reabsorbed back into the body?

A

65% is in the proximal tubule

123
Q

Where does PTH act and what does it do?

A

Acts on the distal tubule to bring back more calcium into the body

124
Q

Where does aldosterone act and how does it act?

A

On the distal proximal tubule; upregulates the Na+/ K+ or H+ transporter so more sodium is brought back into the body and more potassium (or protons if there is no potassium0 is lost

125
Q

What is the local effect of angiotensin II?

A

Restricts the efferent arterioles in the kidney. Tries to make the most of the poor blood flow to kidney

126
Q

What is the renin-angiotensin system?

A
127
Q

What is ramipril?

A

ACE inhibitor

128
Q

What is the action of Lorsartan?

A

Blocks angiotensin II receptors

129
Q

What is aliskeren?

A

A potassium sparing diuretic

130
Q

What is the action of spirnolactone?

A

Blocks the action of aldosterone

131
Q

What are causes of acute renal impairment?

A

Dehydration
Hypotension
Glomerulonephritis
Drugs- e.g. NSAIDS

132
Q

What is renal function expressed as and what is normal?

A

Expressed as the glomerular filtration rate, normally greater than 100mL/ min but declines progressively with age

133
Q

What do diuretics do?

A

Decrease sodium absorption and increases urinary volume

134
Q

What are the different types of diuretics?

A

Loop, thiazide (and thiazide like), postassium sparing, osmotic and carbonic anhydrase inhibitors

135
Q

What is the mechanism of action of loop diuretics?

A

Decreases Na+ K+/ Cl- absorption in the thick ascending limb
Makes the salty area less salty so less water is drawn in

136
Q

What is an example of a loop diuretic?

A

Furosemide

137
Q

What are loop diuretics indicated for?

A

Heart failure- acute and chronic
Renal failure, liver cirrhosis and acute pulmonary oedema

138
Q

What are the adverse effects of loop diuretics/

A

Hyponatraemia, hypokalaemia, metabolic acidosis
Dehydration, hypovolaemia
Ototoxcity= damage to auditory nerve

139
Q

Why does metabolic alkalosis occur in patients taking loop diuretics?

A

There is > loss of H+ in the distal convoluted tube as there is more sodium to swap for it

140
Q

What are examples of thiazide diuretics?

A

Bendroflumethiazide
Thiazide like= indapamide, chlortalidone

141
Q

What is the mechanism of action of thiazide diuretics?

A

Inhibit Na+/Cl- co transport in the distal convoluted tubule

142
Q

What are thiazide diuretics indicated for and why?

A

Hypertension- causes water loss AND seems to have a vasodilation effect on the body

143
Q

What are the adverse effects of thiazide diuretics?

A

Hypokalaemia, hyponatraemia, hypomagnesaemia, hyperglycaemia and alkalosis
Fluid depletion, erectile dysfunction

144
Q

What are the two different ways that potassium sparing diuretics work?

A

Aldosterone receptor antagonists- spironolactone
Sodium channel blockers- amiloride

145
Q

What are potassium sparing diuretics indicated for?

A

Chronic heart failure, liver failure, primary hyperaldosteronism and resistant hypertension

146
Q

What are the adverse effects of potassium sparing diuretics?

A

Hyperkalaemia
Spironolactone= oestrogenic effects such as hynaecomastia

147
Q

When are osmotic diuretics used?

A

Used in situations where fluid needs to be rapidly offloaded
Raised ICP due to cerebral oedema
Raised intra-ocular pressure

148
Q

What are the adverse effects of osmotic diuretics?

A

Initial fluid overload, hypernatraemia

149
Q

What is the mechanism of action of osmotic diuretics?

A

Glucose that is filtered, does not get absorbed but drags water out of the body

150
Q

What is an example of osmotic diuretics?

A

Mannitol

151
Q

What are examples of carbonic anhydrase inhibitors?

A

Acetazolamide, brinzolamide

152
Q

What is the mechanism of action of carbonic anhydrase inhibitors?

A

Inhibits carbonic anhydrase in proximal tubular cells which decreases the H+ and HCO3- available for exchange withNa+

153
Q

What are the adverse effects of carbonic anhydrase inhibitors?

A

Metabolic acidosis

154
Q

What are carbonic anhydrase inhibitors indicated for?

A

Glaucoma and altitude sickness

155
Q

What drugs can cause dehydration?

A

Diuretics
Drug induced diarrhoae- laxatives, antibiotics and proton pump inhibitors
Drug induced vomiting- chemotherapy

156
Q

What drugs are directly toxic to the kidney?

A

Antibiotics
NSAIDs (ibuprofen)
Proton pump inhibitors
Lithium
Aminoglycosides

157
Q

What are some drugs that replace renal products?

A

Erythropoiten= stimulates red blood cell formation in bone marrow.
Vit D= requires hydroxylation in the kidney. Patients can be given hydroxylated version
Sodium bicarbonate= corrects the acidosis of renal failure

158
Q

What drugs should not be paired together for kidney function?

A

Pairing drugs that impair renal function (diuretics, ACEi and NSAIDs) with drugs that are renally excreted (digoxin, lithium, gentamicin) can lead to problems

159
Q

What drugs are eliminated by the kidney?

A

Drugs that are eliminated by the kidney= digoxin, antibiotics, beta blockers, some analgesics, some antidepressant

160
Q

What are the effects of renal impairement?

A

Reduced plasma clearance, increased drug half life and drug accumulation after repeated doses

161
Q

What is sodium glucose transport inhibitors used for?

A

Indicated for type 2 diabetes, second or third line after metformin. Inhibits at least 90% of glucose absorption in proximal tubule. Seems to help with chronic renal failure and chronic heart failure.

162
Q

What are uricouric drugs used for?

A

Inhibit uric acid re absorption in proximal tubule. Indicated for preventing gout. E.g. sulfinpyrazone

Sem 2 Year 2 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions