Renal System Flashcards
Define diuretics
…….don’t cause natriuresis
Drugs which cause net loss of sodium and water in urine.
Osmotic diuretic-mannitol
Describe the diuretics with their site of action.
COLT Pee
Carbonic anhydrase inhibitors-PCT
Osmotic diuretic- thin descending LOH
Loop diuretic-thick ascending LOH
Thiazide diuretics- DCT
Potassium sparing - collecting duct
How to reduce the nephrotoxicity of cisplatin? (3)
- Iv saline
- Amifostine
- Mannitol
Why are loop diuretics called high ceiling diuretics?
At certain high dose, the diuretic action seizes and there is no more diuresis no matter how much dose is increased
Egs of medium ceiling diuretics and weak ceiling
Medium: thiazides and thiazide like-chlorthalidone, metolazone, indapamide
Weak: carbonic anhydrase inhibitor
Osmotic diuretics
K+ sparing
Which are the aldosterone antagonists of k+ sparing and which are renal epithelial sodium channel inhibitors?
Aldosterone antagonist :
spironolactone
Epleronone
Renal epithelial sodium channel inhibitor:
Amiloride, triamterene
MOA of furosemide
Uses uric acid transporter to get inside the epithelial cell from Basolateral side and inhibit Na+K+2cl- cotransporter on luminal side.
Therefore: water follows na+, there is loss of water, sodium, calcium,magnesium are also lost in the lumen and coz furosemide uses uric acid transporter; there is hyperuricemia
Uses of furosemide
HEAMTT
HTN- decrease plasma volume->decrease CO—>decrease Bp
Edema-all types
CHF: decrease preload and afterload
Hypercalcemia of Malignancy
Chemical inToxication
Blood transfusion
Adverse effects of furosemide
- Hypokalemia
Hyponatremia
Hypomagnesemia
Hypocalcemia
Dehydration - Hyper glycemia
Hyperlipidemia
Hyperuricemia - Sulfonamide toxicity
Not given to pregnant females
Ototoxicity.
Max ototoxicity is with …..
Most potent loop diuretic
What does loop diuretic do in medulla?
Ethacrynic acid
Bumetanide
Abolish the hypertonicity of medulla preventing concentration of urine
Hyperchloremic acidosis seen in …..diuretic
Use (2)
Acetazolamide
- Epilepsy
- Acute mountain sickness- hyperventilation->respiratory alkalosis -rx: acidosis
C/I of acetazolamide (3)
- Acidosis conditions : asthma, COPD
CO2 retension - Ascites / cirrhosis
- Self limiting diuretic acidosis
Aldosterone acts on ……part of kidney
All diuretic act on luminal side except…
Distal tubule
Spironolactone- block na/k+ exchange
Metabolite of spironolactone
S/e of amiloride, triamterene (2)
Canrenone
- Hyperkalemia - muscle cramps
- Anti folate - megaloblastic anemia
In cirrhotic ascites , c/I diuretic is ….
Preferred diuretic is ….
- Acetazolamide
Spironolactone
Conditions which spironolactone is preferred?
Hyperaldosteronism
Primary : conn’s syndrome
Secondary : ascites - edema
Initially- furosemide
Later on- add- spironolactone
MOA of thiazide
Indications of thiazide (5)
Inhibit Na+\cl- cotransporter
1. HTN
2. CHF
3. Hypercalcemia
4. Nephrogenic D.I
5. Osteoporosis
Difference between s/e: thiazides and furosemides
Thiazide : impotence
Increased calcium reabsorption
—-> hypercalcemia
Loop diuretics: Ototoxic
Increase calcium loss
—> hypocalcemia
Longest acting thiazide
Acetazolamide is ……inhibitor
Chlorthalidone
Non competitive, reversible carbonic anhydrase
DOC for HTN
Conditions where furosemide is used as AntiHTN (2)
Thiazide - sustained Bp decrease
- HTN crisis
- HTN with low GFR -acute renal failure
Usually thiazides have no effect on decreased GFR; Thiazide which has effect on deceased GFR
Potassium sparing duretics act on …..
Metolazone
Distal tubule/ Cortical collecting duct
Aldosterone receptor antagonist act by…..
Triamterene and amiloride act by ……
Inhibiting Na+K+ exchange
Blocking sodium channels
Menstrual irregularity seen with …..diuretics
Mx diuretic used in heart failure
Mx diuretic used to rx HTN
Potassium sparing
Loop diuretics
Thiazide diuretics
Use of metolazone.
Name a Uricosuric diuretic . Use .
Refractory edema in CKD
Indacrinone
Ethacrynic analogue -used for Rx gout with diuretic rx where loop and thiazides are C/I.
Spironolactone acts on ….side of renal tubular cell
Define anti diuretics
They ……….urine volume
Interstitial side of renal tubular cell.
Inhibit water excretion without affecting sodium excretion.
Decrease
Human ADH is ……
It is a …..secreted by ….
8-arginine vasopressin (AVP)
Non apeptide , secreted by posterior pituitary along with oxytocin
Vasopressin receptors
Action of the receptors
V1a, b: G q
V2: Gs
V1a—>Bv—> vasoconstriction
V1b—> CNS—> increase ACTH
V2—-> collecting duct —> increase water reabsorption in kidney
Eg of vasopressin causing vasoconstriction
Different types of D.I
Terlipressin- V1 a agonist
Central: decrease ADH secretion
Rx: desmopressin
Peripheral : ADH can’t act on C.D
Rx: thiazide
V2 receptors are present on …..
All are vasopressin receptors except….(3)
Principle cells of collecting duct of kidney
Renal collecting duct
Thick ascending LOH
Vascular endothelium
AVP is inactive orally , inactivated by ….
Which route can AVP be given ?
Trypsin
Parenteral , nasal route
Egs of synthetic vasopressin analogues (3)
- terlipressin
- Lypressin
- Desmopressin
MOA and use of lypressin
In place of AVP, for V1 mediated action
8-lysine vasopressin
Synthetic prodrug of AVP is …..
Drug 12 times more potent than AVP
Available as …(2)
Terlipressin
Desmopressin
Oral, nasal spray
Drug given for both pituitary and renal DI
Used of vasopressin (4)
Hydrochlorothiazide
Uses:
1. DI- neurogenic
- Nocturnal enuresis - desmopressin decrease urine volume and control symptoms
- Hemophilia,VW disease - AVP can check for bleeding by checking conc of factor 8 and VWF
- Renal concentration test
Terlipressin is DOC for …..
Bleeding esophageal varices
Selective V2 antagonists
Uses (4)
Tolvaptan, mozavaptan
- SIADH
- Hyponatremia due to CHF
- Cirrhosis of liver
- ADPKD ( decrease growth of cysts)
MOA of conivaptan
RX for SIADH (3)
V1a + V2 receptor antagonist
- 3% saline
- DOC-V2 blocker- vaptans
- Miscellaneous: lithium, demeclocycline
Drugs to increase ADH secretion / ADH like action (8)
C3 OF VAP
Chlorpropamide
Carbamazepine
Cyclophosphamide
Oxytocin
Fluoroquinolones
Vincristine
Antidepressants: TCA/ SSRI
Procarbazine
Define free water clearance
Extra water in urine than needed to produce isoosmotic urine
Free water clearance of
Positive value
Negative value
Zero
Positive: dilute urine
Negative : concentrated urine
Zero: isotonic urine
Medications with decreased positive, negative and zero free water clearance
Positive : thiazides
Negative : ADH and ADH like drugs
Zero: loop diuretics and mannitol - block both positive and negative-FWC =0
