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1. Theme 3: Excretory system and renal function > T3 L6: Diuretic agents > Flashcards

T3 L6: Diuretic agents Flashcards

1
Q

What is the definition of a diuretic agent?

A

A drug that increases excretion of both fluids and solutes

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2
Q

What is Natriuretic excretion?

A

Of Na+

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3
Q

What is Kaliuretic excretion?

A

Of K+ (usually an unwanted effect)

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4
Q

Where do carbonic anhydrase inhibitors take effect as diuretics on a nephron?

A

Proximal tubule (not powerful)

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5
Q

Where do osmotic diuretics take effect on a nephron?

A

Proximal tubule and descending loH (water permeable parts of the nephron)

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6
Q

Where do loop diuretics take effect on a nephron?

A

Ascending loH

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7
Q

Where do thiazides and thiazide-like diuretics take effect on a nephron?

A

Early distal tubule

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8
Q

Where do potassium-sparing diuretics (aldosterone antagonists and non-aldosterone antagonists) take effect on a nephron?

A

Late distal and early collecting tubule (They’re weak)

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9
Q

How do loop diuretics work?

A

They inhibit NKCC2 transporters in the thick ascending limb of the loH so reabsorption of Na+, K+ and Cl- increases. They are the most effective diuretics available

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10
Q

How does weighing yourself prevent dehydration when using diuretics?

A

If they gain weight, they need to drink less and if they lose weight then they need to drink more

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11
Q

What are some clinical uses of loop diuretics?

A

Acute pulmonary oedema, chronic heart failure, cirrhosis of the liver, resistant hypertension, nephrotic syndrome, and acute kidney injury

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12
Q

What are some unwanted effects of loop diuretics?

A

Dehydration, Hypokalaemia, metabolic alkalosis due to loss of H+ in urine, Hypokalaemia can potentiate effects of cardiac glycosides, and deafness when used with aminoglycoside antibiotics

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13
Q

How do loop diuretics cause hypokalaemia?

A

They increase the exchange of Na+ for K+ in the distal tubule

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14
Q

How do Thiazide diuretics work?

A

They inhibit apical Na+/Cl- co-transporters in the distal tubule and therefore cause increased Na+ excretion with increased water excretion. They last up to 24hours

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15
Q

What is the main thiazide diuretic and what is it used for?

A

Bendroflumethiazide used for mild/moderate heart failure

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16
Q

What is indapamide used for?

A

Resistant hypertension because it has less side effects

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17
Q

What are thiazide diuretics used for?

A

Hypertension, oedema, and mild heart failure

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18
Q

What are some unwanted effects of thiazide diuretics?

A

Hypokalaemia, metabolic acidosis, gout, hyperglycaemia as they have an effect on pancreatic beta-cells, increased plasma cholesterol with long-term use, and male impotence that’s reversible

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19
Q

What’s the mechanism behind metabolic acidosis?

A

Loss of urinary H+

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20
Q

What is gout?

A

Increased plasma uric acid

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21
Q

Why do thiazide diuretics cause gout?

A

They work on the transporter that transports uric acid in the nephron

22
Q

What are the symptoms of mild hypokalaemia?

A

Fatigue, drowsiness, dizziness, muscle weakness

23
Q

What are the symptoms of severe hypokalaemia?

A

Abnormal heart rhythm, muscle paralysis, and death

24
Q

How do potassium-sparing diuretics work?

A

They inhibit Na+ reabsorption on the distal tubules where K+ is not secreted

25
Q

Eplerenone and Spironolactone are types of what diuretic?

A

Potassium-sparing aldosterone antagonist diuretics. They are competitive antagonists to aldosterone

26
Q

Amiloride and Triamterene are types of what diuretic?

A

Potassium-sparing non-aldosterone antagonist diuretic

27
Q

What is the active metabolite of Spironalactone?

A

Canrenone

28
Q

Why are potassium-sparing aldosterone antagonist diuretics less effective?

A

They depend on reduction of protein expression is distal tubular cells that take days to develop

29
Q

What are the clinical uses of spironolactone?

A

Heart failure, oedema, and resistant hypertension in short-term

30
Q

Why can’t spironolactone be used in the long-term?

A

Because there was a reported incidence of cancer in the long term in rats

31
Q

What are some unwanted effects of spironolactane?

A

Hyperkalaemia, metabolic acidosis, GI upsets like ulcers, menstrual disorders, testicular atrophy

32
Q

Why does Spironolactane cause Gynaecomastia, menstrual disorders and testicular atrophy?

A

Because aldosterone has an effect on sexual characteristics

33
Q

What is Gynaecomastia?

A

Man boobs

34
Q

What are some unwanted side effects of Triamterene and Amiloride?

A

Hyperkalaemia, metabolic acidosis, GI disturbances, and skin rashes

35
Q

What are Triamterene and Amiloride usually pared with and why?

A

With potassium-depleting diuretics as they limit hypokalaemia

36
Q

What type of diuretic is azetozalamide?

A

A carbonic anhydrase inhibitor

37
Q

What are carbonic anhydrase inhibitors used to treat?

A

Glaucoma (reduces intraocular pressure) and epilepsy (reduces volume and pressure of CSF)

38
Q

What are some unwanted effects of carbonic anhydrase inhibitors?

A

Metabolic acidosis, and kidney stones because of alkaline urine

39
Q

How do carbonic anhydrase inhibitors work?

A

They inhibit the absorption of sodium bicarbonate (NaHCO3) reabsorption in the proximal tubule

40
Q

How do osmotic diuretics work?

A

They act as sponges to remove H2O. They absorb H2O into their chemical structure and are then excreted along with it

41
Q

What type of diuretic is mannitol?

A

An osmotic diuretic

42
Q

What are some clinical uses of osmotic diuretics?

A

Cerebral oedema, glaucoma, for toxin elimination by ‘osmotic diarrhoea’, acute renal failure

43
Q

What is glaucoma?

A

Increased ocular pressure

44
Q

What are the unwanted effects of osmotic diuretics?

A

Their presence in blood exerts osmotic pressure leading to increased blood volume so they can’t be given to those with hypertension

45
Q

How can water act as a diuretic?

A

It increases the volume of water excreted which leads to reduced secretion of ADH

46
Q

What are some unwanted effects of ADH antagonists?

A

Can cause diabetes insipidus, renal failure, tremors

47
Q

Demeclocycline shouldn’t be given to patients with what?

A

Liver disease

48
Q

Lithium, demeclocycline and Amphotericin B are types of what drug?

A

ADH antagonists

49
Q

What are some examples of xanthines?

A

Caffeine (tea and coffee), theophylline, and theobromine

50
Q

How do xanthines produce an diuretic effect?

A

They increase cardiac output and therefore increased renal and glomerular blood flow which increases GFR and urine output

1. Theme 3: Excretory system and renal function (12 decks)

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