Volume Regulation

Question 1

Renin Inhibitor

Answer 1

Aliskiren
Anti-hypertensive
SE: Hypotension, Reversible renal impairment
CI: Pregnancy risk fetal malformations and neonatal death

Question 2

ACE Inhibitors

Answer 2

Captopril, Enalapril, Ramipril, Lisinopril
Decrease BP
Hypertension, Heart Failure, MI
SE: Increased bradykinin dry cough, hypotension, reversible renal impairment, hyperkalaemiandue to reduced aldosterone

Question 3

Angiotensin II Receptor Antagonists

Answer 3

Losartan, Candesartan, Valsartan
Half Life varies
Similar to ACEI without dry cough
Hypertension, Heart Failure when ACEI not tolerated
SE: Hypotension, reversible renal impairment

Question 4

Carbonic Anhydrase Inhibitors

Answer 4

Acetazolamide
Proximal Convoluted Tubule
Reversibly inhibits Carbonic Anhydrase
Overall weak effect on Na retention-downstream compensation
Glaucoma

Question 5

Loop Diuretics

Answer 5

Furosemide, Bumetanide
Inhibit Na/K/2Cl transporter in Thick Ascending Limb
Oedema in CHF, Renal Failure, Liver Disease, Hypercalcaemia
PK: Oral or parenterally, duration 4-6 hours
SE: Hypokalaemia, Gout, Hypovolaemia, Hypocalcaemia, Hypomagnesaemia

Question 6

Thiazide Diuretics

Answer 6

Hydrochlorothiazide, Bendroflumethiazide, Chlortalidone
Inhibit Na/Cl transporter in DCT
Calcium wasting decreased
PK: Take 1-3 weeks for stable reduction, Thalf 4 hours
SE: Hypokalaemia, Hypovolaemia, Hypercalcaemia, Gout, Hyperglycaemia due to decreased K

Question 7

K Sparing- Aldosterone Antagonist

Answer 7

Spironolactone, Eplerenone
CD
Competes with aldosterone, preventing Na channel transcription
Given with diuretics and hyperaldosteronism
SE: Gynaecomastia, Erectile dysfunction, menstrual disorders, hirsutism
PK: Well absorbed orally, Thalf 11.2 hours, slow onset

Question 8

K Sparing- Na channel blockers

Answer 8

Amiloride
Blocks luminal Na channels
Inhibit Na absorption and K secretion
Hypertension with diuretics
PK: Oral, effects in 2 hours for 24 hours
SE: Hyperkalaemia particular with ACEI, K supplements