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Y2 Renal > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Example of loop diuretics

A

Furosemide

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2
Q

Action of loop diuretics

A

Inhibits Na+K+Cl- cotransporter -> increase ions in the tubules -> reduce hyperosmolarity in intersitium -> reduce in water reabsorption

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3
Q

What must happen for loop diuretics to work

A

Loop diuretics must be filtered out of the glomerulus into the ascending loop of Henle to work

= patients with poor renal function will need higher dose for sufficient effect

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4
Q

Where does loop diuretics act on

A

Ascending limb of loop of Henle

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5
Q

Which NKCC variant does loop diuretics mainly act on

A

NKCC2

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6
Q

When is loop diuretics indicated

A

Heart failure
Resistant hypertension in those with poor renal function

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7
Q

Side effects of loop diuretics

A

Hyponatraemia
Hypokalaemia
Ototoxicity
Hypocalcaemia
Hypomagnesaemia
Gout

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8
Q

loop diuretics can interact with other drugs to cause adverse effects. Which drugs

A

Steroids -> further decrease K+ level

Aminoglycosides -> increase risk of ototoxicity

NSAID -> decrease effect of loop diuretics

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9
Q

Examples of thiazide diuretics

A

Indapamide
Chlortalidone
Hydrochlorothiazide

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10
Q

Action of thiazide diuretics

A

Inhibit Na+ Cl- symporter

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11
Q

Where does thiazide diuretics act on

A

Distal convoluted tubule

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12
Q

Effect of thiazide diuretics

A
  1. Decrease in Na+ reabsorption = more excretion of water
  2. Decrease in Na+ causes increase in Na+ Ca2+ anti porter activity (Ca2+ in Na+ out)-> increase Ca2+ into blood
  3. Potassium loss
  4. Loss of Cl-
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13
Q

Why does thiazide diuretics cause loss of potassium

A

Because less Na+ is absorbed, the body will try to compensate by increasing aldosterone secretion.
Aldosterone increases Na+ reabsorption in exchange for K+ excretion

Hence more K+ excreted

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14
Q

Loss of Cl- due to thiazide diuretics causes

A

Hypochloraemic metabolic alkalosis

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15
Q

Side effects of thiazide diuretics

A

Postural hypotension
Impaired glucose tolerance
Impotence
Hyponatraemia
Hypokalaemia
Hypercalcaemia
Gout

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16
Q

Why can thiazide diuretics be used to prevent recurrence of renal stones

A

Because it causes hypercalcaemia = hypocalciuria (more Ca2+ in blood)

17
Q

Thiazide diuretics is contraindicated in

A

renal failure
may worsen glycaemic control in diabetics
Lithium therapy

18
Q

Types of potassium sparing diuretics

A

Aldosterone antagonist
ENaC (epithelial Na+ channels) inhibitors

19
Q

Example of aldosterone antagonist

A

Spironolactone
Eplerenone

20
Q

Examples of ENaC inhibitors

A

Amiloride
Triamterene

21
Q

Aldosterone antagonists act on

A

Collecting duct - blocks expression of Na+/K+ ATPase (used by aldosterone to increase sodium reabsorption and K+ excretion)

22
Q

ENaC inhibitors act on

A

DCT

23
Q

Potassium sparing diuretics are contraindicated in

A

Addison’s disease
ACEi use

24
Q

Why is potassium sparing diuretics contraindicated in ACEi use

A

ACEi blocks aldosterone hence further decrease K+ secretion which can cause hypokalaemia

25
Q

Examples of osmotic diuretics

A

Mannitol
Isosorbide
Glycerine

26
Q

Where do osmotic diuretics act on

A

PCT
Loop of Henle
Collecting duct

27
Q

Side effects of osmotic diuretics

A

Cardiovascular toxicity immediately after injection

28
Q

Osmotic diuretic is contraindicated in

A

Heart failure

29
Q

Examples of carbonic anhydrase inhibitors

A

Acetazolamide
Dorzolamide

30
Q

Action of carbonic anhydrase inhibitors

A

Acts on proximal tubules to inhibit bicarbonate reabsorption

31
Q

Effect of carbonic anhydrase inhibitors

A

Reduces H2CO3 dissociating into HCO3- and H+ -> reduces Na+ reabsorption (because H+ was supposed to be excreted in exchange for reabsorption of Na+)

32
Q

Side effects of carbonic anhydrase inhibitors

A

Metabolic acidosis (H2CO3 is for acid base balance)
Renal stones

33
Q

Which drugs can interact with digoxin to cause toxicity

A

Loop and thiazide diuretics
Spironolactone
Amiodarone
Verapamil
Dilitiazem

34
Q

What happens in digoxin toxicity

A

Caused by hypokalaemia

Digoxin usually competes with K+ to bind to a transporter
Hypokalaemia = less competition = enhanced effect of digoxin

35
Q

Symptoms of digoxin toxicity

A

Unwell
Yellow-green vision
Anorexia
Arrhythmia - bradycardia / heart block
Confusion

36
Q

Management of digoxin toxicity

A

Digibind

Y2 Renal (12 decks)

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