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Yr 2 Sem 2 CPT > 4.1 Diuretics and Renal Pharmacology > Flashcards

4.1 Diuretics and Renal Pharmacology Flashcards

(53 cards)

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1
Q

What is the renal physiology mnuemonic?

A

Regulatory
Excretory
Endocrine
Metabolism

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2
Q

What are the regulatory functions of the kidney?

A

Fluid balance
Acid-base balance
Electrolyte balance

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3
Q

What are the excretory roles of the kidney?

A

Excretion of

  • Waste products
  • Drugs (glomerular filtration, tubular secretion)
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4
Q

What are the endocrine roles of the kidney?

A

Renin
Erythropoietin
Prostaglandins
1-alpha calcidol

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5
Q

What is the role of 1-alpha calcidol?

A

To hydroylate vitamin D

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6
Q

What is metabolised by the kidney?

A

Vitamin D
Polypetides - insulin
Drugs - morphine, paracetamol

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7
Q

Why may a diabetic present with hypoglycaemia when they have kidney damage?

A

Insulin is metabolised int he kidney

If they have kidney damage then insulin will stay in the body of longer

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8
Q

What is diuresis?

A

Loss of water

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9
Q

What word describes loss of sodium?

A

Natriuresis

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10
Q

What does aldosterone do?

A

Increases expression of ENaC and Na/K/ATPase in the principle cells of CD

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11
Q

Name two substances with diuretic action

A

Alcohol

Caffeine

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12
Q

How does alcohol act as a diuretic?

A

Inhibits ADH release

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13
Q

How does caffeine act as a diuretic?

A

Increase GFR
Decrease tubular Na reabsorption

Can become habituated to it

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14
Q

Name two ADH antagonists

A

Lithium

Tolvaptan

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15
Q

How does lithium work?

A

Inhibits action of ADH

Diuretic but not natriuretic

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16
Q

Is tolvaptan a natriuretic?

A

No

It is a diuretic though

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17
Q

What is tolvptan used to treat?

A

Hyponatraemia

Prevent cyst enlargement in APCKD

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18
Q

What are some generic adverse drug reactions to diuretics?

A 
Anaphylaxis/photosensitivity rash 
Hypovolaemia and hypotension 
- Activates RAAS and can lead to acute kidney injury 
Electrolyte disturbance 
Metabolic abnormalities
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19
Q

Name some diuretics

A

Thiazides
Furosemide
Spironolactone
Bumetanide

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20
Q

Name some common specific ADRs to thiazides

A 
Gout
Hyperglycaemia 
Erectile dysfunction 
Increase LDL and TG 
Hypercalcaemia
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21
Q

Name some common specific ADRs to furosemide

A

Ototoxicity
Alkalosis
Increase LDL and TG
Gout

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22
Q

Name some common specific ADRs to spironolactone

Study These Flashcards
A

Hyperkalaemia
Impotence
Painful gynaecomastia

23
Q

Name a common specific ADR to bumetanide

24
Q

Name some uses for diuretics

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A 
Hypertension 
Heart failure 
Decompensated liver disease 
Nephrotic syndrome 
Chronic kidney disease
25
Which diuretics could be used to treat hypertension?
Thiazides (also vasodilate) Spironolactone Loop diuretics (short duration of action so only work well in people with renal failure)
26
Which diuretics can be used to treat HF?
Loop diuretics | Spironolactone (Remodelling of heart)
27
Which drugs can be used for decompensated liver disease?
Spironolactone | Loop diuretics
28
Which diuretics can be used to treat nephrotic syndrome?
Large dose of loop diuretic | +/- thazides and potassium sparing diuretic/K supplements
29
What diuretics can be used to treat CKD?
``` Loop diuretics (+/- thiazides) Avoid K sparing ```
30
Why may someone with CKD need a diuretic?
Decreased GFR leads to salt and water retention
31
What three types of patient may have diuretic resistance? | Why?
Chronic renal failure - Less nephrons working Nephrotic syndrome - oedematous so gut doesn't absorb as well, low albumin Heart failure - Less delivery to kidney
32
Where are diuretics absorbed?
In the gut
33
What do diuretics bind to in the body?
Albumin
34
Why may a patient develop diuretic resistance if they have acute tubular necrosis?
Diuretics are bound to albumin so can't cross the glomerulus Transported by OATs in proximal tubule Proximal tubule won't work well in acute TN
35
What action should be taken in refractory oedema?
Check salt intake Give furosemide IV is gut oedema likely Find minimum effective dose Five repeated bolus or infusion as short half life
36
Why do thiazides cause hyponatraemia and hypokalaemia?
Work in cortex so dont affect medullary interstitial concentration Block sodium reabsorption and water -> hypovolemic -> activate RAAS But water is resorbed because there is still a hypertonic interstitium so ADH still works
37
What are carbonic anhydrase inhibitors used for?
Glaucoma | Altitude sickness
38
Why are carbonic anhydrase inhibitors not used for a diuretic?
Because the rest of the nephron would compensate | Would only end up losing bicarbonate
39
What are osmotic diuretics used for?
Reduce high intracerebral pressure
40
What are loop diuretics used for?
Oedema | Hypertension in CKD
41
What are thiazides used for?
Hypertension
42
What are potassium sparing diuretics used for e.g. amiloride?
Low potassium where diuretic required | May cause hyperkalaemia
43
What are aldosterone antagonists used for?
HF Ascites Hypertension Hyperadrenalism - block effect of aldosterone
44
What are ADH antagonists used for?
Hyponatraemia
45
Name some potentially nephrotoxic drugs
Aminoglycosides eg gentamicin Vancomycin IV Aciclovir NSAIDs
46
Name some drugs that can cause problems with renal dysfunction
ACE inhibitors Diuretics NSAIDs
47
What is the problem with metformin in people with renal dysfunction?
Metformin is not nephrotoxic but is acidotic Impaired renal function can already lead to acidosis So it is adding acidosis to already acidosis
48
How do NSAIDs affect renal perfusion?
Decrease GFR by stopping vasodilation of the afferent arteriole by prostaglandins
49
How do ACE inhibitors affect renal perfusion?
Decrease GFR by stopping AngII from vasoconstriction the efferent arteriole
50
What are two major risk factors for hyperkalaemia?
Increased catabolism/tissue damage | Reduced urine production
51
What initial ECG changes can be seen in hyperkalaemia?
Tall T waves
52
What on an ECG would indicate severe hyperkalaemia?
Sine waves
53
Outline the treatment of hyperkalaemia
1) Protect the heart - calcium gluconate 2) Lower serum K - insulin/dextrose 3) Remove K from body - Calcium resonium

Yr 2 Sem 2 CPT (9 decks)

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