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17. Clinical Pharmacology and Therapeutics > 18. Diuretics and Drugs in Kidney Failure > Flashcards

18. Diuretics and Drugs in Kidney Failure Flashcards

1
Q

What are the four roles of renal physiology?

A

Regulatory, excretory, endocrine, metabolism.

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2
Q

What are the regulatory factors of renal physiology?

A

Fluid balance, acid-base balance, electrolyte balance.

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3
Q

What are the excretory factors of renal physiology?

A

Waste products, drug eliminations - glomerular filtration and tubular secretion.

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4
Q

What are the endocrine factors of renal physiology?

A

Renin-angiotensin-aldosterone, erythropoetin, prostaglandins.

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5
Q

Where is angiotensinogen secreted?

A

The liver.

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6
Q

Where is renin secreted?

A

Renin.

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7
Q

What is the role of renin?

A

Converts angiotensinogen to angiotensin I.

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8
Q

What are the metabolic factors of renal physiology?

A

Vitamin D, polypeptides - insulin and PTH.

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9
Q

Where do carbonic anhydrase inhibitors act?

A

At the PCT.

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10
Q

What is the mechanism of action of carbonic anhydrase inhibitors?

A

Acts at PCT to prevent carbonic anhydrase in tubule, reabsorption of Na+ ions is affected.

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11
Q

What are carbonic anhydrase inhibitors used for?

A

Topical treatment for glaucoma.

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12
Q

What are the risks of using carbonic anhydrase inhibitors as diuretics?

A

Metabolic acidosis and hypokalaemia.

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13
Q

Name an osmotic diuretics.

A

Mannitol.

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14
Q

What is the mechanism of action of osmotic diuretics?

A

Increase osmotic gradient systemically.

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15
Q

What are the risks of osmotic diuretics?

A

Excessive water loss -> hypernatraemia.

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16
Q

What are osmotic diuretics currently used for?

A

Severe cerebral or pulmonary oedema.

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17
Q

What is the mechanism of action of ADH antagonists?

A

Reduce concentrating ability of urine in collecting ducts.

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18
Q

Name an ADH antagonist.

A

Lithium or demeclocycline.

19
Q

Name a loop diuretic.

A

Furosemide.

20
Q

What is the mechanism of action of loop diuretics?

A

Act on NKCC2 transporters on thick ascending limb of loop of Henle so directly prevent Na_ and Cl- reabsorption. Concurrent excretion of Ca2+ and Mg2+ too.

21
Q

What are the risks of loop diuretics?

A

Hypokalaemia.

22
Q

What are indications of use of loop diuretics?

A

Heart failure and liver failure.

23
Q

What are the DDIs for loop diuretics?

A

Aminoglycosides - risk of ototoxicity and nephrotoxicity. Digoxin or steroids - risk of hypokalaemia.

24
Q

What is the mechanism of action of thiazides?

A

Act on Na+-Cl- symporter and promote Ca2+ reabsorption.

25
Q

What are the ADRs of thiazides?

A

Hypokalaemia, hypercalcaemia, hyperuricaemia, risk of erectile dysunction.

26
Q

What are the indications of use of thiazides?

A

Heart failure and hypertension, also kidney stones (calcium reabsorption from urine)

27
Q

What are the DDIs for thiazides?

A

Digoxin or steroids - risk of hypokalaemia. B-blockers - risk of hyperglycaemia, hyperlipidaemia, hyperuricaemia.

28
Q

Name a potassium sparing diuretic.

A

Amiloride.

29
Q

What is the mechanism of action of potassium-sparing diuretics?

A

Act on ENaC channel in late DCT and collecting duct.

30
Q

What is the important DDI with potassium-sparing diuretics?

A

ACE inhibitors - risk of hyperkalaemia.

31
Q

Name a aldosterone antagonist.

A

Spironolactone, eplerenone.

32
Q

What is the mechanism of action of aldosterone antagonist?

A

Inhibit action of aldosterone on mineralocorticoid receptors so affect Na+K+ATPase and ENaC protein synthesis.

33
Q

What is the half life of spironolactone?

A

18-24 hours so can be used long term.

34
Q

What are the ADRs of aldosterone antagonists?

A

Hyperkalaemia, androgenic cross-reactivity -> gynaecomastia.

35
Q

What are the indications of aldosterone antagonists?

A

Heart failure, hypertension, liver failure, hyperaldosteronism.

36
Q

What are the general ADRs of any diuretic use?

A

Anaphylaxis/rash, hypovolaemia, hypotension, electrolyte disturbance, and metabolic abnormalities.

37
Q

What is the mechanism of action of digoxin?

A

Inhibits tubular NaKATPase.

38
Q

What is the mechanism of action of amiloride?

A

Inhibits Na channels in DCT/CD, K+ sparing.

39
Q

What can cause apparent diuretic resistance?

A

Incomplete treatment of primary disorder, continuation of high Na+ intake, non-compliance, poor absorption, volume depletion decreases filtration and increases aldosterone, NSAIDs can reduce renal blood flow.

40
Q

What are some key considerations of prescribing in chronic renal failure?

A

Avoid nephrotoxins if possible, reduce dosages, monitor renal function and drug levels, watch out for hyperkalaemia, uraemia patients may bleed.

41
Q

How is hyperkalaemia managed?

A

Identify cause, ECG, treat with drugs.

42
Q

Which drugs can treat hyperkalaemia?

A

Calcium gluconate, insulin/dextrose, calcium resonium, sodium bicarbonate, salbutamol.

43
Q

What are the features of hyperkalaemia on ECGs?

A

Tall tented T waves, QRS elongation, fewer P waves.

17. Clinical Pharmacology and Therapeutics (25 decks)

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