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MET2 > 29 - Diuretics > Flashcards

29 - Diuretics Flashcards

1
Q

What are diuretics

A

Diminish sodium re-absorption at different sites of the nephron –> Increase Na and H20 loss –> decrease in blood volume

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2
Q

What percent of bloody supply do kidneys receive

A

25%

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3
Q

How much do the kidneys filtrate a day

A

120ml/min

180L filtrate a day

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4
Q

What are they classes of diuretic

A 
Carbonic anhydrase inhibitors
Loop
Thiazide
Potassium sparing diuretics - prevents excess K+ excretion
Osmotic diuretics
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5
Q

Where do carbonic anhydrase inhibitors act on

A

Proximal convulated tubule

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6
Q

How do carbonic anhydrase inhibitors work

A

CA is needed to absorb bicarb so that Na+ can be reabsorbed

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7
Q

Example of CA inhibitor

A

Acetazolamide

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8
Q

What is acetazolomide used for

A

Glaucoma
Epilepsy
Mountain Sickness (it can appose the alkalosis with acidosis)

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9
Q

Side effects of CA inhibitors

A 
Metabolic acidosis (contraindicated in chronic kidney disease)
Sedation
Sulphonamide antibiotics (bone marrow suppression)
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10
Q

Examples of loop diuretics

A

Frusemide

Bumetanide

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11
Q

Where do loop diuretics act

A

Thick ascending limb (Na/K/2Cl symporter)

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12
Q

What do loop diuretics act on

A

Block the Cl- portion of the symporter

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13
Q

What do loop diuretics cause to be excreted

A 
K+
Na+
H2O
Ca2+
Mg
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14
Q

Indications of loop diuretics

A

Hypertension
Heart failure
Volume overload for CKD

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15
Q

Side effects of loop diuretics

A

Hypokalaemia

Dehydration –> acute renal failure, kidney stones, deafness

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16
Q

Where do thiazide diuretics act on

A

Distal convulated tubule

17
Q

What is the mechanism of thiazide diuretics

A

Inhibits Na and Cl- from urine to tubule

Acts on Na+/Cl- symporter

18
Q

Examples of thiazide diuretics

A

Bendroflumethiazide

Hydrochlorothiazide

19
Q

Thiazide like like drugs

A

Chlothalidone
Indapamide
Metolazone

20
Q

How does thiazide diuretics act as a hypertensive

A

Reduces plasma volume and peripheral resistance

21
Q

Side effects of thiazide diuretics

A

Hypokalaemia, hypercalcaemia, hyponatraemia, hyperglycaemia, hypercholesterolaemia

22
Q

What do potassium sparing diuretics do

A

Prevent excess K+ excretion

23
Q

Type of potassium sparing diuretics

A

Epithelial Na Channel antagonists (ENaC)

Aldosterone antagonists

24
Q

Examples of ENaC antagonists

A

Amiloride, Triamterene

25
Q

Where does ENaC act on and what does it do

A

Acts on collecting ducts/late DCT

prevents Na into cell from urine

26
Q

Amiloride uses

A

Heart Failure
Hypokalaemia
Cirrhosis

27
Q

Amiloride side effects

A

Hyperkalaemia

Hyponatraemia

28
Q

Aldosterone antagonists

A

Spironolactone

Eperenone

29
Q

Where do aldosterone antagonist work

A

Collecting tubule

30
Q

What do aldosterone antagonists do

A

Inhibit aldosterone which normally upregulates Na+/K+ on basolateral membrane of intercalated cells

31
Q

Indications for aldosterone antagonists

A

Hyperaldosteronism (Conns)
Heart failure
Hypokalaemia
Cirrhosis

32
Q

SE of aldosterone antagonissts

A

Hyperkalaemia
Gynecomastia
Hyponatraemia

33
Q

What are osmotic diuretics

A

Any osmotically active molecule that is freely filtered in the glomerulus and is not reabsorbed by the tubules

34
Q

Example of osmotic diuretic

A

Mannitol IV - fast acting, fast metabolism

35
Q

What does mannitol do

A

Increase osmolality in the tubular lumen – stops water absorption

36
Q

MoA of osmotic diuretics

A

Reduces re absorption of all solutes (Na, K+,urea, drags Na from interstitium)

37
Q

Indications of osmotic diuretics

A

Cerebral oedema

Oliguric acute renal failure

38
Q

Side effects of osmotic diuretics

A

Transient fluid overload

Urea (disequilibrium syndrome)

39
Q

When to not use diuretics

A 
When hypotensive
When dehydrated
When hypokalaemic (Loop/Thiazide)
When hyperkalaemic (Amiloride, aldosterone antagonists)
Post surgery, with a poor urine output

MET2 (28 decks)

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