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Pharmocolgy > Diurectics > Flashcards

Diurectics Flashcards

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1
Q

What hormones are made in the kidney ?

A

renin, EPO, prostaglandins and Calcitriol

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2
Q

what does the kidney metabolise ?

A

Vit D, Polypeptides (insulin) , drugs such as morphine

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3
Q

how does mannitol work ?

what is the main side effect?

A

increases the Osmolarity of the lumen moving more water into the lumen
hypernatremia

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4
Q

where do loop diuretics work on ? what receptor?

A

thick ascending limb

NK2Cl receptor

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5
Q

why do loop diuretics cause hypokalaemia ?

A

increased Na+ delivery late in tubule leads to incresed K+ loss from ENaC related Na+ absorption

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6
Q

what are the main side effects of Loop diuretics ?

A

hyponatremia , hypocalaemia, hypokalaemia and metabolic alkalosis

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7
Q

how do thiazides work ?

A

block Na+/Cl- in DCT. not as potent

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8
Q

what are the side effects of thiazides ?

A

hypercalaemia , hypokalaemia , metabolic alkalosis

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9
Q

what is the action of aldosterone on the kidney?

A

up regulation of ENaCa and Na/K/ATPase in principal cells of CD

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10
Q

what does amiloride do ?

A

blocks ENaC in the CD

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11
Q

what does spironolactone do ? how is it K+ sparing ?

A

blocks aldosterone receptor in CD which allows K+ not to be released via ROMK channels

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12
Q

what do carbonic anhydrase diuretics do ?

A

block NaHCO3- reabsorption in PCT

can lead to acidosis

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13
Q

How does alcohol and caffeine cause diuresis ?

A

alcohol suppresses ADH

increased GFR and decreased Tubular Na+ reabsorption

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14
Q

name 2 ADH antagonists

A

lithium - only water laves = hypernatremia

Tolvaptan - used in hyponatraemia

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15
Q

what are the general ADRs of diuretics?

A

hypovalaemia and hypotension
AKI
electrolyte disturbances
anaphylaxis

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16
Q

what are side effects of thiazides ?

A

Gout, hyperglyceamia, ED , hypercalaemia , Increases LDL and TG

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17
Q

What are side effects of frusemide ?

A

alkalosis , ototoxicity , Gout

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18
Q

what are the side effects if spironolactone ?

A

hyperkalaemia, impotence and gynaecomastia

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19
Q

what diuretics used in hypertension ?

A

Thiazide (as they can vasodilate)

spironolactone

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20
Q

what diuretics used in HF?

A

Loop and spironolactone

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21
Q

what diuretic used in liver disease?

Study These Flashcards
A

spironolactone and loop

22
Q

what diuretic used in nephrotic syndrome ?

Study These Flashcards
A

loop diuretic

+/- thiazide or K+ sparing w/ K+ supplements

23
Q

what is difference between primary and secondary hyperalodosterism ?

Study These Flashcards
A

primary - low renin levels due to adrenal making too much aldosterone
secondary - high renin with hypotension due to body causing the adrenal glands to release too much aldosterone

24
Q

what diuretic used in CKD ?

Study These Flashcards
A

Loop diuretic - alkalosis and k+ excretion is good

avoid K+ Sparing

25
why can you build up a tolerance to diurectics in HF, Nephrotic syndrome and CKD ?
HF = Not enough blood circulating to deliver drug Nephrotic = not enough protein to bind drug to reduction in nephrons and OATs = CKD Gut oedema can also stop absorption
26
what are the steps you should take in refractory oedema ?
``` check salt intake IV furosemide tritrate dose give repeated bolus need higher doses in HF ```
27
why do thiazides cause hypo natraemia and kalamia the most ?
they work on the top bit of the nephron on the DCT so less like lt to affect the conc gradient so less water is lost compared to loop diuretic
28
Name 3 nephrotoxic drugs drugs shouldn't be used in Renal dysfunction
Aminoglycosides - Gentamicin IV Vancomyosin Aciclovir NSAIDs ACE-i , diuretic, NSAIDs, metformin
29
what happens in renal artery stenosis to AA and EA?
AA- dilates due to prostacyclin | EA- Constricts , ANG2
30
What do NSAIDs and ACE-i do on the kidney ?
NSAIDs stop PGs = less dilation of AA | ACE-I stop ANG2 Which stops constriction
31
what drugs should you be careful with in CKD?
Digoxin , heparin , gentamicin , opiates , cyclosporin
32
what is the management of hyperkalaemia ?
Calcium gluconate - heart protection insulin/dextrose calcium resonium
33
what are the general ADRs of diuretics?
hypovalaemia and hypotension AKI electrolyte disturbances anaphylaxis
34
what are side effects of thiazides ?
Gout, hyperglyceamia, ED , hypercalaemia , Increases LDL and TG
35
What are side effects of frusemide ?
alkalosis , ototoxicity , Gout
36
what are the side effects if spironolactone ?
hyperkalaemia, impotence and gynaecomastia
37
what diuretics used in hypertension ?
Thiazide (as they can vasodilate) | spironolactone
38
what diuretics used in HF?
Loop and spironolactone
39
what diuretic used in liver disease?
spironolactone and loop
40
what diuretic used in nephrotic syndrome ?
loop diuretic | +/- thiazide or K+ sparing w/ K+ supplements
41
what is difference between primary and secondary hyperalodosterism ?
primary - low renin levels due to adrenal making too much aldosterone secondary - high renin with hypotension due to body causing the adrenal glands to release too much aldosterone
42
what diuretic used in CKD ?
Loop diuretic - alkalosis and k+ excretion is good | avoid K+ Sparing
43
why can you build up a tolerance to diurectics in HF, Nephrotic syndrome and CKD ?
HF = Not enough blood circulating to deliver drug Nephrotic = not enough protein to bind drug to reduction in nephrons and OATs = CKD Gut oedema can also stop absorption
44
what are the steps you should take in refractory oedema ?
``` check salt intake IV furosemide tritrate dose give repeated bolus need higher doses in HF ```
45
why do thiazides cause hypo natraemia and kalamia the most ?
they work on the top bit of the nephron on the DCT so less like lt to affect the conc gradient so less water is lost compared to loop diuretic
46
Name 3 nephrotoxic drugs drugs shouldn't be used in Renal dysfunction
Aminoglycosides - Gentamicin IV Vancomyosin Aciclovir NSAIDs ACE-i , diuretic, NSAIDs, metformin
47
what happens in renal artery stenosis to AA and EA?
AA- dilates due to prostacyclin | EA- Constricts , ANG2
48
What do NSAIDs and ACE-i do on the kidney ?
NSAIDs stop PGs = less dilation of AA | ACE-I stop ANG2 Which stops constriction
49
what drugs should you be careful with in CKD?
Digoxin , heparin , gentamicin , opiates , cyclosporin
50
what is the management of hyperkalaemia ?
Calcium gluconate - heart protection insulin/dextrose calcium resonium

Pharmocolgy (22 decks)

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