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2.4.2. Clinical Pharmacology > Diuretics and Renal Pharmacology > Flashcards

Diuretics and Renal Pharmacology Flashcards

1
Q

Outline the key aspects renal physiology

A

R – regulatory = fluid balance, acid-balance balance, electrolyte balance

E – excretory = waste products, drug elimination (glomerular filtration, tubular secretion)

E – endocrine = renin, EPO, prostaglandins, 1-alpha calcidol

M – metabolism = vit D, insulin, drugs

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2
Q

Which drugs can act on the renal tubules?

A

Carbonic anhydrase inhibitors

Osmotic Diuretics

Loop Diuretics

Thiazides

Potassium sparing diuretics

Aldosterone antagonists

ADH Antagonists

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3
Q

Outline Na handling in the kidney

A
  • PCT = Na/H transporter, Na/co-transporters, 65% Na reabsorbed
  • TALLH = NKCC2, 25% Na reabsorbed
  • DCT = NCCT, 5% Na reabsorbed
  • CD = ENaC, aldosterone effects
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4
Q

Discuss carbonic anhydrase inhibitors

A

PCT

If you block this you just get more reabsorption downstream so not particularly effective at blocking Na

Also blocking bicarb reabsorption (promote acidosis)

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5
Q

Outline Loop diuretics

A

TALLH

Block NKCC2

Block 25% Na reabsorption

Very effective for getting rid of excess fluid

Are used in hypercalcemia pts – due to concurrent Ca/Mg excretion

Furosemide

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6
Q

Outline Osmotic agents

A

Hold water in filtrate

Glucose, urea

Drug = mannitol – stops reabsorption of water

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7
Q

Discuss Thiazide diuretics

A

DCT

Block 5% Na reabsorption

Effect K – due to ENaC

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8
Q

Discuss Aldosterone antagonists

A

CT

Inhibits ENaC

Spironolactone

Bind intracellular aldosterone receptor = decreases expression of ENaC + Na/K/ATPase in principle cells

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9
Q

Outline ADH antagonists

A

Effects free water reabsorption – most pts polyuric and dehydrated

Lithium

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10
Q

Explain alcohols diuretic action

A

Inhibits ADH release

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11
Q

How does caffeine increase water loss?

A

Increases GFR, decreases tubular Na reabsorption

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12
Q

What adverse drug reactions can take place when using diuretics?

A

Anaphylaxis

Hypovolaemia/hypotension

Electrolytic disturbance

Metabolic abnormalities

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13
Q

Outline the possible drug interactions

A

ACEi/K sparing diuretic = hyperkalaemia = cardiac arrythmia

Aminoglycosides/loop diuretics = nephrotoxicity

Beta blockers/thiazide diuretics = hyperglycemia

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14
Q

Outline the use of diuretics in hypertension

A

Thiazide diuretics (vasodilatation as well as diuresis)

Spironolactone

Loop diuretics

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15
Q

Outline the use of diuretics in heart failure

A

Loop diuretics

Spironolactone

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16
Q

What diuretics are used in liver disease?

A

Loop diuretics

Spironolactone

17
Q

What diuretics are used in nephrotic syndrome?

A

Loop diuretics

+/- thiazides

+/- potassium-sparing diuretic / potassium supplements

18
Q

What diuretics are used in CKD?

A

(Decreased GFR leads to salt and water retention)

Loop diuretics

+/- thiazide-like

Generally avoid K+-sparing diuretics

19
Q

What should be checked in refractory oedema?

A

= does not respond to Na deitary restriction + diuretics

Check salt intake (24 hour Na excretion if necessary)

Give furosemide iv if gut oedema likely

Find minimum effective dose

Give repeated bolus or infusion (short t1/2)

20
Q

Why do thiazides cause hyponatraemia and hypokalaemia?

A

Relates to the concentrating gradient down the kidney

25% Na reabsorbed from TAL – to interstitium = hypertonic interstitum

Thiazides block 5% Na reabsorbed in DCT = hypertonic medulla interstitum

As you become hypovolemic = RAAS, ADH activated

ADH more affective if hypertonic = now absorbing water

21
Q

Outline the problems of prescribing in renal failure

A

Drugs may reduce kidney function by direct or indirect toxicity

Drugs may accumulate to toxic levels if they are excreted through the kidneys and renal function is impaired

22
Q

What drugs are potentially nephrotoxic?

A

Aminoglycosides: e.g gentamicin

Vancomycin (intravenous only)

Aciclovir

NSAIDs

23
Q

Name some drugs that can cause problems with renal dysfunction

A

ACE-Inhibitors

Diuretics

NSAIDs

Metformin – can make you acidotic

24
Q

How do NSAIDs affect renal perfusion?

A

Inhibits PG vasodilation at AA

25
Q

How do ACEi/ARB affect renal perfusion?

A

Inhibits Ang II vasoconstriction at EA

26
Q

What are the causes of hyperkalaemia?

A

Excess intake

Movement out of cels = acidosis, hypetonicity, tissue damage

Reduced urine loss = reduced GFR, reduced secretion in CD

Drugs = RAASi, NSAIDs, ENaC blockers

27
Q

How is hyperkalaemia managed?

A

Identify cause

ECG

Treatment:

1) protect heart = calcium gluconate
2) lower serum K+ = insulin/dextrose
3) remove K+ from body = Ca resonium

2.4.2. Clinical Pharmacology (27 decks)

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