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Pharmacology 1 > drugs that act on the kidney > Flashcards

drugs that act on the kidney Flashcards

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1
Q

what is the role of the kidney?

A

to balance salts and fluid in body

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2
Q

describe the path of water through the kidney

A
  • glomerulus
  • proximal tubule
  • loop of henle
  • distal tubule
  • collecting duct
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3
Q

what are diuretics?

A

drugs taht increase the amount of fluid and salts excreted by the kidneys

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4
Q

what are the main uses of diuretics?

A
  • oedema - fluid collection in tissue
  • hypertension - high BP
  • glaucoma - decreases fluid pressure in the eye (intraocular pressure)
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5
Q

how do diuretics help to treat oedema?

A

by increasing urine production → this draws fluid from swollwn areas of tissue thus reducing swelling

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6
Q

how do diuretics help to treat hypertension?

A
  • increase urine production
  • decrease blood volume
  • decrease blood pressure
  • decrease pressure on blood vessels
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7
Q

name three ways in which salts and water move

A
  1. active transport - via pumps
  2. passive transport - via channels
  3. osmosis
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8
Q

name three ‘pumps’ within the body which move salts - what is required for this to occur?

A
  1. sodium/potassium (Na+/K+pump)
  2. sodium/chloride (Cl- pump)
  3. sodium/ potassium / chloride (Na+/K+/ Cl- pump)

* all use energy to move salts

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9
Q

what are channels? and do they require energy?

A

channels are ion selective openings in the cell membrane - no energy required

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10
Q

what is the osmotic effect?

A

where salts go water follows

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11
Q

name the three classes of diuretic

A
  1. thiazide and related diuretics
  2. potassium sparing diuretics
  3. loop diuretics
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12
Q

what is the site of action for thiazide and related duiretics?

A

distal convoluted tubule

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13
Q

what are the clinical uses of thiazide and related diuretics?

A
  1. oedema
  2. hypertension - long term
  3. mild heart failure
  4. liver and kidney disease
  5. steriod/hormone treatment
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14
Q

name two thiazide diuretics

A
  1. bendroflumethazide
  2. cyclopenthiazide (navidrex®)
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15
Q

name four thiazide related diuretics

A
  1. metolazone (metenix®)
  2. chlortalidone (hygroton®)
  3. indapamide (natrilix®)
  4. xipamide (duirexan®)
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16
Q

where are thiazide and related diuretics metabolised and excreted?

A

metabolised - liver

excreted - kidneys

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17
Q

describe the mechanism of action of thiazide and related diuretics

A
  • blocks chloride pump
  • increases excretion of sodium and chloride
  • increases excretion of potassium (due to sodium exchangeof potassium in collecting ducts via ion channels)
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18
Q

what is the potency of thiazide and related diuretics?

A

moderate

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19
Q

what % of filtered sodium is excreted due to thiazide diuretics?

20
Q

when taking thiazide diuretics how much is the urine flow increased by?

Study These Flashcards
A

from 1ml/per/min to 3ml/per/min

21
Q

how long do thiazide diuretics take to act and what is the duration of action?

Study These Flashcards
A

acts within 1-2hrs

duration of action 24hrs

22
Q

what are the side effects associated with taking thiazide diuretics?

Study These Flashcards
A
  • hypokalemia
  • hypocalcemia
  • hyperuricemia - high uric acid
  • hyperglycemia
23
Q

what is the site of action of loop diuretics?

Study These Flashcards
A

ascending loop of henle

24
Q

what are the clinical uses of loop diuretics?

Study These Flashcards
A
  1. oedema
  2. hypertension
  3. severe heart failure
  4. acute ventricular failure (pulmonary oedema)
25
give three examples of loop diuretics
1. furosemide (lasix®) 2. bumetanide (burinex®) 3. torasemide (torem®)
26
where are loop diuretics metabolised and excreted?
metabolised - liver excreted - urine
27
describe the mechanism of action of loop diuretics
* blocks sodium /potassium /chloride pump * increases excretion of: * sodium * chloride * potassium - exchange with sodium in collecting ducts
28
what are the side effects of loop diuretics?
* hypokalemia * hpocalcemia * hpyeruricema * hyperglycemia * deafness - very high dose IM, IV dosing (8th cranial nerve damage)
29
what % of filtered sodium is excreted when using loop diuretics?
very powerful - 30% filtered sodium excreted
30
what is the increase in urine flow when taking loop diuretics?
from 1ml/per/min to 8ml/per/min
31
how long do loop diuretics take to act and how long do they work?
act within 1hr work for 6hrs
32
when should loop diuretics be given?
upto twice daily (morning and before 4pm)
33
what is the site of action of potassium sparing diuretics?
late distal tuble and collecting duct
34
what are the clincal uses of potassium sparing diuretics?
1. oedema - heart failure/live disease 2. hypertension 3. hypokalemia - caused by loop or thiazide diuretics 4. primary hyperaldosteronism (Conn's syndrome)- use spironolactione only
35
name four potassium sparing diuretics
1. spironolactone (aldactone®) 2. eplerenone (inspra®) _aldosterone antagonists_ 1. amiloride 2. trimterene (dytac®) _sodium channel blockers_
36
where are potassium sparing diuretics metabolised and excreted?
metabolised - liver excreted - urine and bile
37
what is the mechanism of action of potassium sparing diuretics?
* increased sodium and water excretion * chloride and calcium also excreted * decreased excretion of potassium and H+
38
how much filtered sodium is excreted when using potassium sparing diuretics?
fairly weak diuretic - 5% of filtered sodium excreted
39
what are the side effects of using potassium sparing diuretics?
hyperkalaemia - low potassium diet required close monitoring of electrolyte levels - especially with ACE inhibitors, angiotensin receptor antagonists and beta adrenoceptor anatagonists
40
what is the site of action for antidiuretic drugs?
collecting tubules
41
what are the clinical uses of antidiuretics?
central diabetes insipidus (lack of ant-diuretic hormone
42
what is the mechanism of action of antidiuretics?
* released from posterior pituitary gland * increases no. of water channels in V2 receptors * increases passive reabsorption of water
43
name two antidiuretic drugs
1. vasopressin 2. desmopressin
44
describe the action, administeration and use of vasopressin
* very short acting * injection/infusion only * increases blood pressure (V1 receptors in smooth muscle)
45
describe the action, administeration and use of desmopressin
* longer duration of action * nasal spray or tablets * no effect on blood pressure (V2 receptors - selective) \*dose needs to be balanced to avoid H2O intoxication
46
what information must be gathered before and during administeration of diuretics?
* patient history - allergies, meds, organ impairment * administer in morning * check urine output * monitor weight * monitor serum electrolytes * check oedema/congestion is reducing * check BP - hypotension * diet - rich/low in potassium and low in sodium

Pharmacology 1 (11 decks)

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