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Medications Used for the Renal System

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Abstract

This chapter examines the commonly prescribed drugs used for the treatment and management of certain clinical conditions that alter the excretory functions of the kidneys. The drugs reviewed include those that affect water and sodium losses such as diuretics as well as drugs that alter the pH of the urine (alkalizing agents), for example, sodium and potassium citrate and ammonium chloride. These drugs are reviewed in relation to their pharmacokinetics, mechanism of action, clinical indications, contraindications, drug–drug interactions and unwanted effects. The clinical uses of these drugs are reviewed in the context of the management of what is termed volume overload, hypertension and heart failure.

Keywords

  • Carbonic anhydrase inhibitors
  • Osmotic diuretics
  • Loop diuretics
  • Thaizide diuretics
  • Potassium-sparing diuretics
  • Combined diuretics

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  • DOI: 10.1007/978-3-030-32004-1_8
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References

  • Ashley C, Dunleavy A (2014) The renal handbook, 4th edn. Radcliffe, London

    Google Scholar 

  • Aung T, Laganovska G, Hernandez Paredes TJ, Branch JD, Tsorbatzoglou A, Goldberg I, Franco AM (2014) Twice-daily brinzolamide/brimonidine fixed combination versus brinzolamide or brimonidine in open-angle glaucoma or ocular hypertension. Ophthalmology 121(12):2348–2355

    CrossRef  Google Scholar 

  • Bennett S (2008) Diuretics: use, actions and prescribing rationale. Nurs Prescrib 6(2):72–77

    CrossRef  Google Scholar 

  • Braunwald E (2014) Responsiveness to loop diuretics in heart failure. Eur Heart J 35:1235–1237

    CrossRef  Google Scholar 

  • Domanski M, Norman J, Pitt B, Haigney M, Hanlon S, Peyster E (2003) Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 42(4):705–708

    CAS  CrossRef  Google Scholar 

  • Edwin K (2006) Diuretics. In: Brunton LL et al (eds) Goodman & Gilman’s the pharmacological basis of therapeutics, 11th edn. McGraw-Hill, New York

    Google Scholar 

  • Felker GM, O’Connor CM, Braunwald E (2009) Loop diuretics in acute decompensated heart failure-necessary? Evil? A necessary. Circ Heart Fail 2(1):56–62

    CrossRef  Google Scholar 

  • Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR (2011) Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364:797–805. https://doi.org/10.1056/NEJMoa1005419

    CAS  CrossRef  Google Scholar 

  • Ives HE (2009) Diuretic agents. Chapter 15. In: Katzung’s basic and clinical pharmacology, 11th edn, McGraw-Hill/Lange, New York. ISBN: 978-0-07-160405-5

    Google Scholar 

  • Jansena PM, Frenkelb WJ, van den Bornb BH, de Bruijnec ELE, Deinumd J, Kerstense MN, Arnoldusf JHA, Woittiezg AJ, Wijbengah JAH, Zietsea R, Jan Dansera AH, van den Meiracker AH (2013) Determinants of blood pressure reduction by Eplerenone in uncontrolled hypertension. J Hypertens 31(2):404–413

    CrossRef  Google Scholar 

  • Kaufman G (2013) Prescribing and medicines management in older people. Nurs Older People 25(7):33–41

    CrossRef  Google Scholar 

  • Klabunde RE (2015) Cardiovascular pharmacology concepts. Diuretics. http://www.cvpharmacology.com/diuretic/diuretics. Accessed 20 Feb 2015

  • Kushner FG, Hand M, Smith SC Jr, King SB III, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE Jr, Green LA, Jacobs AK, Hochman JS, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO (2009) 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Catheter Cardiovasc Interv 74(7):E25–E68

    CrossRef  Google Scholar 

  • Musini VM, Nazer M, Bassett K, Wright JM (2014) Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev (5):CD003824

    Google Scholar 

  • Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, AJS C, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200

    CrossRef  Google Scholar 

  • Reilly RF, Jackson EK (2010) Chapter 25: regulation of renal function and vascular volume. In: Goodman & Gilman’s the pharmacological basis of therapeutics, 12th edn. Laurence L. Brunton, La Jolla, CA

    Google Scholar 

  • Ronco C, McCullough PA, Anker SD, Anand I, Aspromonte N, Bagshaw SM, Bellomo R, Berl T, Bobek I, Cruz DN, Daliento L, Davenport A, Haapio MH, House AA, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P (2009) Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 31(6):703–711

    CrossRef  Google Scholar 

  • Roush GC, Sica DA (2016) Diuretics for hypertension: a review and update. Am J Hypertens 29(10):1130–1137

    CAS  CrossRef  Google Scholar 

  • Shawkat H, Westwood M, Mortimer A (2012) Mannitol: a review of its clinical uses continuing education in anaesthesia, critical care & pain. Br J Anaesth 12(2):82–85

    Google Scholar 

  • Snigdha M, Kumar SS, Deepa K, Lalit S, Tanuja S (2013) Review on recent advances in a modern day treatment: diuretic therapy. Int Res J Pharm 4(6):25–30

    CrossRef  Google Scholar 

  • Sugrue MF (2000) Pharmacological and ocular hypotensive properties of topical carbonic anhydrase inhibitors. Prog Retin Eye Res 19(1):87–112

    CAS  CrossRef  Google Scholar 

  • Wargo KA, Banta WM (2009) A comprehensive review of loop diuretics: should Furosemide be the first choice? Ann Pharmacol 43(11):1836–1847

    CAS  CrossRef  Google Scholar 

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Correspondence to Roseline Elsie Agyekum .

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Appendices

Multiple Choice Questions

  1. 1.

    A 35-year-old patient has been admitted to your ward with mild hypertension. Her blood pressure during observations was 145/95 mmHg; there is no other clinically significant complaint. She is otherwise physically fit and adheres to a dietary regimen. She was prescribed antihypertensive drugs on admission, and chlorothiazide was added to her medications. How does this diuretic cause action and effect?

    1. (a)

      Inhibition of sodium and chloride reabsorption in the early distal convoluted tubule

    2. (b)

      Decreases net excretion of chloride, sodium and potassium

    3. (c)

      Increases calcium excretion

    4. (d)

      Inhibits reabsorption of sodium chloride in the thick ascending loop of Henle

    5. (e)

      Interferes with potassium secretion

  2. 2.

    A person presented at A&E with complaints of sharp pain in his flanks and dysuria is admitted to the ward with a diagnosis of idiopathic hypercalcaeuria. What is the common type of medication used for the condition?

    1. (a)

      Loop diuretics

    2. (b)

      Carbonic anhydrase inhibitors

    3. (c)

      Thiazide diuretics

    4. (d)

      Potassium-sparing diuretics

    5. (e)

      Osmotic diuretics

  3. 3.

    A 45-year-old patient with a history of medication-controlled hypertension has been readmitted to the ward with a left painful swollen big toe. A provisional diagnosis of gout has been made. A laboratory analysis of blood requested this morning revealed raised uric acid levels. From the list of his medication below, which of them might be a contributory factor for his current symptoms?

    1. (a)

      Acetazolamide

    2. (b)

      Amiloride

    3. (c)

      Mannitol

    4. (d)

      Hydrochlorothiazide

    5. (e)

      Spironolactone

  4. 4.

    A patient diagnosed with a first episode of congestive heart failure secondary to alcoholic cardiomyopathy has been admitted to the ward. The cardiologist has recommended the inclusion of a diuretic as part of the routine medications, which of the following is the preferred diuretic for this patient?

    1. (a)

      Loop diuretics due to their action at the distal convoluted tubule

    2. (b)

      Thiazide diuretics due to their effect on the thick ascending limb of the loop of Henle

    3. (c)

      Loop diuretics due to its high capacity for sodium chloride reabsorption

    4. (d)

      Thiazide diuretics because they increase peripheral vascular resistance

    5. (e)

      Thiazide diuretics because they increase cardiac output

  5. 5.

    A patient admitted with myocardial infarction develops respiratory distress. Upon assessment by the medical team, flash pulmonary oedema secondary to myocardial infarction was confirmed. Furosemide was included as part of the pharmacological management. What is the mechanism of action of this diuretic?

    1. (a)

      Furosemide inhibits the action of aldosterone

    2. (b)

      It inhibits bicarbonate and sodium reabsorption

    3. (c)

      Furosemide inhibits active reabsorption of sodium chloride at the distal convoluted tubule

    4. (d)

      It alters the diffusion of water relative to sodium and hence reduces sodium reabsorption

    5. (e)

      Furosemide inhibits active reabsorption of sodium chloride at the thick ascending loop of Henle

  6. 6.

    Which of the following diuretic cause dizziness and tinnitus?

    1. (a)

      Spironolactone

    2. (b)

      Mannitol

    3. (c)

      Furosemide

    4. (d)

      Amiloride

  7. 7.

    Which of the following might not be prescribed for the patient taking potassium supplements?

    1. (a)

      Furosemide

    2. (b)

      Amiloride

    3. (c)

      Mannitol

    4. (d)

      Hydrochlorothiazide

  8. 8.

    Which of the below mentioned drug produce its action by competitively inhibiting the sodium-potassium-chloride cotransporter?

    1. (a)

      Loop diuretics

    2. (b)

      Thiazide diuretics

    3. (c)

      Inhibitors of carbonic anhydrase

    4. (d)

      Potassium-sparing diuretics

  9. 9.

    Which diuretic drug produces its action by acting on proximal tubules?

    1. (a)

      Thiazide diuretics

    2. (b)

      Potassium-sparing diuretics

    3. (c)

      Loop diuretics

    4. (d)

      Inhibitors of carbonic anhydrase

  10. 10.

    Which of the below mentioned diuretic drug produce its action by acting on distal convoluted tubule?

    1. (a)

      Carbonic anhydrase inhibitors

    2. (b)

      Thiazide diuretics

    3. (c)

      Loop diuretics

    4. (d)

      Potassium-sparing diuretics

Answers

  1. 1.

    a

  2. 2.

    c

  3. 3.

    e

  4. 4.

    c

  5. 5.

    e

  6. 6.

    d

  7. 7.

    b

  8. 8.

    a

  9. 9.

    d

  10. 10.

    b

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Agyekum, R.E. (2020). Medications Used for the Renal System. In: Hood, P., Khan, E. (eds) Understanding Pharmacology in Nursing Practice . Springer, Cham. https://doi.org/10.1007/978-3-030-32004-1_8

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  • DOI: https://doi.org/10.1007/978-3-030-32004-1_8

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