19- Renal Drugs Flashcards
1
Q
acetazolamide (Diamox)
A
Diuretic- Carbonic Anhydrase Inhibitor
-leaves NaHCO3 in urine and decreases elimination of H+ leading to metabolic acidosis
-less H+ being anti-ported with Na+ leading to decreased Na+ reabsorption
-Increases excretion of: Na, K, HCO3-, H2PO4-
Sulfranliamide and K wasting
-Indication: counteracting diuretic induced metabolic alkalosis
-Adverse Reactions: allergic reactions, metabolic acidosis, diversion of renal ammonia into circulation, kidney stone, bone marrow depression, paresthesia, tingling
2
Q
chlorothiazide (Diuril)
A
Thiazide Diuretic- sulfonamide analogs, but NOT CA inhibitors
- block NaCl symport, but not K
- enter urine via organic ion transporters in PCT
- K wasting
- increase excretion of: Na, K, H+, Mg, Cl, bicarb and phos (weak effect)
- decrease excretion of Calcium
- act distal to macula so not limited by TGF
- medullary salt concentration is NOT affected so water retention during dehydration is preserved
- indications: HTN, edema, calcium nephrolithiasis, osteoporosis, nephrogenci DI
- adverse effects: hypotension, hypokalemia, hyponatremia, metabolic alkalosis (corticosteroids and amphotericin B increase risk of hypokalemia and cardiac arrhytmias) HYPERcalcemia and hyperuricemia, decrease glucose tolerance, rare CNS, GI and ED effects
- contraindicated with sulfonamide sensitivity
- NSAIDs reduce diuretic response d/t decreased GFR
- Probenecid blocks organic ion transporter thus decreasing diuretic effectiveness
3
Q
hydrochlorothiazide (HydroDiuril)
A
Thiazide Diuretic sulfonamide analogs, but NOT CA inhibitors
- block NaCl symport, but not K
- enter urine via organic ion transporters in PCT
- K wasting
- increase excretion of: Na, K, H+, Mg, Cl, bicarb and phos (weak effect)
- decrease excretion of Calcium
- act distal to macula so not limited by TGF
- medullary salt concentration is NOT affected so water retention during dehydration is preserved
- indications: HTN, edema, calcium nephrolithiasis, osteoporosis, nephrogenci DI
- adverse effects: hypotension, hypokalemia, hyponatremia, metabolic alkalosis (corticosteroids and amphotericin B increase risk of hypokalemia and cardiac arrhytmias) HYPERcalcemia and hyperuricemia, decrease glucose tolerance, rare CNS, GI and ED effects
- contraindicated with sulfonamide sensitivity
- NSAIDs reduce diuretic response d/t decreased GFR
- Probenecid blocks organic ion transporter thus decreasing diuretic effectiveness
4
Q
metolazone (Zaroxolyn)
A
Thiazide-like Diuretic sulfonamide analogs, but NOT CA inhibitors
- block NaCl symport, but not K
- enter urine via organic ion transporters in PCT
- K wasting
- increase excretion of: Na, K, H+, Mg, Cl, bicarb and phos (weak effect)
- decrease excretion of Calcium
- act distal to macula so not limited by TGF
- medullary salt concentration is NOT affected so water retention during dehydration is preserved
- indications: HTN, edema, calcium nephrolithiasis, osteoporosis, nephrogenci DI
- adverse effects: hypotension, hypokalemia, hyponatremia, metabolic alkalosis (corticosteroids and amphotericin B increase risk of hypokalemia and cardiac arrhytmias) HYPERcalcemia and hyperuricemia, decrease glucose tolerance, rare CNS, GI and ED effects
- contraindicated with sulfonamide sensitivity
- NSAIDs reduce diuretic response d/t decreased GFR
- Probenecid blocks organic ion transporter thus decreasing diuretic effectiveness
5
Q
bumetanide (Bumex)
A
Loop Diuretic
- inhibit Na+/K+/2 Cl- symporter in ascending think limb of loop of henle
- enter urine through organic ion transporters in proximal tubules
- inc. excretion of all luminal ions (Na, K, H, Ca, Mg, Cl, HCO3) (K wasting)
- short half-life but high ceiling diuretic (not limited by TGF)
- used in pulm. edema, CHF, HTN, nephrotic syndrome, edema/ascites of cirrohsis, CRF
- Adverse effects: hyponatremia/kalemia, metabolic alkalosis, vol. depletion, ototoxicity
6
Q
ethacrynic acid (Edecrin)
A
Loop Diuretic
- inhibit Na+/K+/2 Cl- symporter in ascending think limb of loop of henle
- enter urine through organic ion transporters in proximal tubules
- inc. excretion of all luminal ions (Na, K, H, Ca, Mg, Cl, HCO3) (K wasting)
- short half-life but high ceiling diuretic (not limited by TGF)
- used in pulm. edema, CHF, HTN, nephrotic syndrome, edema/ascites of cirrohsis, CRF
- Adverse effects: hyponatremia/kalemia, metabolic alkalosis, vol. depletion, ototoxicity
7
Q
furosemide (Lasix)
A
Loop Diuretic- most common
- inhibit Na+/K+/2 Cl- symporter in ascending think limb of loop of henle
- ALSO: weak CA inhibitor (sulfa allergy), can inc. venous capacitance, and uniquely glucuronidated in kidney
- inc. excretion of all luminal ions (Na, K, H, Ca, Mg, Cl, HCO3) (K wasting and more H then HCO3- alkalosis)
- short half-life but high ceiling diuretic (not limited by TGF)
- used in pulm. edema, CHF, HTN, nephrotic syndrome, edema/ascites of cirrohsis, CRF
- Adverse effects: hyponatremia/kalemia, metabolic alkalosis, vol. depletion, ototoxicity
8
Q
torsemide (Demadex)
A
Loop Diuretic
- inhibit Na+/K+/2 Cl- symporter in ascending think limb of loop of henle
- enter urine through organic ion transporters in proximal tubules
- inc. excretion of all luminal ions (Na, K, H, Ca, Mg, Cl, HCO3) (K wasting)
- short half-life but high ceiling diuretic (not limited by TGF)
- used in pulm. edema, CHF, HTN, nephrotic syndrome, edema/ascites of cirrohsis, CRF
- Adverse effects: hyponatremia/kalemia, metabolic alkalosis, vol. depletion, ototoxicity
9
Q
amiloride (Midamor)
A
K+ Sparing Diuretic
- inhibits renal Na+ channels in late distal tubule and collecting duct
- blocking channel reduces K+ and H+ secretion into lumen
- inc. excretion of Na+ and Cl- (only slightly), but all other ions have dec. secretion
- typically given with other diuretics to enhance their effects and reduce K+ loss
- used in Liddle’s syndrome and cystic fibrosis
- Adverse effects: hyperkalemia (will interact with other K+ sparing drugs)
10
Q
eplerenone (Inspra)
A
K+ Sparing Diuretic
- competitive antagonist of mineralocorticoid receptor in distal convoluted tubule and collecting duct (receptor activation induces Na, Cl, and water absorption and K excretion)
- Inc. excretion of Na and Cl but dec. secretion of K, H, Ca, and Mg
- typically co-administered with other diuretics for K sparing effects
- drug of choice for ascites and edema assoc. with cirrhosis
- used for primary and secondary hyperaldosteronism
- Adverse effects: hyperK+, cross reaction with other steroid receptors, gastric bleeding, CNS effects
- UNIQUE: clearance reduced by CYP3A4 inhibitors
11
Q
spironolactone (Aldactone)
A
K+ Sparing Diuretic
- competitive antagonist of mineralocorticoid receptor in distal convoluted tubule and collecting duct (receptor activation induces Na, Cl, and water absorption and K excretion)
- Inc. excretion of Na and Cl but dec. secretion of K, H, Ca, and Mg
- typically co-administered with other diuretics for K sparing effects
- Adverse effects: hyperK+, cross reaction with other steroid receptors, gastric bleeding, CNS effects
12
Q
triamterene (Dyrenium)
A
K+ Sparing Diuretic
- inhibits renal Na+ channels in late distal tubule and collecting duct
- blocking channel reduces K+ and H+ secretion into lumen
- inc. excretion of Na+ and Cl- (only slightly), but all other ions have dec. secretion
- typically given with other diuretics to enhance their effects and reduce K+ loss
- used in Liddle’s syndrome and cystic fibrosis
- Adverse effects: folate antagonism may lead to megaloblastic anemia, hyperkalemia (will interact with other K+ sparing drugs)
13
Q
glycerin (Osmoglyn)
A
Osmotic Diuretic
- draw water into blood from tissues
- inc. RBF and wash out medullary salt gradient
- primary site of action is Loop of Henle, secondary site is PCT were water efflux inhibited by osmotic gradient
- K+ wasting and inc. excretion of all ions except H+
- used in ARF, acute tubular necrosis, glaucoma, dialysis disequilibrium
- can cause pulm. edema, hyponatremia and dehydration
- contraindicated in anuria and liver failure
- may cause hyperglycemia
14
Q
mannitol (Osmitrol)
A
Osmotic Diuretic
- draw water into blood from tissues
- inc. RBF and wash out medullary salt gradient
- primary site of action is Loop of Henle, secondary site is PCT were water efflux inhibited by osmotic gradient
- K+ wasting and inc. excretion of all ions except H+
- used in ARF, acute tubular necrosis, glaucoma, dialysis disequilibrium
- used to reduce brain swelling but contraindicated in active intracranial bleeds
- can cause pulm. edema, hyponatremia and dehydration
- contraindicated in anuria and liver failure
15
Q
chlorpropamide
A
Antidiuretic
- sulfonylurea previously used for type II DM
- also increased ADH secretion
- unknown MOA
