#6 Komiskey - Clinical Pharmacology of Diuretic Agents Flashcards
Diuretic resistance in which the diuretic response is diminished or lost can happen by which two routes?
- Braking” phenomenon in which there is a decrease in response after the first dose is administered.
- Long-term tolerance in which tubular hypertrophy occurs to compensate for salt loss.
What are some causes for diuretic resistance in heart failure?
Noncompliance Excess dietary Na+ intake Decreased GFR Decreased CO ACE Inhibitors NSAIDS Reduced diuretic absorption
What are some mechanisms of induced Acute Renal Failure?
Diuretics NSAIDS Sulfonamides Glycosides Cyclosporine
Renal prostaglandins’ mechanism of action stimulates what enzyme which results in the increase of ____?
adenylcyclase enzyme increases cAMP
- relaxes vascular smooth muscle
- counteracts angiotension
Renal cortical PGI2 and PGE2 play a role in maintaining ____________ and _________ ____________ in hypovolemic states.
blood pressure and renal function in hypovolemic states
Inhibition of PG synthesis with NSAID can lead to _____?
reversible renal ischemia
Due to decreased vasodilatory PG which leads to lower GFR.
Presence of ACEI or ARBS leads to decreased Angiotensin II. What affect does the ACEI have on GFR?
Lower AII causes a slight increase in the vasodilatory PG and results in lower GFR.
Which risk factors are prevalent in people with CKD?
Diabetics
HBP
Family history of CKD
Older
Acute TIN can be caused by which drugs?
Antibiotics NSAIDS Diuretics Allopurinol Phenytoin Rifampin Interferon PPI
How would you treat analgesic nephropathy?
Discontinue treatment
How does CKD affect parathyroid gland?
Elevated PTH - multisystemic toxicity
Decreased 1,25-D activates parathyroid to secrete PTH and take Ca2+ from bone
Red Blood Cell Production decreased
What recommendations should be given to the patient in CKD?
- Avoid high phosphorus foods (dairy, nuts, dark sodas, beans)
- Initiate treatment with exogenous Active Vitamin D
- Some may benefit from Calcimimetics
