B5-047 Renal Drugs Flashcards
recommended monotherapy for HTN in elderly
thiazides or ca+ channel blockers
what part of the tubule do carbonic anhydrase inhibitors work on?
proximal
what part of the tubule do loop diuretics work on?
ascending loop of Henle
what part of the tubule do thiazide diuretics work on?
DCT
what part of the tubule do Na+ channel inhibitors and aldosterone receptor antagonists work on?
collecting duct
main clinical applications for diuretics
heart failure (loop)
HTN (thiazide)
opthalmic preparation of carbonic anhydrases
2
- brinzolamide
- dorzolamide
-amide
carbonic anhydrase inhibitors
- used to treat glaucoma
- both oral and topical preparations
carbonic anhydrase inhibitors
-amides
causes self limited NaHCO3 diuresis and decreased total body HCO3- stores
carbonic anhydrase inhibitors
-amides
used to treat:
metabolic alkalosis
alititude sickness
intracranial HTN
glaucoma
carbonic anhydrase inhibitors
-amides
adverse effects
- type 2 RTA
- renal stones
- renal potassium wasting
- CNS effects
carbonic anhydrase inhibitors
-amides
“acid” azolamide causes acidosis
loop diuretics
4
- furosemide
- bumetanide
- torsemide
- ethacrynic acid
-ide
- inhibit NKCC
- abolish hypertonicity of medulla
- prevent concentration of urine
loop diuretics
-ides
cause increased Ca+ and Mg2+ excretion
loop diuretics
-ides
Loops Lose Ca2+
nonsulfonamide loop diuretic
ethacrynic acid
adverse effects:
- ototoxicity
- hypokalemia
- hypomagnesium
- dehydration
- allergy (sulfa)
- Alkalosis
- Nephritis
- Gout
loop diuretics
OHH DAANG
-ides
interact with NSAIDs
loop diuretics
-ides
- cause hypokalemia
- frequently combined with potassium sparing agent
loop diuretics
-ides
powerful stimulators of renin release
loop diuretics
-ides
may have to add beta blocker to counteract
most commonly used for relief of pulmonary edema
loop diuretics
-ides
used to treat:
- HTN if thiazides don’t work
- severe hyperkalemia
- acute renal failure (increase urine volume)
loop diuretics
-ides
which loop diuretic is most prone to causing ototoxicity?
ethacrynic acid
adverse effects
- dehydration
- hyponatremia
- hypokalemia
- ototoxicity
- hyperuricemia/gout
- allergic reactions
loop diuretics
-ides
- inhibit NaCl reabsorption in the early DCT
- reduce the diluting capacity of nephron and reduce Ca2+ excretion
-thiazides
inhibit Na+/Cl- cotransport
-thiazides
preferred as antihypertensive drugs in AA and elderly
-thiazides
enhance Ca2+ reabsorption due to increased Na+ gradient
-thiazides
adverse effects:
- hyperuricemia
- hypokalemia
-thiazides
ineffective at low GFR
-thiazides
use loop diuretic instead
effective treatment for:
- HTN at low dose
- CHF at high dose
- nephrolithiasis
- diabetes insipidus
-thiazides
preferred -thiazide due to long half-life and proven reduction of CVD in clinical trials
low dose chlorthalidone
adverse effects
- hyperglycemia
- hyperlipidemia
- hyperuricemia
- hypercalcemia
-thiazides
hyperGLUC
contraindicated in prediabetic patients and those with elevated lipid panels
-thiazides
due to adverse effects
which are better antihypertensives: loop or thiazides?
-thiazides
which have a better diuretic efficacy: loops or thiazides?
loop diuretics
act in the ascending loop of Henle on NKCC transporter
loop diuretics
act in DCT on NaCl transporter
-thiazides
cause increased Ca2+ excretion
loops or thiazides
loops
cause reduced calcium excretion
loops or thiazides
-thiazides
effective at a low GFR
loop or thiazides
loop
ineffective at a low GFR
loop or -thiazides
-thiazides
two groups of potassium sparing diuretics
aldosterone antagonists
Na+ channel blockers
-ones
eplerenone, spironolactone
aldosterone antagonists
Na+ channel blockers
2
amiloride
triamterene
weak diuretics
but can be used to counteract hypokalemia caused by loops or -thiazides
potassium sparing diuretics
often combined with thiazide or loop diuretics to minimize or prevent potassium depletion
potassium sparing diuretics
aldosterone antagonists
2
eplerenone
spironolactone
effective treatment for:
- primary mineralcorticoid hypersecretion
- secondary aldosteronism due to CHF, cirrhosis, nephrotic syndrome
- Liddle’s syndrome
potassium sparing diuretics
adverse effects
- hyperkalemia
- metabolic acidosis
- gynecomastia
- kidney stones
potassium sparing diuretics
Spironolactone
Eplerone
Amiloride
Triamterene
potassium sparing diuretics
Keep your SEAT
-vaptans
ADH antagonists
used to manage SIADH when water restriction cannot correct the abnormality
ADH antagonists
-vaptans
used in CHF when ADH is elevated due to low blood volume
ADH antagonists
-vaptans
what should be monitored closely when using ADH antagonists?
serum Na+
can cause hypernatremia and DI
osmotic diuretic
mannitol
prevents water reabsorption
used for emergency reduction of ICP
mannitol
first choice diuretics in heart failure
loop diuretics
recommended for monotherapy of mild to moderate HTN
thiazides
B1 selective blockers
B1 expressed in kidney and heart, 4
- atenolol
- betaxolol
- bisprolol
- metoprolol
more effective for treatment of HTN in young and caucasians
B1 blockers
drug of choice for CAD
b1 blockers
normally combined with other antihypertensives to counteract:
* increased renin by thiazides/loops
* reflex tachy
b1 blockers
why are b1 blockers not considered first line for HTN?
significant risk of new onset diabetes
-flozin
SGLT2 inhibitors
- block glucose reabsorption
- results in A1C reduction and weight loss
SGLT2 i
increase secretion of uric acid in urine
URAT 1 inhibitors
URAT 1 inhibitors
3
- probenecid
- silfinpyrazole
- lesinurad
used in patients will gout that do not respond to allopurinol or febuxostat
uricosuric drugs
can cause kidney stones due to high uric acid
uricosuric drugs
used for type 2 diabetes
SGLT2
used for hyperuricosuria, gout
uricosuric drugs
