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GIR Test 3 > B5.047 - Renal Drugs > Flashcards

B5.047 - Renal Drugs Flashcards

1
Q

main drugs acting on the kidney

A

diuretics
beta blockers
SGLT2 inhibitors
uricosuric drugs

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2
Q

how much plasma do kidneys filter

A

180 L daily

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3
Q

main diuretic classes

A 
Carbonic anhydrase inhibitors
loop diuretics
thiazides
K+ sparing agents
ADH antagonists
osmotic diuretics
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4
Q

what part of the tubule do CA inhibitors act on

A

proximal

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5
Q

what part of the tubule do Loop diuretics act on

A

ascending loop

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6
Q

what part of the tubule do thiazides work on

A

distal (Na/Cl symporter)

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7
Q

what part of the tubule do Na channel inhibitors work on

A

collecting duct

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8
Q

main clinical applications for diuretics

A

acute and chronic heart failure
HTN
acute and chronic renal failure
nephrotic syndrome, cirrhosis

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9
Q

what are CA inhibitors oral

A

Acetazolamide
Dichlorphenamide
Methazolamide

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10
Q

what are CA inhibitors opthalmic

A

brinzolamide

dorzolamide

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11
Q

how do CA inhibitors work

A

block NaHCO3 reabsorption

diuretic effect diminishes over several days bc bicarb depletion enhances NaCl reabsorption by remainder of nephron

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12
Q

what are CA inhibitors used to treat

A 
glaucoma
orally
acetazolamide, dichlorphenamide, methazolamide
topically
brinzolamide
dorzolamide
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13
Q

how do CA inhibitors work on glaucoma

A

ciliary body secretes bicarb into acqueous humor; inhibition of CA decreases aqueous humor formation which reduces intraocular pressure

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14
Q

possible toxicities of CA inhibitors

A

hyperchloremic metabolic acidosis
renal stones: calcium phosphage salts are less soluble at alkaline pH
renal potassium wasting

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15
Q

renal potassium wasting in Ca inhibitors mechanism

A

bc more Na reaches the collecting duct more K is secreted, combine with K+ sparing diuretic

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16
Q

other toxicities of CA inhibitors

A

drowsiness, parasthesias with large doses of acetazolamide. Nervous system toxicity in pts with renal failure because of accumulation

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17
Q

what are the loop diuretics

A

furosemide
bumetanide
torsemide
ethacrynic acid

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18
Q

what do loop diuretics do

A

they are selective inhibitors of Na/K/2Cl cotransporter leading to decreased NaCl reabsorption
also leads to increased excretion of Ca and Mg

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19
Q

what are high ceiling diuretics

A

loop diuretics, bc they are most effective

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20
Q

what loop do you use for pts with a sulfa and when

A

ethacrynic acid if they have a sulfa allergy

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21
Q

how are loops eliminated

A

tubular secretion and filtration; half life depends on renal function; NSAIDS can interact for secretion

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22
Q

why can NSAIDs interact with secretion of loops

A

bc they use the same OA transporter in proximal tubule

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23
Q

AEs of loops

A

hypokalemia - increased delivery of Na to distal tubule enhances K and H secretion
hypomagnesemia

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24
Q

what are vascular effects of loops

A

direct vascular effects due to increased prostaglandin synthesis may increase renal blood flow

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25
loop diuretics are powerful stimulators of the release of what
renin bc reduced NaCl reabsorption leads to lower intracellular Na leading to increased secretion of prostaglandins and renin secretion
26
clinical uses of loops
most commonly for relief of pulmonary edema or other edematous conditions, and acute hypercalcemia other uses are: HTN, severe hyperkalemia, acute renal failure
27
loops adverse effects
dehydration and hyponatremia leading to hypotension hypokalemia ototoxicity, more common with Ethacrynic acid hyperurcemia and gout attacks allergic reactions
28
what are the thiazides and thiazide like drugs
``` end in thiazide chlorthalidone indapamide metolazone quinethazone ```
29
what do thiazides do
inhibit Na Cl cotransport sulfonamides enhanced Ca reabsorption bc of increased Na gradient across the basolateral membrane
30
who are thiazides more effective in
as antihypertensives in african americans
31
what is the thiazide prototype drug
hydrochlorothiazide
32
thiazide effects on other transporters
secreted by organic acid secretory system that handles uric acid so competition can cause hyperuricemia hypokalemia increased Ca reabsorption infeffective if GFR low
33
clinical uses of thiazides
HTN at low dose chlorthalidone preferred CHF nephrolithiasis due to idiopathic calciuria nephrogenic DI to reduce polyuria
34
AEs of thiazides
``` hypokalemic metabolic alkalosis hyperuricemia hyperlipidemia hyperglycemia hyponatremia ```
35
severe but rare AEs of thiazides
TTP, hemolytic anemia, acute necrotizing pancreatitis, photosensitivity, allergy
36
what are the potassium sparing diuretics
``` aldosterone antagonists eplerenone spironolactone Na channel blockers amiloride, triamterene ```
37
what are aldosterone antagonist MOA
decreases Na reabsoprtion and K and H secretion
38
how do amiloride and triamterene work
block apical Na channels to cause loss of potential and reduce K and H secretion
39
what are potassium sparing diuretics used for
usually to counteract hypokalemia caused by loop or thiazide diuretics also often combined with thiazide or loop diuretics to minimize or prevent potassium depletion conns syndrome (primary mineralcorticoid hypersecretion) secondary aldosteronism
40
what is eplerenone used for
mild to moderate heart failure after MI
41
potassium sparing diuretic toxicities
hyperkalemia hyperchloremic metabolic acidosis due to inhibition of H secretion gynecomastia d/t steroid chemical structure of spironolactone kidney stones
42
what can happen if indomethacin combined with triamterene
acute renal failure
43
what are the ADH antagonists
vaptans conivaptan tolvaptan
44
what are vaptans used for
SIADH | CHF if ADH elevated d/t low blood volume
45
osmotic diuretics
mannitol
46
how does mannitol work
filtered by glomerulus but not reabsorbed --> increase osmolarity of ultrafiltrate and prevent water reabsorption and promote diuresis
47
what part of the tubule has the greatest effect by mannitol
proximal and descending LOH
48
what is mannitol used for
primarily rapid reduction in intracranial pressure
49
AEs of mannitol
severe dehydration, loss of free water, hypernatremia, headache, nausea, vomiting
50
clinical uses of diuretics
reducing fluid | HTN
51
first choice of drugs for HF
loop furosemide, ethacrynic acid only if allergic to sulfas) thiazides for mild
52
first choice diuretics for HTN
thiazides, low dose | chlorthalidone to treat HTN low dose, 50-100 for diuresis
53
what is the preferred thiazide like diuretic
chlorthalidone bc of long half life
54
how do you treat patients with chronic kidney disease
thiazides if GFR >30 loop if <30
55
beta 1 selective blockers
atenolol betaxolol bisoprolol metoprolol
56
beta 1 selective and vasodilatory beta blockers
nebivolol
57
non selective beta blockers
nadolol | propranolol
58
beta blockers with intrinsic sympathomimetic activity
acebutolol (beta 1) penbutolol (non sel) pindolol (non sel beta 2 ag) cartelol (non sel NO prod)
59
beta blockers with comibned alpha and beta receptors
carvedilol ( alpha 1 antagonist, blocks calcium entry) | labetalol (alpha 1 antagonist)
60
what do beta blockers do with HTN
inhibit release of renin
61
how do beta blockers lower BP
block beta receptors in heart, kidneys (reduce renin sec) and CNS to reduce sympathetic vasomotor tone
62
who are beta blockers more effective in
young and caucasians
63
AEs of beta blockers
beta blockade may worsen symptoms in patients with reduced myocardial reserve, asthma, periph vascular insufficiency, DM
64
how do beta blockers predispose atherogenesis
increasing plasma triglycerides decreasing HDL cholesterol risk of new onset DM
65
what does beta blockade do
delays recovery of normoglycemia bc it inhibits hyperglycemic responses mediated by epi
66
SGLT2 inhibitors
dapagliflozin canagliflozin empagliflozin
67
what are SGLT2 inhibitors used for
3rd line for T2DM | block glucose reabsorption so most is excreted
68
what are uricosuric drugs
drugs that inrease excretion of uric acid and reducing concentration of uric acid in blood plasma probenecid sulfinpyrazole lesinurad
69
how do uricosuric drugs work
URAT1 inhibitors, block uric acid reabsorption
70
what pt population do you give uricosuric drugs
used in pts with gout and underexcretion of uric acid when allopurinol or febuxosat are contraindicated or when tophi are absent
71
what are xanthine oxidase inhibitors
allopurinol | febuxostat
72
what are tophi
gout stones

GIR Test 3 (6 decks)

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