Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how much plasma do kidneys filter

A

180 L daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

main diuretic classes

A 
Carbonic anhydrase inhibitors
loop diuretics
thiazides
K+ sparing agents
ADH antagonists
osmotic diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what part of the tubule do CA inhibitors act on

A

proximal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what part of the tubule do Loop diuretics act on

A

ascending loop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what part of the tubule do thiazides work on

A

distal (Na/Cl symporter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what part of the tubule do Na channel inhibitors work on

A

collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

main clinical applications for diuretics

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are CA inhibitors oral

A

Acetazolamide
Dichlorphenamide
Methazolamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are CA inhibitors opthalmic

A

brinzolamide

dorzolamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are CA inhibitors used to treat

A 
glaucoma
orally
acetazolamide, dichlorphenamide, methazolamide
topically
brinzolamide
dorzolamide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the loop diuretics

A

furosemide
bumetanide
torsemide
ethacrynic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are high ceiling diuretics

A

loop diuretics, bc they are most effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

ethacrynic acid if they have a sulfa allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how are loops eliminated

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why can NSAIDs interact with secretion of loops

A

bc they use the same OA transporter in proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

AEs of loops

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are vascular effects of loops

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

loop diuretics are powerful stimulators of the release of what

A

renin bc reduced NaCl reabsorption leads to lower intracellular Na leading to increased secretion of prostaglandins and renin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

clinical uses of loops

A

most commonly for relief of pulmonary edema or other edematous conditions, and acute hypercalcemia
other uses are: HTN, severe hyperkalemia, acute renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

loops adverse effects

A

dehydration and hyponatremia leading to hypotension
hypokalemia
ototoxicity, more common with Ethacrynic acid
hyperurcemia and gout attacks
allergic reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the thiazides and thiazide like drugs

A 
end in thiazide
chlorthalidone
indapamide
metolazone
quinethazone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what do thiazides do

A

inhibit Na Cl cotransport
sulfonamides
enhanced Ca reabsorption bc of increased Na gradient across the basolateral membrane

30
Q

who are thiazides more effective in

A

as antihypertensives in african americans

31
Q

what is the thiazide prototype drug

A

hydrochlorothiazide

32
Q

thiazide effects on other transporters

A

secreted by organic acid secretory system that handles uric acid so competition can cause hyperuricemia
hypokalemia
increased Ca reabsorption
infeffective if GFR low

33
Q

clinical uses of thiazides

A

HTN at low dose chlorthalidone preferred
CHF
nephrolithiasis due to idiopathic calciuria
nephrogenic DI to reduce polyuria

34
Q

AEs of thiazides

A 
hypokalemic metabolic alkalosis
hyperuricemia
hyperlipidemia
hyperglycemia
hyponatremia
35
Q

severe but rare AEs of thiazides

A

TTP, hemolytic anemia, acute necrotizing pancreatitis, photosensitivity, allergy

36
Q

what are the potassium sparing diuretics

A 
aldosterone antagonists
eplerenone
spironolactone
Na channel blockers
amiloride, triamterene
37
Q

what are aldosterone antagonist MOA

A

decreases Na reabsoprtion and K and H secretion

38
Q

how do amiloride and triamterene work

A

block apical Na channels to cause loss of potential and reduce K and H secretion

39
Q

what are potassium sparing diuretics used for

A

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
Q

what is eplerenone used for

A

mild to moderate heart failure after MI

41
Q

potassium sparing diuretic toxicities

A

hyperkalemia
hyperchloremic metabolic acidosis due to inhibition of H secretion
gynecomastia d/t steroid chemical structure of spironolactone
kidney stones

42
Q

what can happen if indomethacin combined with triamterene

A

acute renal failure

43
Q

what are the ADH antagonists

A

vaptans
conivaptan
tolvaptan

44
Q

what are vaptans used for

A

SIADH

CHF if ADH elevated d/t low blood volume

45
Q

osmotic diuretics

A

mannitol

46
Q

how does mannitol work

A

filtered by glomerulus but not reabsorbed –> increase osmolarity of ultrafiltrate and prevent water reabsorption and promote diuresis

47
Q

what part of the tubule has the greatest effect by mannitol

A

proximal and descending LOH

48
Q

what is mannitol used for

A

primarily rapid reduction in intracranial pressure

49
Q

AEs of mannitol

A

severe dehydration, loss of free water, hypernatremia, headache, nausea, vomiting

50
Q

clinical uses of diuretics

A

reducing fluid

HTN

51
Q

first choice of drugs for HF

A

loop
furosemide, ethacrynic acid only if allergic to sulfas)
thiazides for mild

52
Q

first choice diuretics for HTN

A

thiazides, low dose

chlorthalidone to treat HTN low dose, 50-100 for diuresis

53
Q

what is the preferred thiazide like diuretic

A

chlorthalidone bc of long half life

54
Q

how do you treat patients with chronic kidney disease

A

thiazides if GFR >30 loop if <30

55
Q

beta 1 selective blockers

A

atenolol
betaxolol
bisoprolol
metoprolol

56
Q

beta 1 selective and vasodilatory beta blockers

A

nebivolol

57
Q

non selective beta blockers

A

nadolol

propranolol

58
Q

beta blockers with intrinsic sympathomimetic activity

A

acebutolol (beta 1)
penbutolol (non sel)
pindolol (non sel beta 2 ag)
cartelol (non sel NO prod)

59
Q

beta blockers with comibned alpha and beta receptors

A

carvedilol ( alpha 1 antagonist, blocks calcium entry)

labetalol (alpha 1 antagonist)

60
Q

what do beta blockers do with HTN

A

inhibit release of renin

61
Q

how do beta blockers lower BP

A

block beta receptors in heart, kidneys (reduce renin sec) and CNS to reduce sympathetic vasomotor tone

62
Q

who are beta blockers more effective in

A

young and caucasians

63
Q

AEs of beta blockers

A

beta blockade may worsen symptoms in patients with reduced myocardial reserve, asthma, periph vascular insufficiency, DM

64
Q

how do beta blockers predispose atherogenesis

A

increasing plasma triglycerides
decreasing HDL cholesterol
risk of new onset DM

65
Q

what does beta blockade do

A

delays recovery of normoglycemia bc it inhibits hyperglycemic responses mediated by epi

66
Q

SGLT2 inhibitors

A

dapagliflozin
canagliflozin
empagliflozin

67
Q

what are SGLT2 inhibitors used for

A

3rd line for T2DM

block glucose reabsorption so most is excreted

68
Q

what are uricosuric drugs

A

drugs that inrease excretion of uric acid and reducing concentration of uric acid in blood plasma
probenecid
sulfinpyrazole
lesinurad

69
Q

how do uricosuric drugs work

A

URAT1 inhibitors, block uric acid reabsorption

70
Q

what pt population do you give uricosuric drugs

A

used in pts with gout and underexcretion of uric acid when allopurinol or febuxosat are contraindicated or when tophi are absent

71
Q

what are xanthine oxidase inhibitors

A

allopurinol

febuxostat

72
Q

what are tophi

A

gout stones

GIR Test 3 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions