Copy of Renal - Sheet1

Question 1

Mannitol

Answer 1

1) Use: Inc icp/iop, drug overdose
2) Class/MOA: Osmotic diuretic (inc tubular fluid osmolarity, inc urine flow, dec icp/iop
3) Side effects/ADEs: Pulmonary edema, dehydration; contraindicated in anuria, chf
4) Fun Facts:

Question 2

Acetazolamide

Answer 2

1) Use: Glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri
2) Class/MOA: Carbonic anhydrase inhibitor, prevents bicarb reabsorption in PCT (causes self limited nahco3 diuresis & dec in total body bicarb)
3) Side effects/ADEs: hyperchloremic metabolic acidosis, neuropathy/paresthesias, NH3 toxicity, sulfa allergy
4) Fun Facts: ACIDazolamide causes ACIDosis

Question 3

Furosemide

Answer 3

1) Use: Edema (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia
2) Class/MOA: sulfonamide Loop diuretic. Inhibits cotransport system (Na, K, 2Cl) of thick ascnding limb, preventing solutes from entering medulla (abolishes hypertonicity there–>Prevents concentration of urine. Stimulates PGE release for vasodilation of afferent arteriole. Increases calcium excretion (loops lose ca2+)
3) Side effects/ADEs: OH DANG! (Ototoxicity, hypokalameia, dehydration, allergy-sulfa, nephritis-interstitial, gout)
4) Fun Facts: Inhibited by NSAIDS

Question 4

Ethacrynic acid

Answer 4

1) Use: Diuresis for people with sulfa allergies
2) Class/MOA: loop diuretic. Phenoxyacetic acid derivative (not a sulfonamide). Inhibits Na, K, Cl cotransporter in ascending limb
3) Side effects/ADEs: OH DANG! (Same as furosemide)
4) Fun Facts: Same MOA as furosemide. Can cause hyperuricemia.

Question 5

Hydrochlorothiazide

Answer 5

1) Use: HTN, CHF, idiopathic hypercalciuria, nephrogenic DI
2) Class/MOA: thiazide diuretic. Inhibits NaCl reabsorption in early DCT, limiting diluting capacity. Decrease calcium excretion.
3) Side effects/ADEs: HyperGLUC (hyperglycemia, hyperlipidemia, hyperuricemia, hpercalcemia). Hypokalemic matabolic alkalosis, hyponatremia, sulfa allergy.
4) Fun Facts:

Question 6

Spironolactone, eplerenone

Answer 6

1) Use: Hyperaldosteronism, K+ depletion, CHF
2) Class/MOA: K+ sparing diuretics. competitive aldosterone receptor antagonist in cortical collecting duct.
3) Side effects/ADEs: Hyperkalemia (arrhythmias), endocrine effects (gynecomastia and other androgen effects)
4) Fun Facts: The K+ STAys (Spironolactone, triamterene, amiloride)

Question 7

Triamterene, amiloride

Answer 7

1) Use: Hyperaldosteronism, K+ depletion, CHF
2) Class/MOA: K+ sparing diuretic. block Na channel in CCT.
3) Side effects/ADEs: Hyperkalemia (arrhythmias)
4) Fun Facts:

Question 8

Captopril, enalapril, lisinopril

Answer 8

1) Use: HTN, CHF, diabetic renal disease, prevent unfavorable heart remodeling from chronic HTN
2) Class/MOA: Inhibit ACE to reduce angiotensin II–>dec gfr by preventing constriction of efferent arteriole. Prevents inactivation of bradykinin and causes vasodilation. Renin release increases (loss of feedback inhibition).
3) Side effects/ADEs: CAPTOPRIL (Cough, Angioedema, Proteinuira, Taste changes, hypOtension, Pregnancy problems (Teratogen–>fetal renal malformations), Rash, Increased renin, Lower ATII) creatinine inc (dec gfr). Hyperkalemia. Avoid with bilateral renal artery stenosis becauase ACE inhibitors reduce GFR–>renal failure
4) Fun Facts: ATII receptor blockers (sartans) are similar to these without inc bradykinin (no angioedema or cough).

Question 8

What do all diuretics do to serum/urine NaCl?

Answer 8

Increase NaCl in urine. Decrease NaCl in serum

Question 9

What do all diuretics do to serum/urine K?

Answer 9

Increase urine K. Decrease serum K

Question 9

What do all loop diuretics vs thiazides do to urine calcium?

Answer 9

Loop diuretics increase it. thiazides decrease it from enhanced paracellular calcium reabsorption in PCT and loop of henle.