Drugs Flashcards
Loop Diuretics
Furosemide/Lasix
Site of action: LOH thick ascending
Mechanism: Blocks NaK2Cl transporter, decreasing ability to concentrate urine by removing salt
Indications: Edema, CHF
Side effects: Very potent so diuresis effects- hypovolemia
Electrolytes: hypoK, hypoNa, HypoMg, alkalosis
Tinnitus/hearing loss
Thiazide Diuretics (hydochlorothiazide)
Site of action: DCT
Mechanism: Blocks action of Na+/Cl cotransporter
Indications: HTN
Side effects: Electrolytes: hypoK, hypoNa, HypoMg, HYPERCa
Metabolic- gout, hyperlipidemia, hyperglycemia
Carbonic Anhydrase Inhibitor
acetazolimide
Site of action: PCT
Mechanism: Blocks Na/HCO3 antiporter by blocking carbonic anhydrase
Indications: Altitude sickness
Side effects: Metabolic acidosis, hypoNa, hypoK, confusion
Potassium Sparing Diuretics
spironolactone
Site of action: Collecting duct
Mechanism:
a) aldosterone antagonist @ principle cell
b)block epithelial sodium channel of principle cell
Indications: HTN, Conn’s syndrome, edema/ascites, LVdisfunction
Side effects: HyperK, breast enlargement
How do NSAIDS affect kidney?
- Vasoconstrict afferent arteriole
- Decrease renin release
- Increase sodium reabsorption
- Increase response to ADH
Can cause renal injury at each stage, electrolyte abnormalities
How do NSAIDS cause pre-renal failure?
Decrease perfusion pressure and GFR, especially important in CHF or when using ACEi
How do NSAIDS cause renal injury?
Ischemia: acute tubular necrosis
Interstitial nephritis (any time)
Papillary necrosis (ischemia): vascular
Membranous, minimal change disease; glomerular
What electrolyte abnormalities does NSAID use cause?
Hyperkalemka ( decreased filtration and decreased aldosterone)
Theoretical hyponatremia (doesn’t really happen)
Actions of prostaglandins
Vasodilate afferent arteriole
Increase renin release (Aldo)
Inhibit sodium reabsorption
Decrease response to ADH
Bisphaosphanates
Mech: inhibit osteoclasts resorption action, making bone harder and decreasing fragility fractures
Side effects: few, rare but serious (femur and jaw)
Indications: better in those at high risk. May be better to stop at around 3-5 years
Contra: children and pregnancy
Denosumab
Mechanism: anti-Rank ligand antibody
Effect: reduces fractures by up to 50%
Side effects: ONJ, femur
Denosumab
Mechanism:
