Jan4 M3-Antihypertensives, K and PO4 binders, Renally Cleared Drugs Flashcards
3 ways kidney affects CVS
- EPO production: RBCs
- ECF volume
- TPR
three kinds of baroreceptors
arterial, cardiopulmonary, intrarenal
what intrarenal baroreceptors do
RAAS, GFR, salt and water reabsorption
what produces ADH
hypothalamus (not pituitary)
3 messages to renin production and which one is different
- SS via beta adrenergic receptors
- decreased P in renal arterioles
- macula densa (this one can also decrease renin prod)
how macula densa communicates an increased flow
senses increased Na delivery, releases ATP (adenosine) which then decreases GFR and renin secretion
how macula densa communicates a decreased flow
drop in Na delivery, secretes NO and PGs, GFR and renin secretion increase
in the control of sodium excretion, what are drivers of Na excretion
dopamine, ECF conc of Na, ECF volume, natriuretic peptides
in the control of sodium excretion, what are drivers of Na retention
AT2, aldo, SS, ADH
why ACEi causes cough
ACE metabolizes kinins and substance P. kinins enhance production of PGs which may cause bronchial irritation and cough
only way to resolve ACEi cough side effect if present
stop this med and take ARB instead
less common side effects of ACEi
- severe hypotension (if hypovolemic)
- acute renal failure (if bilateral RAS)
- hyperK
4 drug types in BP management
- AT blockers (RAAS inhibitors)
- Sympathoplegic agents
- Direct vasodilators (like hydralazine)
- Diuretics
anti htn drugs: choice in diabetic patient with proteinuria
RAAS inhibitors (AT blockers)
anti htn drugs: choice in patients with angina
beta blockers or CCB
anti htn drugs in HF
diuretic**,ARB, ACEi, beta blocker or hydralazine + nitrates
anti htn drugs in BPH (benign prostatic hyperplasia)
a1 blockers
5 classes of diuretics
CA inhibitors loop diuretics thiazides K-sparing diuretics osmotic
thiazides mode of action
block Na-Cl transporter in the DCT (5-7% reabso of Na note done)
3 thiazides
indapamide, hydrochlorothiazide, metolazone
thing that can influence effect of thiazides and loop diuretics
renal PG production, modified if taking NSAIDs
side effect of thiazides (electrolytes)
hypokalemia and metabolic alkalosis
3 mechanisms of hypoK and metabolic alkalosis as side effects in thiazides
- increased Na to CT exchanged for K and H (CD for water..)
- secondary hyperaldo
- volume contraction
other side effects of thiazides
hyponatremia, hyperuricemia, hyperglycemia, weakness-fatigue-parasthesias
changes in serum lipids
loop diuretics are of choice in what 2 conditions
pulmonary edema and CHF
2 mechanisms of loop diuretics and why are said to be potent
- block Na-K-2Cl cotransporter in TAL (potent bc medullary interstitium not salty as a consequence
- venous vasodilation by inducing production of PGs and NO in endoth cells to relax SM
2 categories of loop diuretics, their drugs and why use the second
- sulfonamides (furosemide, bumetanide, torsemide)
- nonsulfonamides (ethacrynic acid): for sulfonamide intolerant patients
side effects of loop diuretics
hypokalemia, metabolic alkalosis (contraction), hyperuricemia, hypomagnesemia, ototoxicity
how diuretics are handled by the body and consequence
kidneys secrete them actively. can develop resistance (transporters in the kidney change)
reasons for diuretic resistance
- high Na diets
- CKD, aging
- NSAIDs, low BP, low flow to the kidney
- gut edema (less abso)
K-sparing diuretics 2 different modes of action
MRA (nuclear receptor)
Na channel blockers in the CT and CD
2 MRAs
spironolactone, eplerenone
2 CT Na channel blockers
amiloride, triamterene
CA inhibitors name and mode of ation
acetazolamide. no H + HCO3 produced so no Na-H exchange in PCT
3 side effects of CAi
hyperchloremic MA
renal stones
renal potassium wasting
osmotic diuretics: prototypic one and where acts mainly
mannitol. mainly PCT and DL
side effects of mannitol (water and electrolytes)
- volume expansion (prior to diuresis)
- dehydration, hyperK and hyperNa
- hypoNa: in renal failure (water not excreted)
main side effect of k-sparing diuretics
hyperK
