Nephrology Meds

Question 1

Adrenergic Inhibitors

Answer 1

Central (alpha agonists)
Peripheral (alpha blockers*, beta blockers, alpha + beta)
*Not usually used in monotherapy

Question 2

Direct Vasodilators

Answer 2

Not usually used as monotherapy

- you get reflex tachy, reflex salt and H20 retention; not used as primary drug

Question 3

Ca channel blockers

Answer 3

Very safe, very effective. Have slight diuretic effect.

• Dihydropyridine
• Non-dihydropiridine

Question 4

RAAS blockers

Answer 4

ACE I’s
ARB’s
Renin inhibitors

Question 5

Initial HTN Therapy

Answer 5

Based on Study Data:
General Population –> Non Black: Thiazide, CCB, ACE I, ARB combo
General Population –> Black: CCB, Thiazide. Much more effective in this group
Diabetes and CKD –> ACE I or ARB. Reduces mortality in this group.

Question 6

Drug Combinations preferred for HTN

Answer 6

• Thiazide + ACE I
• Thiazide + ARB
• Thiazide + Ca antag
• Ace I + Ca (very good clinical trial data that this has best bang for buck in reducing CV mortality)
• Ca Antag + ARB or ACE I
• Thiazide + Beta Blockers (useful)

Question 7

ACE I or ARB contraindications

Answer 7

Pregnancy
Hyperkalemia
Bilateral renal artery stenosis

Question 8

Beta Blocker contraindication

Answer 8

Asthma
AV Block (grade 2 or 3)

Question 9

Ca Channel blocker contraindications

Answer 9

AV Block, Severe LV dysfunction, Heart failure

Question 10

Mineralcorticoid receptor antag contraindications

Answer 10

Acute or severe renal failure, hyperkalemia

Question 11

Acetazolamide

Answer 11

Carbonic Anhydrase Inhibitor (diuretic)

Question 12

Mannitol

Answer 12

Osmotic diuretic

Question 13

Furosemide

Answer 13

Loop diuretic

Question 14

Bumetanide

Answer 14

Loop diuretic

Question 15

HCTZ

Answer 15

Thiazide diuretc

Question 16

Chlorthiazide

Answer 16

Thiazide Diuretic

Question 17

Amiloride

Answer 17

Sodium channel blocker

Question 18

Triamterene

Answer 18

Sodium channel blocker

Question 19

Spirinolactone

Answer 19

Aldosterone antagonist

Question 20

Eplerenone

Answer 20

Aldosterone antagonist

Question 21

Conivaptan

Answer 21

Vasopressin V2 Receptor antagonist

Question 22

Tolvaptan

Answer 22

Vasopressin V2 Receptor antagonist

Question 23

Metoprolol

Answer 23

Beta-blocker

Question 24

Carvedilol

Answer 24

Beta-Blocker

Question 25

Labetalol

Answer 25

Dual alpha/beta blocker

Question 26

Captopril

Answer 26

Short acting ACE I

Question 27

Enalapril

Answer 27

ACE I

Question 28

Lisinopril

Answer 28

ACE I

Question 29

Candesartan

Answer 29

ARB

Question 30

Valsartan

Answer 30

ARB

Question 31

Losartan

Answer 31

ARB

Question 32

Amlodipine

Answer 32

Ca channel blocker

Question 33

Nifedipine

Answer 33

Ca channel blocker

Question 34

Diltiazem

Answer 34

Ca Channel blocker

Question 35

Verapamil

Answer 35

Ca Channel Blocker

Question 36

Centrally acting agents

Answer 36

Ca Ch blocker

Question 37

Clonidine

Answer 37

Ca Channel Blocker

Question 38

Nitroprusside (IV)

Answer 38

Vasodilator – HTN emergency

Question 39

Fenoldopam (IV)

Answer 39

Vasodilator – HTN emergency

Question 40

Labetalol (IV)

Answer 40

Adrenergic inhibitor – HTN Emergency

Question 41

Nicardipine (IV)

Answer 41

Ca channel blocker – HTN emergency

Question 42

Prednisone

Answer 42

Immunosuppressive agent

Question 43

Methylprednisone

Answer 43

Immunosuppressive agent, IV

Question 44

Mycophenolic acid

Answer 44

Purine synthesis Inhibitor (immunosuppressive)

Question 45

Cyclosporin

Answer 45

Calcineurin inhibitor/Immunosuppressive

Question 46

Tacrolimus

Answer 46

Calcineurin inhibitor/immunosuppressive

Question 47

Rapamycin

Answer 47

mTor inhibitor (post-transplant immunsuppression)

Question 48

Anti-thymocyte globulin

Answer 48

Anti-T cell Antibody (post-transplant)

Question 49

Eculizumab

Answer 49

Anti-C5 monoclonal antibody (atypical HUS!)

Question 50

Epoetin alfa

Answer 50

Erythropoiesis stimulating agent

Question 51

Calcitrol

Answer 51

Activated Vit D

Question 52

CaCO3

Answer 52

Phosphate binder (calcium based)

Question 53

Ca acetate

Answer 53

Phosphate binder (calcium based

Question 54

Sevelamer

Answer 54

non-Ca cationic polymer, phosphate binder.

Question 55

ARB indications

Answer 55

“sartan” suffix

HTN, diabetic nephropathy (dyed bead kidney), CHF

Question 56

ARB Side effects

Answer 56

Hyperkalemia

Question 57

HTN Medications

Answer 57

ACE Is, ARB’s, Ca channel blockers, Beta blockers, diuretics

Question 58

Acetazoleamide specific SE

Answer 58

metabolic acidosis (increased bicarb excretion)

Question 59

Thiazide specific SE

Answer 59

Hypercalcemia by increasing Ca reabsorption

Question 60

Loops diuretic specific SE

Answer 60

Hearing impairment, Increased calcium excretion in urine

Oh, dang! - ototoxicity, hypoK, dehydration, allergy, nephritis, gout

Question 61

Amiloride specific SE

Answer 61

Hyperkalemia (blocks ENAC, lowers membrane potential, inhibits H+ and K+ excretion)

Question 62

Diuretic side effects (general)

Answer 62

Symptoms of volume depletion:
Increased RAAS–> hypoK, met alk, hyperuricemia
Thirst + ADH –> increased free water and hyponatremia

Question 63

Aquaretics specific SE

Answer 63

Hypernatremia

Block vasopressin, cause increased excretion of dilute urine

Question 64

Meds to give in hyperkalemia?

Answer 64

Calcium to stabilize cardiac membrane
Bicarb, insuline, beta agonist
Kayexalate
Stop beta blocker
Stop heparin