Nephron

Question 1

Which part of nephron do Carbonic Anhydrides inhibitors effect?

Answer 1

• Proximal Tubule

This is where most of the absorption occurs

  - 65% - NaCl, K, Ca, Mg
  - 85% - NaHCO3, 
  - 100% Glucose & AA

• Secretion of Acids & Bases

Question 2

Carbonic Anhydrides inhibitor - MOA?

Answer 2

• Reduces Aqueous Humor production in the eye

- Inhibits enzymes responsible for dehydration of H2CO3

Question 3

Carbonic Anhydrides inhibitor drugs?

Answer 3

• Acetazolamide –> Altitude sickness
• Dorzolamide (topical) –> Glaucoma
• Brinzolamide (topical) –> Glaucoma

Question 4

Carbonic Anhydrides inhibitor - Uses?

Answer 4

• **GLAUCOMA
• Urinary alkalization,
• Metabolic alkalosis,
• Acute mountain sickness

Can cause (incr pH)

Question 5

Carbonic Anhydrides inhibitor - ADRs?

Answer 5

• Stones,
• K wasting,
• Drowsiness,
• Hypersensitivity

Question 6

Carbonic Anhydrides inhibitor - CI?

Answer 6

Hepatic cirrhosis

Question 7

Loop diuretics drugs?

Answer 7

• Furosemide - 40
• Toresemide - 20
• Bumetanide - 1
• Ethacrynic Acid (Edercin)
  - Safe in pts w/ sulfa allergy

Question 8

Loops MOA?

Answer 8

Inhibits Na, K & Cl transport/pump

Question 9

Loops uses?

Answer 9

• Edema,
• CHF
• ↑ Ca
• ↑ K
• Anion overdose

Question 10

What drug can effect loops and how?

Answer 10

NSAIDS reduce the effect of loops

Question 11

LOOP - CI?

Answer 11

• Sulfa allergy (Ethacrynic Acid is safe to use)

- overuse in HF, Cirrhosis, RF

Question 12

Loop - ADRs?

Answer 12

• ↓ Mg
• ↑ Uric acid
• Ototoxicity
• Hypersensitivity

Question 13

Role of Loop of henle?

Answer 13

• Reabsorbs 15-25% of
  - NaCl, K, Ca, Mg,
• Secretes
  - K

Question 14

Loop conversion of Furosemide?

Answer 14

PO - IV –> 2:1

Ceiling effect can occur

Question 15

Which part of nephron do Thiazides effect?

Answer 15

DCT

DCT role:
Reabsorbs 4-8% of:
- Na, Cl

Secretes
- Ca (ctrl’ed by parathyroids)

Question 16

Thiazides - drugs?

Answer 16

• HCTZ (Hydrodiuril)

- Chlorothiazide (Diuril)

Question 17

Thiazides - MOA?

Answer 17

• Inhibit NaCl transporter
• Enhance Ca reabsorption
• Slow absorption

Question 18

Thiazides - Uses?

Answer 18

• **HTN (MC)
• HF
• DM,
• Nephrolithiasis

Question 19

Thiazides - ADRs?

Answer 19

• ↓ Na
• ↓ K
• ↑ Uric acid
• ↑ lipids
• Photosensitivity
• Hypersensitivity

Question 20

Thiazides - CI?

Answer 20

• *Overuse in
  
  • HF
  • Cirrhosis
  • RF, *****GFR< 20

Question 21

Thiazides-like diuretic drugs?

Answer 21

• Metolazone (Zaroxylin)
• Indapamide (Lozol)
• Chlorthalidone IV

Question 22

Thiazides-like diuretic - MOA?

Answer 22

Works same as Thiazides (d/t sulfa group they contain), but structurally different

Question 23

What’s unique about Metolazone?

Answer 23

Can be used in ***GFR <20

Question 24

Which Thiazides-like diuretic has slowest absorption?

Answer 24

Chlorthalidone IV

- has long 1/2 life***

Question 25

Thiazides-like diuretic ADRs & CI?

Answer 25

SAME as Thiazides

Question 26

At what level of GFR are thiazides ineffective?

Answer 26

*****GFR < 20 - Except Metolazone

Question 27

What is the only Thiazide-like diuretic on IV formulation?

Answer 27

Chlorthalidone

Question 28

Which part of nephron do K Sparing work on?

Answer 28

Cortical Collecting Tubule Cortical Collecting Tubule role: - Reabsorbs 2-5% - Na - Secretes - H & K

Question 29

K Sparing - Drugs?

Answer 29

- Spironolactone - Eplerenone (DI: Fluconazole, diltiazem, ******GF juice) - Triamterine - Amiloride

Question 30

K Sparing - MOA?

Answer 30

Spironolacton & Eplerenone: - Prevents K secretion - Antagonizes mineralocorticoid receptors - Prevents aldosterone from binding Triamterine & Amiloride - Inhibits Na ion channels

Question 31

K Sparing - Uses?

Answer 31

* ***Hypokalemia | - For prevention & tx

Question 32

Spironolacton uses?

Answer 32

- Hyperaldosterone, - PCOS, - Hirsutism. - *Slow onset (days)

Question 33

Spironolacton ADR & CI?

Answer 33

ADR: - Gynecomastia, - Impotence. CI: - Addison’s

Question 34

What MUST you ALWAYS check before giving K Sparing?

Answer 34

***K levels, - bc K-sparing can cause ****Hyperkalemia

Question 35

Triamterine ADR?

Answer 35

Kidney Stones

Question 36

Which part of the nephrons does ADH (aka vasopressin) Antagonist effect?

Answer 36

Medullary collecting duct Medullary duct role: - Reabsorbs: - *H2O - Secretes - Nothing

Question 37

ADH Antagonist - drugs?

Answer 37

Indirect: - Lithium, - Demeclocycline Direct (DI: Fluconazole, diltiazem, ***GF juice): - Conivaptan, - Talvaptan

Question 38

ADH Antagonist - MOA (indirect)

Answer 38

Unknown

Question 39

ADH Antagonist - MOA (direct)

Answer 39

- Inhibits vasopressin receptors | - Direct binding

Question 40

ADH Antagonist - Uses?

Answer 40

- ***CHF - ***SIADH Onset - hrs

Question 41

ADH Antagonist - ADRs (Direct)

Answer 41

- Nausea, - Dry mouth, - Thirst

Question 42

ADH Antagonist - CI (Direct)

Answer 42

- Hypovolemia | - Hyponatremia

Question 43

ADH Antagonist (direct)- drug-drug interaction?

Answer 43

- Strong CYP 3A4 - Fluconazole - Diltiazem - ***GF juice

Question 44

Osmotic Diuretic - Drugs?

Answer 44

- Glycerol - Mannitol (PO, Inhale, IV) - IV formulation crystalized - keep it worm

Question 45

Osmotic Diuretic - MOA?

Answer 45

- ↑ Osmotic pressure in Glomerulus, - ↓ reabsorption of H2O & lytes - Work outside of the nephron

Question 46

Osmotic Diuretic - Uses?

Answer 46

- *Cerebral edema, - *Acute glaucoma, - Bronchial hyper-responsiveness.

Question 47

What is the problem with Osmotic Diuretics absorption?

Answer 47

- ***Poor absorbed & quick excreted | - Oral better tolerated (mix w/ OJ to help pt tolerate it better)

Question 48

Glycerol ADRs?

Answer 48

N/V/D

Question 49

Mannitol ADRs?

Answer 49

- ****Excess volume expansion - HF - Edema - Pulm congestion

Question 50

Osmotic Diuretic - CI?

Answer 50

Hypersensitivity