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Renal Final > Pharm Module 2 > Flashcards

Pharm Module 2 Flashcards

1
Q

which diuretic has an osmotic effect

A
  • mannitol
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2
Q

which diuretic acts as a carbonic anhydrase inhibitor

A
  • acetazolamide
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3
Q

which diuretics are loop diuretics

A
  • furosemide
  • torsemide
  • bumetanide
  • ethacrynic acid

LOOP FUCK THAT BITCH, EH

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4
Q

which diuretics are thiazide diuretics

A
  • Hydrochlorothiazide
  • Chlorthalidone
  • Metolazone
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5
Q

which drugs are considered K+ sparing

A
  • aldosterone antagonists

- ENaC inhibitors

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6
Q

which drugs are aldosterone antagonists

A
  • spironolactone

- eplerenone

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7
Q

which drugs are ENaC inhibitors

A
  • triamterene

- amiloride

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8
Q

side effects of carbonic anhydrase inhibitors

A
  • hypokalemia

- metabolic acidosis

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9
Q

side effects of loop diuretics

A
  • hypokalemia
  • hypercalcuria
  • hyperuricemia
  • metabolic alkalosis
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10
Q

side effects of thiazide diuretics

A
  • hypokalemia
  • hypocalcuria and hypercalcemia
  • hyperuricemia
  • metabolic alkalosis
  • hyperglycemia
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11
Q

side effects of ENaC inhibitors

A
  • hyperkalemia

- metabolic acidosis

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12
Q

side effects of aldosterone antagonists

A
  • hyperkalemia
  • Metabolic Acidosis
  • gynocomastia
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13
Q

side effects of osmotic diuretics

A
  • hypokalemia

- metabolic alkalosis

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14
Q

where do carbonic anhydrase inhibitors and osmotic diuretics act

A
  • PCT
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15
Q

where do loop diuretics act

A
  • ascending limb of LOH
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16
Q

where do thiazide diuretics act

A
  • DCT
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17
Q

where do potassium sparing diuretics act

A
  • collecting duct
18
Q

MOA of acetazolamide

A
  • inhibits activity of carbonic anhydrase
  • blocks generation of H+ in epithelial cells
  • reduces absorption of Na+ by H+/Na+ antiporter
  • Na+ and H2O build up in developing urine
19
Q

how does acetazolamide cause metabolic acidosis

A
  • blocks production and reabsorption of HCO3-

reduced buffering –> decreased blood pH (acidic)

20
Q

how does acetazolamide cause hypokalemia

A
  • urine Na+ high when reaching collecting duct
  • Na+ reabsorbed through ENaC
  • K+ excreted through ROMK
21
Q

how do loop diuretics cause hypokalemia

A
  • same way as acetazolamide

- decreased EBV activates RAAS

22
Q

how do loop diuretics cause metabolic alkalosis

A
  • aldosterone promotes loss of H+ by stimulating H+ ATPase in alpha intercalated cells
23
Q

how do loop diuretics cause hypocalcemia/hypercalcuria

A
  • loss of K+ gradient through ROMK so paracellular Ca2+ transport inhibited
24
Q

what may hypercalcuria cause

A
  • neprholithiasis (development of kidney stones)
25
Q

how do loop diuretics cause hyperuricemia and gout

A
  • reduce renal clearance of urate

- compete with urate for clearance

26
Q

what transport proteins transport loop diuretics into the lumen

importance of this

A
  • OAT4 and OAT10

- anti porters that reabsorb urate and cause it to build up in the blood

27
Q

MOA of thiazide diuretics

A
  • act on Na/CL cotranspoter in DCT
28
Q

which is more potent, thiazide diuretics or loop diuretics?

A
  • loop diuretics
29
Q

how do thiazide diuretics cause hypokalemia

A
  • same way as carbonic anhydrase inhibitors and loop diuretics
30
Q

how do thiazide diuretics cause hypercalcemia/hypocalcuria

A
  • inhibit uptake of Na through Na/CL transporter
  • reduces epithelial cell concentration of Na
  • basolateral Na/Ca2+ antiporter pumps in more Na into epithelial cells and pumps out Ca2+ into blood
31
Q

are thiazide diuretics associated with kidney stones?

A
  • no
32
Q

how do thiazide diuretics cause metabolic alkalosis

A
  • same way as loop
33
Q

how do thiazide diuretics cause hyperuricemia and gout

A
  • compete with urate for for secretion by basolateral transporters OAT1 and OAT2
34
Q

how do thiazide diuretics cause hyperglycemia and maybe diabetes

A
  • reduce volume of extracellular water compartment
  • decrease CO
  • increase sympathetic stimulation
  • inhibits hepatic glucose uptake causing serum glucose levels to rise
  • hypokalemia decreases insulin secretion which will result in increased serum glucose levels
35
Q

how do K+ sparing diuretics cause hyperkalemia

A
  • block ENaC so Na+ stays in lumen

- no K+ secretion

36
Q

how do K+ sparing diuretics cause metabolic acidosis

A
  • Na remains in tubular lumen

- lose negative charge gradient so H+ ATPase doesn’t secrete H+ into lumen

37
Q

how spironolactone causes anti-testosterone effects?

A
  • competes with binding of testosterone to SHBG
  • inhibits synthesis of testosterone
  • converts testosterone to estradiol
38
Q

can eplerenone cause these antiandrogenic effects?

why?

A
  • no

- more selective for aldosterone receptor

39
Q

is mannitol reabsorbed or secreted?

A
  • no

- stays in tubule lumen

40
Q

MOA of mannitol

A
  • draws water into tubule
41
Q

how mannitol causes hypokalemia and metabolic alkalosis

A
  • increases lumen water content
  • decreases concentration of tubular lumen K+ and H+ by dilution
  • solutes drawn out of serum and into lumen

Renal Final (13 decks)

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