Pharmacology

Question 1

Angiotensin converting enzyme inhibitors

Answer 1

Captopril, Enalapril, lisinopril, Ramipril

Question 2

ACE inhibitor MOA

Answer 2

Inhibit ACE decreasing AT II leading to dilation of efferent arteriole which decreases GFR

Question 3

ACE inhibitor contraindications

Answer 3

C1 esterase inhibitor deficiency

Bilateral renal artery stenosis - leads to renal failure

Question 4

ACE inhibitor side effects

Answer 4

Cough, Angioedema, Teratogen, increased Creatinine, Hyperkalemia and Hypotension

Question 5

Benefit of ACE inhibitor in chronic kidney disease

Answer 5

Decreases intraglomerular pressure slowing GBM thickening

Question 6

ATII receptor blockers

Answer 6

Losartan, candesartan, valsartan

Question 7

ATII receptor blockers MOA

Answer 7

Selectively block AT1 receptors

Question 8

Cause of cough with ACE inhibitors

Answer 8

ACE inhibitors prevent breakdown of bradykinins

Question 9

Benefit of ATII receptor blockers over ACE inhibitors

Answer 9

Do not increase bradykinin levels

Question 10

Indications for ACE inhibitors

Answer 10

HTN, HF, proteinuria, diabetic nephropathy

Question 11

Benefits of ACE inhibitors in heart disease

Answer 11

Decrease mortality in HF and prevent unfavorable heart remodeling as a result of chronic HTN

Question 12

Indications for ATII receptor blockers

Answer 12

HTN, HF, proteinuria, CKD with ACE inhibitor intolerance

Question 13

ATII receptor blockers side effects

Answer 13

Hyperkalemia, decreased GFR, HoTN, teratogen

Question 14

Aliskiren MOA

Answer 14

Blocks conversion AT-I to AT-II by blocking renin

Question 15

Aliskiren indications

Answer 15

HTN

Question 16

Aliskiren side effects

Answer 16

Hyperkalemia, decreased GFR, HoTN, angioedema

Question 17

Aliskiren contraindications

Answer 17

In those already taking ACE inhibitors or ARBs

Question 18

Thiazide diuretics

Answer 18

Hydrochlorothiazide, chlorthalidone, metolazone

Question 19

Thiazide diuretics MOA

Answer 19

Inhibit NaCl reabsorption in DCT decreasing diluting capacity of nephron

Question 20

Thiazide diuretics indications

Answer 20

HTN, HF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis

Question 21

Thiazide diuretics side effects

Answer 21

Hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia

Question 22

Thiazide diuretics contraindications

Answer 22

Sulfa allergy

Question 23

Potassium sparing diuretics

Answer 23

Spironolactone and Eplerenone; Triamterene and Amiloride

Question 24

Spironolactone and Eplerenone MOA

Answer 24

Competitive aldosterone receptor antagonists in cortical collecting tubule

Question 25

Triamterene and Amiloride MOA

Answer 25

Block Na channels in cortical collecting tubule

Question 26

Potassium sparing diuretics indications

Answer 26

Hyperaldosteronism, K depletion, HF, antiandrogen

Question 27

Additional indication for spironolactone

Answer 27

Hepatic ascites

Question 28

Additional indication for amiloride

Answer 28

Nephrogenic diabetes insipidus

Question 29

Potassium sparing diuretics side effects

Answer 29

Hyperkalemia - causes arrhythmias

Question 30

Spironolactone side effects

Answer 30

Gynecomastia and antiandrogen effects

Question 31

What may urine electrolyte may increase with all diuretics

Answer 31

Urine NaCl - serum NaCl decreases too

Question 32

What may urine electrolyte may increase with thiazide diuretics

Answer 32

Potassium - serum K decreases too

Question 33

Mechanism for alkalemia in loop diuretics

Answer 33

1. Volume contraction - increased AT-II increases Na/H+ exchange in PCT increasing HCO3- reabsorption 2. K loss causes H-K shift K out and H+ into cells 3. Low K state H+ exchanged for Na - also causes paradoxical aciduria

Question 34

Mechanism for acidemia in carbonic anhydrase inhibitors

Answer 34

Decreased HCO3 reabsorption

Question 35

Mechanism for acidemia K-sparing diuretics

Answer 35

Aldosterone blockade prevents K and H+ secretion

Question 36

Mechanism for acidemia in hyperkalemia

Answer 36

H-K shift moves K in and H+ out of cells

Question 37

Mechanism for increased urine Ca with loop diuretics

Answer 37

Decreased paracellular Ca reabsorption causes hypocalcemia

Question 38

Mechanism for decreased urine Ca with thiazide diuretics

Answer 38

Enhanced Ca reabsorption

Question 39

Osmotic diuretic which increases tubular fluid osmolarity leading to increased urine flow and used to treat increased ICP/intraocular pressure

Answer 39

Mannitol

Question 40

Indications for mannitol

Answer 40

Drug overdose and increased ICP/intraocular pressure

Question 41

Mannitol side effects

Answer 41

Pulmonary edema, dehydration

Question 42

Mannitol contraindications

Answer 42

Anuria and HF

Question 43

Carbonic anhydrase inhibitor

Answer 43

Acetazolamide

Question 44

Acetazolamide MOA

Answer 44

Causes self limited NaHCO3 diuresis and decreased total body stores of HCO3- stores

Question 45

Acetazolamide indications

Answer 45

Glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri

Question 46

Acetazolamide side effects

Answer 46

Proximal renal tubular acidosis, paresthesias, NH3 toxicity, hypokalemia, sulfa allergy

Question 47

Loop diuretics

Answer 47

Furosemide, bumetanide, torsemide

Question 48

Loop diuretics MOA

Answer 48

Sulfonamide loop diuretics inhibit Na/K/2Cl of thick ascending limp of loop of Henle preventing concentration of urine

Question 49

Loop diuretics side effects

Answer 49

Ototoxicity, Hypokalemia, Hypomagnesemia, Dehydration, Allergy (sulfa), metabolic Alkalosis, Nephritis, Gout

Question 50

Loop diuretics indications

Answer 50

Edematous state, HTN, hypercalcemia

Question 51

Non-sulfonamide inhibitor of Na/K/2Cl of thick ascending limb of loop of Henle

Answer 51

Ethacrynic acid

Question 52

Ethacrynic acid indications

Answer 52

Diuresis of patients allergic to sulfa drugs

Question 53

Ethacrynic acid side effects

Answer 53

Same as loop diuretics but more ototoxic