Pharmacology Renal

Question 1

Decreases intraocular and intracranial pressure

Answer 1

Mannitol: osmotic diuretic–increases tubular fluid osmolarity–>increased urine flow. Tx: pulmonary edema, dehydration, Contraindicated in anuria, CHF

Question 2

Used in glaucoma

Answer 2

Acetazolamide: carbonic anhydrase inhibitor–self limited NaHCO3 diuresis, decrease total-body HCO3. Used in glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri

Question 3

Tx of acetazolamide? Acid/Base disturbance?

Answer 3

Hyperchloremic metabolic acidosis, paresthesias, NH3 toxicity, sulfa allergy

Question 4

Sulfonamide loop diuretic

Answer 4

Furosemide: inhibits NaK2Cl cotransporter in thick ascending limb–>abolishes hypertonicity of medulla and inhibits urine concentration. Stimulates PGE release, which dilates afferent arteriole. Increases Ca excretion.

Question 5

Uses for furosemide:

Answer 5

Edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia

Question 6

Furosemide toxcity:

Answer 6

Sulfa drug!! OH DANG: ototoxicity, hypokalemia, dehydration, allergy, nephritis (interstitial), gout

Question 7

What is the difference between furosemide and ethacrynic acid?

Answer 7

Both have same MoA. Ethacrynic acid is phenoxyacetic acid derivative and safe to use in sulfa-allergic patients.

Question 8

Tx of ethacrynic acid

Answer 8

Can cause hyperuricemia, induce gout. Never use to treat gout.

Question 9

Thiazide diuretic

Answer 9

HCTZ–inhibits NaCl reabsorption in early distal tubule, decreases diluting capacity of nephron, decreased Ca excretion

Question 10

Uses for HCTZ:

Answer 10

HTN, CHF, hypercalciuria, nephrogenic diabetes insipidus, osteoporosis (save calcium)

Question 11

HCTZ toxicity:

Answer 11

Hypokalemic metabolic alkalosis. Hyponatremia, HyperGLUC: Hyerglycemia, hyperLipidemia, hyperUricemia, hyperCalcemia. Sulfa allergy.

Question 12

K sparing diuretics

Answer 12

Spironolactone, epleronone, Triamterene, Amiloride. All can cause hyperkalemia. Use in hyperaldosteronism, K depletion, CHF

Question 13

Competitive aldosterone receptor antagonists

Answer 13

Spironolactone, epleronone

Question 14

Block Na channels in collecting tubule

Answer 14

Triamterene, amiloride

Question 15

Toxicity of spironolactone

Answer 15

Mild anti-androgen effects: gynecomastia

Question 16

Increase urine NaCl

Answer 16

all diuretics except acetazolamide

Question 17

Increase urine K+

Answer 17

loop and thiazide diuretics

Question 18

Causes acidemia

Answer 18

carbonic anhydrase inhibitors, K+ sparing diuretics

Question 19

Causes alkalemia

Answer 19

loop diuretics, thiazides

Question 20

What causes alkalosis and paradoxical aciduria

Answer 20

In low K state, H+ (instead of K) is used in Na/K exchange to re-absorb Na–>aciduria

Question 21

Calcium wasting

Answer 21

loop diuretics cause hypocalcemia (decrease paracellular Ca re-absorption)

Question 22

Hypercalcemia

Answer 22

thiazides can cause hypercalcemia

Question 23

What happens to renin levels when ACEi are used?

Answer 23

Renin levels increase (loss of ACE negative feedback). Also bradykinin levels rise (ACE inactivates bradykinin)

Question 24

ACEi toxicity?

Answer 24

CATCHH: cough, angioedema (contraindicated in C1 esterase deficiency), teratogen (fetal renal malformations), increased creatinine (low GFR), Hyperkalemia, Hypotension

Question 25

ACEi contraindicated when?

Answer 25

C1 esterase deficiency, pregnancy, bilateral renal artery stenosis