Pharmacology: Renal Flashcards
Mannitol
Osmotic diruetic
Tx: Shock, drug OD, to decrease ICP/IOP
SEs: Pulm edema, dehydration
**Contrainidicated in anuria, CHF!
Acetazolamide
Carbonic anhydrase inhibitor
- Self-limited NaHCO3- diuresis
- Inhibits action of CA in the proximal tubule, preventing HCO3- reabs, resulting in decreased total body HCO3- stores.
- Alkalinizes urine
- Causes hyperchloremic metabolic acidosis
Tx: Glaucoma, metabolic alkalosis, altitude sickness (NOT for CHF)
SEs: Hyperchloremic metabolic acidosis, SULFA allergy, neuropathy/paresthesias, somnolence, NH3 toxicty
Which diuretic class is the most potent?
Loop diuretics!
Furosemide, torsemide, bumetanide, ethacrynic acid
Furosemide
Loop diuretic
- Inhibits TAL Na/K/2Cl cotransport.
- Abolishes medulla hypertonicity, preventing urine concentration
- Stimulates PGE release –> vasodilation of aff arteriole
- Incr Ca excretion!
- Rapid onset, good for acute edematous states
Tx: Edema (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hyperCa
SEs: Ototoxicity! Hypokalemia metabolic alkalosis! Sulfa allergy! Gout! Nephritis! HypoK/Mg/Ca, HTN
Ethacrynic acid
Loop diuretic
- Same as furosemide, but not a sulfa drug. Good for pts with sulfa allergy
SEs: Same as furosemide (ototoxic, hypokalemia metabolic alkalosis, nephritis). Hyperuricemia (gout)
Hydrochlorothiazide
Thiazide diuretic
- Inhibits NaCl reabs (cotransport) in the early DCT
- Reduces concentrating capacity of the nephron
- Decreases Ca excretion! (less Ca in the nephron)
Tx: HTN, CHF (but if pt has DM, give ACEI), idiopathic hypercalciuria
SEs; Hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCa.
Sulfa allergy!
Spirnolactone
K+ sparing diuretic
- Competitive aldosterone receptor antagonist in the CCT
Tx: Hyperaldosteronism, K+ depletion, CHF (improves mortality for Class III and IV CHF on top of ACEI, dig, diuretic)
SEs; HyperK, anti-androgen effects (gynecomastia)
Eplerenone
similar to the diuretic spironolactone, though it is much more selective for the mineralocorticoid receptor in comparison (i.e., does not possess any antiandrogen, progestogen, or estrogenic effects
Triamterene
Block Na+ channels in the CCT
Amiloride
Block Na+ channels in the CCT
Catopril
SE mnenomic?
ACE I
- inhibits ACE –> decr AII and prevent bradykinin inactivation –> vasdilation
- incr RENIN, 2/2 loss of feedback inhibition
Tx: HTN, CHF, diabetic renal disease, prevent unfavorable heart remodeling as a result of chronic HTN
SEs: (CAPTOPRIL) Cough, Angioedema, Potassium incr, Taste changes, Orthostatic hypotension, Pregnancy complications (kidney malformations), Rash, Increased renin, Lower AII.
**Avoid with BL RAS bc will kill your GFR by preventing efferent arteriole constriction
Enalapril
ACE I
- inhibits ACE –> decr AII and prevent bradykinin inactivation –> vasdilation
- incr RENIN, 2/2 loss of feedback inhibition
Tx: HTN, CHF, diabetic renal disease, prevent unfavorable heart remodeling as a result of chronic HTN
SEs: (CAPTOPRIL) Cough, Angioedema, Potassium incr, Taste changes, Orthostatic hypotension, Pregnancy complications (kidney malformations), Rash, Increased renin, Lower AII.
**Avoid with BL RAS bc will kill your GFR by preventing efferent arteriole constriction
Lisinopril
ACE I
- inhibits ACE –> decr AII and prevent bradykinin inactivation –> vasdilation
- incr RENIN, 2/2 loss of feedback inhibition
Tx: HTN, CHF, diabetic renal disease, prevent unfavorable heart remodeling as a result of chronic HTN
SEs: (CAPTOPRIL) Cough, Angioedema, Potassium incr, Taste changes, Orthostatic hypotension, Pregnancy complications (kidney malformations), Rash, Increased renin, Lower AII.
**Avoid with BL RAS bc will kill your GFR by preventing efferent arteriole constriction
Losartan
ARB (angiotensin receptor blocker)
- Similar effects as ACE I, but no cough bc do no increase kallikrein
