Renal 2

Question 1

Hyperphosphatemia

Answer 1

Elevated levels of phosphate
- Greater than 1.46 nM

A sign of Chronic Kidney Disease

Question 2

Hyperkalemia

Answer 2

Elevated levels of potassium
- Standard: Greater than 5.5 nM
- Mild: 5.6 - 5.9 nM
- Moderate: 6.0 - 6.4 nM
- Severe: Greater than 6.5 nM

Is induced by:
- Potassium Sparing Diuretics (Spironolactone)
- NSAIDS
- ACE Inhibitors

Question 3

Phosphate Binders
- Examples

Answer 3

Aluminium Hydroxide, Calcium Carbonate, Sevelamer Hydrochloride

Question 4

Phosphate Binders
- Use

Answer 4

Treats Hyperphosphatemia by binding to phosphate to form insoluble phosphate complexes

Calcium Carbonate prevents Hypocalcemia

Sevelamer Hydrochloride is less likely to cause calcification
- Can also lower LDL cholesterol

Question 5

Phosphate Binders
- Adverse Effects

Answer 5

In General Phosphate Binders are contraindicated in:
- Hypophosphatemia
- Bowel Obstructions

Calcium Carbonate: Hypercalcemia and accelerated vascular calcification

Sevelamer Hydrochloride: Reduces bioavailability of fat soluble vitamins

Question 6

Hyperkalemia Treatment Drugs
- Examples

Answer 6

• Sodium/Calcium Polystyrene Sulfonate
• Glucose + Insulin
• Salbutamol

Question 7

Sodium/Calcium Polystyrene Sulfonate
- MOA

Answer 7

Cation Exchange Resin
- Binds to potassium in exchange of sodium/calcium

Prescribed with sorbitol to prevent constipation

Question 8

Sodium/Calcium Polystyrene Sulfonate
- Adverse Effects

Answer 8

Combination with sorbitol may lead to GI Adverse effects
- Bleeding
- Ischemic Colitis
- Perforation

Question 9

Glucose + Insulin
- MOA

Answer 9

Treats Hyperkalemia
- Insulin increases Na+/K+ ATPase activity which causes potassium to shift into cells
- Glucose is given to prevent hypoglycemia
(Insulin provides therapeutic effect)
(Glucose controls effects of insulin)

Question 10

Salbutamol
- MOA

Answer 10

Treats Hyperkalemia
- Activates beta 2 adrenoceptor which increases Na+/K+ ATPase causing an increase of potassium uptake into cells

Dose is significantly higher than what is used to treat Bronchospasms (10-20mg)

Question 11

Drugs that act on Na+/K+ ATPase
- Examples

Answer 11

Glucose + Insulin
Salbutamol

Treat Hyperkalemia by shifting potassium in blood into cells

Question 12

Enuresis

Answer 12

Urinary Incontinence (Bed Wetting)
- Common in children

Most drugs that prevent incontinence will cause urinary retention

Question 13

Mictuition

Answer 13

The process of expelling urine and emptying the bladder
- Disordered Micturition is common in adults

Question 14

Antidiuretic Hormone
- Examples

Answer 14

Vasopressin, Desmopressin

Question 15

Antidiuretic Hormone
- Use

Answer 15

Desmopressin is used to manage nocturnal enuresis in children to prevent them from wetting the bed

Question 16

Antidiuretic Hormone
- MOA

Answer 16

Acts on Vasopressin 1 and Vasopressin 2 Receptors

V2 receptors are found in the collecting ducts of the nephron
Stimulation of V2 Receptors stimulates aquaporins to reabsorb water

Desmopressin:
- More specific for V2 receptors to stimulate aquaporins to reabsorb water

Question 17

Antidiuretic Hormone
- Adverse Effecs

Answer 17

Water Intoxication (Hyponatremia)
Hypotension (When administered IV)

Question 18

Where are V2 receptors found?

Answer 18

V2 receptors are found in the collecting ducts of the nephron

Question 19

Anticholinergics
- Examples

Answer 19

M3 Specific:
- Darifenacin
- Solifenacin

Nonselective:
- Oxybutynin
- Tolterodine

Question 20

Anticholinergics
- Use

Answer 20

Treats overactive bladder (Urinary Incontinence)

Question 21

Anticholinergics
- MOA

Answer 21

Bladder expresses all 5 Muscarinic Receptor
- M3 is the responsible for contraction of the muscles that are responsible for emptying the bladder
- By blocking M3 you block the action of urinating

Question 22

Beta 3 Adrenoceptor
- Examples

Answer 22

Mirabegron

Question 23

Beta 3 Adrenoceptor
- Use

Answer 23

Treats overactive bladder (Urinary Incontinence)

Question 24

Beta 3 Adrenoceptor
- MOA

Answer 24

Activation of Beta 3 Adrenoceptor induces relaxation of smooth muscle of the bladder
- Increases Bladder Capacity

Question 25

Beta 3 Adrenoceptor
- Adverse Effects

Answer 25

• Increase Blood Pressure
• Bladder Pain
• Dry mouth