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PHARM SHELF AND BOARDS > RENAL > Flashcards

RENAL Flashcards

1
Q

Name 2 diuretics that act in the PCT

A

mannitol and acetazolamide

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1
Q

What acid base status would result from a person going on acetazolamide?

A

acidosis (metabolic) because they are losing their NaHCO3

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1
Q

What is the most common sulfonamide loop diuretic?

A

furosemide

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2
Q

Where does acetazolamide act in the nephron?

A

PCT

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2
Q

In what 2 ways do loop diuretics cause diuresis?

A

1) By inhibiting the NKCC pump in the TALH they cause a loss of hypertonicity in the renal medulla, thus, you cannot concentrate urine. 2) The stimulate PGE production which dilates the afferent arteriole and increases GFR

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2
Q

What AE is shared by spironolactone and cimetidine?

A

development of gynecomastia

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3
Q

What is the MOA of acetazolamide?

A

It is a carbonic anhydrase inhibitor, therefore, NaHCO3 is lost in the urine, this causes acidosis

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3
Q

3 indications for thiazides

A

HTN, idiopathic hypercalciuria, nephrogenic diabetes insipidus

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3
Q

What 2 diuretics cause alkalosis and why?

A

Loops and thiazides. This is predominately secondary to K loss, this pulls H in from plasma in exchange for K? Also, the volume contraction turns on RAAS which further causes H loss

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4
Q

Which K sparing diuretics are competitive antagonists of ENaC?

A

Triamterene, Amiloride

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6
Q

What are the indications (3) for loop diuretics?

A

Edematous states, hypercalcemia, and hypertension

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6
Q

What are the two MOA’s of potassium sparing diuretics?

A

1) competitive aldosterone inhibitor in cortical collecting tubules 2) Sodium Channel blocker (ENaC) in cortical collecting tubule

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8
Q

Which type of diuretic is actually contraindicated in congestive heart failure?

A

mannitol

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9
Q

Which diuretic is used to treat pseudotumor cerebri?

A

acetazolamide

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10
Q

What are the AE of thiazide diuretics (5)?

A

Sulfa allergy and hyperGLUC = Hyper -Glycemia, -Lipidemia, -Uricemia, -Calcemia

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12
Q

Which diuretic would be best for a hypercalcemic patient? Hypocalcemic?

A

Loop diuretics cause loss of Ca; Thiazides increase serum Ca

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13
Q

Which K sparing diuretics are competitive aldosterone antagonists?

A

Spironolactone and eplerenone

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14
Q

Which side effects are not present in ARBs that ACE-inhibitors cause?

A

Cough and Angioedema because ARBs do not increase bradykinin

15
Q

Where does mannitol act in the nephron?

A

PCT

16
Q

How is the chemical makeup of ethacrynic acid different from furosemide?

A

Ethacrynic acid is from phenoxyacetic acid whereas furosemide is from sulfonamides

17
Q

Which diuretic has the most endocrine AE?

A

Spironolactone, can cause gynecomastia

18
Q

What effect do ACE-I have on cardiac tissue in CHF?

A

Somehow prevent unfavorable remodeling of heart tissue

19
Q

Which 2 diuretics may cause acidosis and why?

A

1) Carbonic anhdyrase inhibitors (Acetazolamide) because it increases secretion of HCO3 2) K sparing diuretics because it blocks aldosterones ability to secrete H, and the excess K is exchanged for H at the cellular level, further increasing the acidosis

21
Q

What are the indications for K sparing diuretics?

A

Hyperaldosteronism, CHF, and K depletion

22
Q

What are the indications for mannitol?

A

Decreasing an increase in intracranial pressure and for drug overdose

23
Q

What is acetazolamide indicated for (5)?

A

Glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness (respiratory alkalosis), and pseudotumor cerebri

24
Q

In whom is mannitol contraindicated?

A

Anuric patients and CHF

26
Q

What is the MOA of thiazide diuretics?

A

Inhibit NaCl reabsorption by the distal tubule, this blocks the diluting capability of the nephron

27
Q

Why do ACE inhibitors cause hyperkalemia?

A

Because there is no stimulation of aldosterone which would cause K secretion

29
Q

Why do ACE inhibitors increase serum creatinine?

A

because they decrease the GFR

30
Q

What are the adverse effects of mannitol?

A

pulmonary edema and dehydration

31
Q

What is the MOA of mannitol?

A

An osmotic diuretic, it increases the osmolarity of the renal TUBULE, thereby increasing urine flow

32
Q

Which renal drugs are highly teratogenic?

A

ACE inhibitors

33
Q

Which diuretic is a phenoxyacetic acid derivative? Significance?

A

Ethacrynic acid? Other loop diuretics are from sulfa drugs, so ethacrynic acid can be given to a pt with sulf allergy

34
Q

Which type of diuretic is most likely to lead to a cardiac arrhythmia and why?

A

K sparing diuretic because of the potential for hyperkalemia

35
Q

What drug increases tubular fluid osmolarity thereby producing an increase in urine flow?

A

mannitol

36
Q

Which diuretics can be used to treat nephrogenic diabetes insipidus?

A

thiazides

37
Q

Which diuretics are best for osteoporotic patients?

A

Thiazides because increase calcium reabsorption

39
Q

What are the plasma renin levels of a person on ACE-inhibitors?

A

increased due to loss of negative feedback

40
Q

Where in the nephron is the increased calcium reaborption with thiazides taking place?

A

Paracellular route in LOH and PCT; HOWEVER, thiazides act on the DCT

41
Q

Name 3 types of diuretics that can cause sulfa allergy

A

acetazolamide, hydrochlorothiazide, and loop diuretics (ethacrynic acid is safer)

42
Q

What are the AE (6) of loop diuretics?

A

Ototoxicity, Hypokalemia, Dehydration, sulfa Allergy, interstitial Nephritis, Gout (OH DANG = mnemonic)

43
Q

Which drugs can inhibit loop diuretics? Why?

A

NSAIDs; part of the effect of the loop diuretic involves the release of PGE to dilate afferent arteriole and increase GFR, NSAIDs would block that

44
Q

In whom are ACE inhibitors contraindicated because they will precipitate renal failure?

A

Bilateral renal artery stenosis, as they will further decrease GFR

PHARM SHELF AND BOARDS (13 decks)

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