Renal

Question 1

Mannitol

Answer 1

MOA:
Osmotic diuretic

Use:
For drug OD; ↑ intracranial/intraocular pressure

Tox:
Pulm edema; hypernatremia; dehyrdration; contraindicated in anuria & CHF

Question 2

Acetazolamide

Answer 2

MOA:

• Carbonic anhydrase inhibitor
• Causes self limited NaHCO3 diuresis and ↓ total-body HCO3- stores

Use:
Glaucoma; urinary alkalinization; met alkalosis; altitude sickness; pseudotumor cerebra

Tox:
Hyperchloremic metabolic acidosis
Paresthesias
NH3 toxicity 
Sulfa allergy

Question 3

Furosemide

Answer 3

Sulfonamide loop diuretic

MOA:

• Inhibits cotransport system (Na+/K+/2Cl-) of thick ascending limb of loop of Henle
• Stim’s PGE release (vasodilatory effect on afferent arteriole–> increases GFR–> enhance drug delivery)
• Inhibited by NSAIDs
• ↑Ca2+ excretion

Use:

• Edematous states –> CHF, cirrhosis, nephrotic syndrome, PE
• HTN
• HyperCa2+

Tox:
OH DANG!
Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout

Question 4

Ethacrynic acid

Answer 4

Phenoxyacetic acid loop diuretic

MOA:
-Inhibits cotransport system (Na+/K+/2Cl-) of thick ascending limb of loop of Henle

Use:
Diuresis in pt’s allergic to sulfa drugs

Tox:
-Can cause hyperuricemia (never us to Tx gout)

Question 5

Hydrochlorothiazide

Answer 5

MOA:

• Inhib’s NaCl reabsorption in early distal tubule
• ↓ diluting capacity of the nephron
• ↓ Ca2+ excretion

Use:

• HTN
• CHF
• Idiopathic hpercalciuria
• Nephrogenic diabetes insipidus
• Osteoporosis

Tox:

• Hypokalemic metabolic alkalosis
• Hyponatremia
• HyperGLUC
• Sulfa allergy

Question 6

Spironolactone and Eplerenone

Triamterene and Amiloride

Answer 6

MOA:
-Spironolactone and eplerenone are competitive aldosterone receptor antagonists in the cortical collecting tubule.

-Triamterne and amiloride act at the same part f the tubule by blocking Na+ channels in the CCT

Use:
Hyperaldosteronism, K+ depletion, CHF

Tox:
Hyperkalemia (can lead to arrhythmia)
Endocrine effects with sprinolactone (gynecomastia, anti androgen effects)

Question 7

ACEi –> Captopril, enalapril, lisinopril

Answer 7

MOA:

• Inhib ACE –> ↓ATII –> ↓GFR by preventing constriction of efferent arterioles.
• ↑levels of renin

Use:

• HTN, CHF, proteinuria, diabetic rephropathy.
• Prevent heart remodeling due to HTN

Tox:

• Cough, Angioedema, Teratogen, ↑Cr (↓GFR), Hyperkalemia, and Hypotension.
• *Avoid in bilateral renal artery stenosis, b/c ACEi will further ↓GFR –> renal failure

Question 8

5-Alpha reductase inhibitors –> Finasteride, dutasteride

Answer 8

MOA:
-Inhibit conversion of testosterone to dihydrotestosterone in the prostate.

Use:

• (BPH) Reduce prostate gland size (volume) to improve fixed component of bladder outlet obstruction.
• Can take up to 6-12 months for symptom improvement

Tox:

• Decreased libido
• Erectile dysfunction

Question 9

Alpha adrenergic antagonists –> Terazosin, tamsulosin

Answer 9

MOA:
-Relax smooth m. in bladder neck, prostate capsule, prostatic urethra

Use:

• BPH
• Work on dynamic component of bladder outlet obstruction
• Works w/n days to weeks

Tox:
Orthostatic hypertension, dizziness

Question 10

Medical therapy for benign prostatic hyperplasia

Answer 10

**5-Alpha reductase inhibitors –> Finasteride, dutasteride

**Alpha-adrenergic antagonists –> Terazosin, tamsulosin

**Antimuscarinics –> Tolterodine

Question 11

Drugs that cause ototoxicity

Answer 11

• Loop diuretics
• Aminoglycosides (GNATS)
• Salicylates
• Cisplatin