RENAL

Question 1

List some brand names for the generic drug FUROSEMIDE (pg 931)

Answer 1

Lasix, Frusid, Frusax, Urex

Question 2

List the available forms of FUROSEMIDE

Answer 2

Ampoules: 20mg/2mL, 40mg/4mL, 250mg/25mL\
Tablets: 20mg, 40mg, 500mg
Oral solution: 10mg/mL

Question 3

List the actions of FUROSEMIDE (pg 931)

Answer 3

• Sulfonamide
• diuresis onset within 1 hour (oral), peak 1-2 hours, duration 6-8 hours
• diuresis onset within 10-15 minutes (IM), 5 minutes (IV), peak 30 minutes, duration 2 hours (IM, IV).
• biphasic half-life is about 100 minutes
• oral bioavailability is about 50% of IV (e.g. 20 mg IV = 40 mg oral)
• oral bioavailability may be reduced in those with severe heart failure or renal impairment.

Question 4

What drug classification is FRUOSEMIDE?

Answer 4

High-Ceiling (LOOP) Diuretics

Question 5

List three general ACTIONS of high-ceiling (loop) diuretics (pg 926)

Answer 5

• Potent diuretics that inhibit potassium, sodium and chloride absorption in the proximal and distal convoluted tubules, but mainly in the ascending limb of the loop of Henle, resulting in increased water excretion.
• some direct vascular effect, which may be due to reduced response to angiotensin II and noradrenaline (both vasoconstrictors)
• rapid onset of action.

Question 6

List some generic and brand names of three high-ceiling (loop) diuretics

Answer 6

BUMETANIDE, (Burinex)

ETACRYNIC (ETHACRYNIC) ACID, (Edecrin)

FUROSEMIDE (FRUSEMIDE), (Frusax, Frusid, Lasix, Lasix High Dose, Uremide, Urex, UrexM, UrexForte)

Question 7

List three general USES of high-ceiling (loop) diuretics (pg 926)

Answer 7

• oedema associated with heart failure, cirrhosis, nephrotic syndrome and renal impairment
• acute pulmonary oedema (where other diuretics have been ineffective)
• hypertension (alone or with antihypertensive agent.

Question 8

List some general adverse effects of high ceiling (loop) diuretics (pg 927)

Answer 8

• electrolyte imbalance (hyponatraemia, hypokalaemia, hypomagnesaemia, hyperglycaemia, metabolic acidosis, increased creatinine and blood urea nitrogen (BUN).
• hypovolaemia, dehydration (thirst, dizziness, headache, dry mouth, visual disturbances)
• urinary retention
• deafness, vertigo, tinnitus, sense of fullness in the ears

Question 9

List some general interactions of high-ceiling (loop) diuretics (pg 927

Answer 9

• not recommended with lithium because lithium serum levels and toxicity are increased.
• effects of antihypertensive agents may be enhanced
• high-ceiling (loop) diuretic-induced hypokalaemia may increase risk of toxicity and arrhythmias of digoxin.
• increased risk of ototoxicity and nephrotoxicity if given with aminoglycosides.
• caution if used with angiotensin receptor antagonist or ACE inhibitors because of increased risk of first dose hypotension (severe)

Question 10

What are Diuretics?

Answer 10

Diuretics are designed to increased the amount of water and salt expelled from the body as urine.

Question 11

How do diuretics decrease BP?

Answer 11

Diuretics work on the renal system and increase the amount of water and sodium expelled in urine, therefore decreasing overall plasma volume, this decreases the blood pressure.

Question 12

What is PUJ obstruction?

Answer 12

Ureteropelvic junction obstruction. Is defined as the obstruction of the flow of urine from the renal pelvis to the proximal ureter.

Question 13

DESCRIBE FELODIPINE (Felodour ER) and its use in a patient presenting with ARF with a background of CRF and HTN.

Answer 13

EXTENDED RELEASE calcium channel blocker
actions: 
>dihydropyridine
>mild natriuretic and diuretic effect
>no effect on conduction. 

• can be given QD (once daily), as medication is extended release. FELODIPINE has an onset of action of 120-300 minutes., peak 2.5-5 hours and a duration of action of 24 hours.
• clinical reasoning for HTN/ARF with a background of CRF: this medication will both increase urine output by the process of increased sodium excretion in the kidneys, as well as treat the diagnosed hypertension, decreasing cardiac workload and pressure on the kidneys.

Question 14

Describe TCC. What does it stand for and what is the treatment?

Answer 14

TCC stands for transitional cell carcinoma or UCC urothelial carcinoma is a cancer that typically occurs in the urinary system. It is the most common type of bladder cancer and cancer of the ureter and/or urethra.
Intervention is often surgical excision of affected organ.

Question 15

Bx stands for

Answer 15

biopsy - an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease