Renal and Endocrine Flashcards
1
Q
Vaptans
A
Collecting Duct Diuretics V2 antagonists Drugs: - conivaptan - tolvaptan - satavaptan Use: - resolves hyponatremia
2
Q
Desmopressin
A
V1 and V2 agonist ADH analog - DDAVP Actions: - vasoconstriction - releases vWF from endothelial cells - helps pts reabsorb water Indications: - diabetes insipidus - sleep enuresis - hemophilia and vWF disease
3
Q
Acetazolamide
A
Carbonic Anhydrase inhibitor - others: dorzolamide, zonisamide Weak diuretic - limited by GT balance activation Bicarbonaturia - makes you acidic, metabolic acidosis Not used for volume overload Indications: - glaucoma - epilepsy - altitude sickness - metabolic alkalosis - hyperK/hypoK periodic paralysis Side effects: - drowsiness - dizziness - headache - fatigue
4
Q
Mannitol
A
Osmotic diuretic
- induce convective movement of water into lumen (more than solutes)
- huge aquaresis
Not effective for IV contrast nephropathy
Indications:
- decreases intracranial pressure
- induce forced diuresis - rhabdomyolysis
- free radical scavenger
Side effects:
- initial ECF volume expansion before water loss
5
Q
Furosemide
A
Loop diuretic - blocks Na K 2Cl transporter in TALH - weak carbonic anhydrase inhibitor - vasodilation Large volume natriuresis Isosthenuria Minimum amount needed to achieve effect, with a maximal level of effectiveness 6 hours Variable oral bioavailability Sulfonamide moiety - anaphylaxis can occur Indications: - edema - 1st line for CHF - edema, other - acute pulm edema (immediately vasodilates), cirrhosis, nephrotic syndrome - HTN - hypercalcemia - induces Ca loss - forced diuresis Side effects: - excess volume depletion - hypoK - leading to cardiac arrhythmias - hypoCa - hypoMg - ototoxicity Other use: - tumor lysis syndrome with normosaline to increase loss of uric acid - accelerate Na turnover, give with normosaline
6
Q
Loop diuretics
A
Furosemide Torsemide - sulfa - high bioavailable Bumetanide - sulfa - high bioavailable Ethacrynic acid - no sulfa - high bioavailable
7
Q
HCTZ
A
Thiazide diuretics - block NCC in DCT - moderate volume natriuresis Cannot produce maximally dilute urine - can't lose electrolyte free water (no hypotonic urine) Ineffective if GFR less than 40 Direct vasodilator Usual dose not over 25 Contraindicated if hyponatremia Uses: - nephrogenic DI - induces Na depletion, increases collecting duct water reabsoprtion Indications: - HTN - first line - edema - nephrogenic DI - hypercalciuria - risk factor for kidney stones - dose over 25 Side effects: - hyponatremia - hypoK - hyperlipidemia - hypercalcemia - hyperuricemia - azotemia - glucose intolerance
8
Q
Metolazone
A
Thiazide diuretic - significant proximal tubular effects - partial carbonic anhydrase inhibitor - increased natriuresis Contraindicated if hyponatremia
9
Q
Amiloride
A
K sparing diuretic - blocks ENaC - reduce K excretion Small to moderate diuresis Indications: - cirrhosis - combination with HCTZ - blocks hypoK from thiazides Side effects: - hyperK - potentiated by NSAIDs and ACE-I - hypotension
10
Q
Spironolactone
A
K sparing diuretic - block aldo - inhbits K excretion Small to moderate diuresis Long half-life Indications: - cirrhosis - CHF - hyperaldosteronism - 1st line Side effects: - hyperK - hypotension - gynecomastia - erectile dysfnx
11
Q
Eplerenone
A
K sparing diuretic - block mineralocorticoid receptor - inhibits K excretion Small to moderate diuresis Indications: - CHF - cirrhosis? Side effects: - hyperK - hypotension
12
Q
Triamterene
A
K sparing diuretic - blocks ENaC - reduce K excretion Small to moderate diuresis Indications: - cirrhosis - combination with HCTZ - blocks hypoK from thiazides Side effects: - hyperK - potentiated by NSAIDs and ACE-I - hypotension
13
Q
Dutasteride
A
5 alpha reductase inhibitor - blocks conversion of testosterone to DHT - reduces size of prostate in BPH - reduces urinary symptoms in BPH Takes 6 mo for action Side effects: - sexual dysfnx - gynecomastia - increased hair growth
14
Q
Finasteride
A
5 alpha reductase inhibitor - blocks conversion of testosterone to DHT - reduces size of prostate in BPH - reduces urinary symptoms in BPH Takes 6 mo for action Side effects: - sexual dysfnx - gynecomastia - increased hair growth
15
Q
Mifepristone
A
Anti-progesterone - disrupts endometrium - softens cervix - lowers progesterone in body Abortion bill
16
Q
Flutamide, Bicalutamide, Nilutamide
A
Anti-testosterone
- 2nd line for prostate cancer
17
Q
Clomiphene
A
Selective estrogen receptor modulator - stimulates ovulation - used for infertility Mechanism: - binds to estrogen receptors in hypothalamus and anterior pituitary - inhibits negative feedback of estrogen - increases FSH production - has pro-estrogenic effects in ovary
18
Q
Tamoxifen
A
Selective estrogen receptor modulator - breast cancer rx and prevention Antagonist on breast tissue Agonist on endometrium Agonist on bone - reduced osteoporosis Side effects: - endometrial hyperplasia - heavy periods - endometrial polyps - DVT and VTE - strokes - hot flashes - cataracts
19
Q
Raloxifene
A
Selective estrogen receptor modulator - breast cancer rx and prevention Antagonist on breast Antagonist on endometrium - no endometrial hyperplasia Agonist on bone - reduced osteoporosis Side effects: - DVT and VTE - hot flashes - MSK Contraindications: - clotting disorders
20
Q
Ospemifene
A
Selective estrogen receptor modulator
- rx of postmenopausal symptoms
21
Q
Aromatase inhibitors
A
Drugs: - letrozole - anastrazole - exemastane Use: - rx and prevention of breast cancer If premenopausal women, must suppress ovaries Side effects: - vasomotor symptoms - like menopause - MSK complaints - vaginal dryness - HTN
22
Q
Oral Contraceptive Pills
A
Progesterone and Estrogen Regular menses Lighter menses Improvement of premenstrual syndrome Improvement in acne Decreased libido - cuz decreased testosterone from increased sex binding hormone globulin (binds free T)
23
Q
Emergency contraception
A
Morning after pill
High dose progesterone
- inhibits LH surge
- only effective if used before LH surge
24
Q
Estrogen therapy
A
For hormone replacement in menopause
- approved for hot flashes
25
Q
Progesterone therapy
A
For hormone replacement in menopause
- only for endometrial protection due reduce endometrial growth in women with uterus
