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Pharmacology > renal and GU agents > Flashcards

renal and GU agents Flashcards

1
Q

BPH

A

benign prosthetic hypertrophy

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2
Q

why are kidneys/renal function so important

A

we die without them, involved in electrolytes allowing our muscles, heart, work and how much water we hold onto

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3
Q

why would we want to manipulate electrolyte and H2O

A

To manage different diseases?

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4
Q

How can we manipulate electrolytes and H2O

A

v?

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5
Q

glomerulus filtration

A

filters electrolytes and non electrolytes and water

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6
Q

what are the elctrolytes

A

Na, K , Ca, M, HCO3 Cl, and phosphate

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7
Q

_____ % of material is reabsorbed at the renal tubules

and is the site of where most diuretics work

A

99%

at tubules specifically loop of henle and convuluted tube

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8
Q

what are the 5 classes of diuretics

A
  1. loop
  2. thiazide
  3. thiazide like
  4. potassium sparing
  5. carbonic anhydrase inhibiotrs and osmotic (NOT GOING TO ASK US ABOUT this one)
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9
Q

what are drugs that interfere with normal transport of fluids and electrolytes in the kidney

A

Diuretics

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10
Q

what are diuretics used for (like what indications)

A

electrolyte disturbances (can bring K back down)

renal failure (can help them produce more urine and prevent fluid overload)

heart failure (prevent people from becoming fluid overloaded)

edema and hepatic failure

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11
Q

where do loop diuretics work

A

thick ascending limb

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12
Q

thiazide diuretics work where

A

distal convuluted tubule

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13
Q

where do K sparing diuretics work

A

collecting tubules

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14
Q

Proximal convuluted tubules

A

no a lot of drug action here

some NaHCO3 and NaCl reabsorbed

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15
Q

What does the thick ascending loop do

A

actively reabsorbs NaCl from the lumen into tissue

impermeable to water

dilutes the filtrate in the tubule due to lack of H2O absorption

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16
Q

Within the thick ascending loop, what transporter is used to reabsorb NaCl

A

Na/K/2Cl cotransporter

1 NA, 2 CL, and 1 K in together

Na is the main ion

some K leaks back out

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17
Q

What do Loop diuretics do to thick ascending loop

A

block the Na/K/2Cl/ cotransporter = lack of reabsorption of NaCl and K

HE DOESNT CARE TOO MUCH ABOUT WHAT CHANNEL FOR ANY OF THESE

to be effective some renal funciton must be present (same with thiazide)

K loss cannot be totally recollected later one

lack of reabsorption of NaCl = less water reabsorbed = more dilute urine / increase diuresis

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18
Q

What is the strongest diuretic/why

A

loop diuretics because acts on the spot where there is the most Na/Cl reabsorption occuring

aka most potent
!!!!!!

work fast

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19
Q

What is the concentration gradient in the cells most important for in regard to the tubule system

why is this significant

A

important for reabsorption of Ca and Mg

if mess with this electrical gradient - can impact how much absorbed

loop diuretics’ can cause to lose Ca
- may be issue with osteoporosis

20
Q

absorption of loop diuretics

A

rapidly absorbed

IV effects are almost immeadiate

21
Q

Metabolism and excretion of loop diuretics

A
  • eliminated by renal secretion- half life depends on renal function
  • act on the luminal side of tubule- diuretic response is positive correlation with their excretion in urine
  • any decrease in filtration = prevents diuretics from reaching their site action
22
Q

What are the different loop diuretics’

A

furosemide (lasix)
bumetanide (bumex)- only used if cannot tolerant lasix
toresmide (demedex)

“FOUR LASy BUMS- BUM TO-REsMIDE to get DEM-MEDs”

in hospital have patient have a catheter

23
Q

Furoesmide

A

Lasix

  • most popular loop diuretic used
  • lasts for 6 hours aka why it is called Lasix!!!!!!
24
Q

Side effects of loop diuretics

A
  • HYPOKALEMIA- concomitant K replacement in most cases (K chloride mix) - based on daily dose (can be given IV)
  • dehydration
  • hyponatremia
  • renal toxicity with other agents
  • ototoxicity in high doses
25
Q

what happens if you give K too fast

A

can stop someones heart

26
Q

What is the pharmacology of thiazide diuretics

What does it enhance

A

inhibits NaCl reabsorption from luminal side of epithlelial cells in DCT

thus promotes Na and Cl excretion

NOT as strong as loop - so not used for CHF

enhances Ca reabsorption

27
Q

what is the absorption/distribution for thiazide diruetics

A

all thiazides absorbed well orally

onset of action is usually seen in few days with maximal effect in 2-4 weeks

28
Q

what is the metabolism/excretion of thiazide diuretics

A

plasma concentration correlate poorly with efficacy bc has to be excreted in urine

  • plasma levels can be high but not working is possible

excreted in urine

if creatinine clearance is low (like 50) decrease in efficacy of thiazide diuretics because relies on renal function even more so than loop diuretics

29
Q

What do thiazide diuretics block

A

block NaCl symporter (cotransporter)

  • aka more Na/Cl in lumen = increased H2O
  • he thinks K lost down stream due to increased Na in lumen and increase in that pump at collecting ducts

weak diuretic

some affect on reabsorption of Ca

  • increases reabsorption of Ca
  • so good for someone with bp probs and osteoporosis!!!
30
Q

What are the thiazide diuretics

A
  1. hydrochlorothiazide (aka HCTZ)
    - most popular
  2. chlorthalidone
    - most popular other countries
    - studies say this is best for BP
  3. metolazone (zaroxolyn)
    - hospital use
    - much more potent than others! (IV)

top two are interchangeable

31
Q

what are the side effects of thiazide diuretics

A
  • hyponatremia
  • hypokalemia (not as much K wasted as loops)
  • hypercalcemia (not common)
  • gout !!! (prevent the excretion of uric acid= elevated Uric acid)
32
Q

What are thiazides diuretics used for

A
  • most commonly for BP= FIRST LINE TREATMENT
  • often combined with ACE-I, ARB, beta blocker (other antihypertensive drugs)
  • also combined with potassium sparing to balance potassium loss
    >dyazide
    >maxzide
33
Q

What are the two drugs that are a combo of thiazide diuretics and potassium sparing diuretics

what specifically are they a combo of

A
  1. dyazide
  2. maxzide

both are a combo of HCTZ and triamterene

34
Q

what are loop diuretics not used for

A

BP

only fluid overload

35
Q 
Potassium sparing diuretics
what are the features of this subclass of drugs
A

most commonly used in combination products (usually with HCTZ which would be there for the BP)

weak diuretic

within the collecting ducts

helps retain K if giving a diff diuretic chronically

36
Q

what are the potassium sparing diuretic drugs

A
  1. spironolactone (aldosterone antagonist)

2. triamterene

37
Q

what is the MOA of potassium sparing diuretics

A

black Na/K exchanger

aka na stays out and K stays in

38
Q

effect of aldosterone increasing

A

increasing BP by retaining sodium and decreasing K through excretion

impact is at DNA levels by increasing Na channels into cell and K out of cell

also create Na/K ATPase pump that put Na into blood stream and taking K out of blood stream

39
Q

hyperaldosteronism common cause of…

A

common cause of HTN in patients with low K

40
Q

effect of aldosterone blockers

A

decreased reabsorbtion of Na= more H20 out

and retention of K = potassium sparing

41
Q

where do aldosterone blockers work

A

at the collecting tubule and late DCT

42
Q

spironolactone

what is it/ what does it cause

A

aldosterone antagonist

synthetic steriod that binds to cytoplasmic mineralalocorticoid receptors that prevent translocation of receptor complex to nucleus of target cell

causes increase reabsorption of K and small amount of excretion of sodium/water

43
Q

Brand name of spironolactone

A

aldactone

44
Q

side effect of spironolactone

A

hyperkalemia

hypotension

gynecomastia (anti testosterone/pro estrogen)!!

anti androgen (effect acne)

45
Q

eleprenone

A

another aldosterone antagonist

brand name: inspra

more selective 
less estrogenic (good for not causing gynecomastia)
46
Q

What he wants us to know for the above info

not an actual flashcard just notes

A

MOA:

  • know where each class works
  • net effects

potency
- know which of classes produce most diuresis (loop)

side effects

remember that loops work wayyyy faster and larger effect than thiazide

Pharmacology (13 decks)

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