Renal CIS Flashcards
_______ = how much of a drug gets into the system through metabolism
Biodistribution
________ = expected and unintended effects of a drug
Adverse effect
_______ = physiologic affinity
Selectivity
Thiazides, K-sparing diuretics, and carbonic anhydrase inhibitors act on the DT and CCD, which are _______-sensitive areas due to the presence of ______ receptors
Aldosterone; MR
What type of diuretic reduces Na reabsorption along the proximal tubule
Carbonic anhydrase inhibitor
What type of diuretic inhibits Na and Cl transport along the TAL of the LOH
Loop diuretics
Carbonic anhydrase inhibitors increase the excretion of what?
Bicarbonate
What class of diuretic has been used in to reduce intraocular pressure in glaucoma as well as to prevent high-altitude sickness?
CAI’s
_______ diuretics are substances that are freely filtered but poorly reabsorbed
Osmotic (mannitol)
Mannitol is _________, so it can expand ECF volume and increase ECV
Hypertonic
Primary adverse effect of mannitol
Osmotic diarrhea
Which of the following is not a loop diuretic?
A. Furosemide
B. Indapemide
C. Torsemide
D. Bumetanide
B. Indapamide
[b is a thiazide]
Which class of diuretics are considered “potassium-wasting”
Loop diuretics
Primary adverse effects associated with loop diuretics
Ototoxicity –> hearing loss and/or tinnitus
Hypomagnesemia
[also note sulfa allergies are a contraindication]
Loop diuretics increase excretion of what ions?
Calcium and magnesium
Thiazides inhibit the ______cotransporter, thus increasing urine volume, ________ urinary calcium, and _________ urinary Na and Cl
NCC; decreasing; increasing
Primary adverse effect of thiazides
Hyponatremia
Which of the following are you most likely to use in a patient with CHF?
A. Carbonic anhydrase inhibitor
B. Loop diuretic
C. Thiazide
D. K-sparing diuretic
B. Loop diuretic
[more potent and specific]
Which of the following is considered a “mineralocorticoid antagonist”?
A. Carbonic anhydrase inhibitor
B. Loop diuretic
C. Thiazide
D. K-sparing diuretics
D. K-sparing diuretics
What is the difference between spironolactone and eplerenone?
Both are k-sparing diuretics.
Eplerenone has 100x greater affinity and selectivity for MR than spironolactone
What class of diuretics is not frequently used on its own?
Na+ channel blockers like amiloride and triamterene
Which of the following correctly describes caffiene?
A. Natriuretic adenosine receptor agonist
B. Natriuretic adenosine receptor antagonist
C. Aquaretic adenosine receptor agonist
D. Aquaretic adenosine receptor antagonist
B. Natriuretic adenosine receptor antagonist
Physiology of edema regarding capillary hydrostatic pressure
Arteriolar dilation
Venous constriction
Increased venous pressure = CHF
ECF increased
Physiology of edema regarding capillary oncotic pressure
Decreased plasma protein concentration
Severe liver failure (failure to synthesize protein)
Physiology of edema regarding hydraulic conductance
Burn inflammation (release of histamine; cytokines)
Impaired lymphatic drainage
Would you prescribe a diuretic for a patient presenting with LE edema consistent with chronic venous insufficiency in the absence of other medical hx?
No; diuretics would only dehydrate the pt and potentially lead to adverse effects
More likely to recommend compression stockings and decrease Na intake
What conditions involving edema typically require treatment with a diuretic?
Pulmonary edema
CHF, nephrosis, cirrhosis
Which class of diuretic would you use to treat pulmonary edema?
Pulmonary edema can be urgent/emergent –> tx with more potent diuretic = loop diuretic
Diuretics _______ effective blood volume, contributing to tissue perfusion and fluid mobilization due to a ________ in venous and intracapillary pressure
Decrease; decrease
[plasma volume is maintained]
Which of the following would you keep track of when treating a patient with a diuretic for edema?
A. Weight
B. BUN
C. Creatinine
D. All of the above
D. All of the above
Other than loop diuretics, which class of diuretic has significant benefit in patients with heart failure involving reduced EF?
Spironolactone = MR antagonist
Blocks aldosterone cardiac effects, so will inhibit pro-arrythmia risk in CHF and improves EF
Mediated by induction of aldosterone synthase by angiotensin II in the failing ventricle; works to augment ACE inhibition in HF patients
Which of the following would you try to avoid prescribing to manage the edema in a patient with diabetes mellitus?
A. Thiazides
B. Loop diuretics
C. Carbonic anhydrase inhibitors
D. K-sparing diuretics
A. Thiazides
These can cause hyperglycemia by inhibiting insulin
