Renal Drugs

Question 1

Acetazolamide

Answer 1

Makes urine alkaline

Notes - CA inhibitor @ PCT. SE - metabolic acidosis, sulfa allergy, loss electrolytes. Use - alkalosis (ex. altitude), epilepsy, IBS, glaucoma

Question 2

Furosemide & Bumetanide

Answer 2

Loop diuretics

Notes - Inhibit K/Na/Cl cotransporter @ ascending loop of Henle. SE - contraction alkalosis, hypovolemia, hypokalemia, hypotension, hyperuricemia (gout). DDI - digoxin, class 3 antiarrhythmics (amiodarone, dronedarone, sotalol), aminoglycosides, NSAIDs, BB, corticosteroids

Question 3

Hydrochlorothiazide, chlortalidone, metolazone

Answer 3

Thiazide diuretics that increase Ca2+ reabsorption

Notes - inhibit Na/Cl cotransporter @DCT. SE - same as loop but milder

Question 4

Spironolactone

Answer 4

K+ sparring diuretic

Notes - inhibit Na/K exchange @ CD. Also an ARB (good for patients with hormonal imbalances). SE - hyperkalemia. DDI ACEi

Question 5

Amiloride

Answer 5

K+ sparring diuretic

Notes - inhibit ENAC @ CD. SE - hyperkalemia. DDI ACEi

Question 6

Eplerenone

Answer 6

ARB

Question 7

Mannitol

Answer 7

Osmotic diuretic - IV

Notes - increases osmolarity of tubule & draws water out at all parts of nephron permeable to water. Use - rapidly reduce ICP/intraocular pressure, moisten nephron in acute renal failure. Paradox @ first will increase ICF while its moving to kidneys

Question 8

Probenecid, sulfinpyrazone

Answer 8

Uricosuric drugs

Notes - inhibit reabsorption AND secretion (subtherapeutic doses only inhibit secretion) by blocking transporters (including OAT which helps with excretion of other drugs like aspirin @ penicillin). DDI - aspirin, furosemide, penicillin. Use - for gout

Question 9

Allopurinol

Answer 9

Xanthase oxidase inhibitor that blocks FORMATION of uric acid

Notes - effective in patients with renal impairment. DDI - warfarin (can inhibit CYP) & azathioprine. Use - for gout

Question 10

Benzbromarone

Answer 10

For gout

Notes - SE fatal hepatotoxicity

Question 11

Uricase

Answer 11

For gout

Notes - breaks down uric acid. SE Ab formation

Question 12

Terazosin, Doxazosin, Tamsulosin, Alfuzosin, Silodosin

Answer 12

A1 blockers (1A, 1B, 1D)

Notes - 1st line treatment for BPH by targeting irritative (dynamic) component of BOO which affect the tone of SMC.. Do not affect prostate volume or PSA or the natural history of the disease. Increase urine flow & erection. SE of antihypertensive meds

Question 13

Goserelin, Buserelin, Leprolin, Naferelin

Answer 13

GnRH agonists

Notes - based on negative feedback. Use with antiandrogens is best to avoid the initial flare up. SE bone pain

Question 14

Finasteride, dutasteride

Answer 14

5-ARIs

Notes - 2nd line treatment for BPH by targeting static (obstructive) component of BOO. Reduces PSA levels (so reduces risk of prostate cancer) & reduces DHT by 70-90%. SE of low DHT. Finasteride faster onset than dutasteride. Finasteride also used for male pattern baldness

Question 15

Oxybutinin, Tolterodine, Fesoterodine, Darifenacin, Solifenacin, Trospium

Answer 15

M3 Antagonists

Notes - treat OAB & DO by decreasing urination. Non selectivity for M3 so anticholinergic SE & CVS SE (bc blocked vagal input)

Question 16

Mirabegron

Answer 16

B3 agonist

Notes - treat OAB & DO by relaxing detrusor muscle. SE HT

Question 17

Sildenafil

Answer 17

PDE5 inhibitor

Notes - “Viagra” . Increases erection & decreases PAH by causing faster SMC relaxation. SE of antihypertensive meds. DDI with other drugs that cause SE of antihypertensive meds

Question 18

Cyproterone acetate

Answer 18

Steroidal anti-androgen

Notes - suppresses LH release. SE castration syndrome & hepatotoxicity

Question 19

Bicalutamide, Flutamide

Answer 19

Non-steroidal anti-androgens

Notes - maintain LH release so SE not as severe. still have hepatotoxicity

Question 20

Abarelix

Answer 20

GnRH antagonists

Notes - SE castration syndrome