Renal Drugs Flashcards
1
Q
Acetazolamide
A
- Inhibits Carbonic Anhydrase in the PCT leading to an increase in HCO3 loss to urine and an increase in H2O and Na loss
- Used for altitude sickness because slight metabolic acidosis can counteract respiratory alkalosis of altitude
- Used for glaucoma to decrease aqueous humor prduction
- S/E: Sulf allergy and metabolic acidosis
2
Q
Mannitol
A
- Osmotic diuretic that is freely filtered but not resorbed/transported across membranes. Most effective in PCT
- Used: Increased intracranial/intraoccular pressure, drug overdose
- Tox: Pulmonary edema and dehydration.
- Contraindicated in CHF
3
Q
Furosemide
A
- Loop diuretic that inhibts the Na/K/2Cl transporter in the thick ascending limb of henle. Abolished gradient leading to massive diuresis.
- Losses calcium
- Use: Strongest diuretic: CHF, Edema, Pulmonary edema, HTN, hypercalcemia
- S/E: Ototoxicity, nephritis, Gout, sulfa allergy, hypokalemia, hypocalcemia.
- Contraindicated in Gout (causes hyperuricemia)
- Use ethacyrininc acid if sulfa allergic
4
Q
Ethacrynic acid
A
- Loop diuretic without sulfa allergy problem
- Loop diuretic that inhibts the Na/K/2Cl transporter in the thick ascending limb of henle. Abolished gradient leading to massive diuresis.
- Losses calcium
- Use: Strongest diuretic: CHF, Edema, Pulmonary edema, HTN, hypercalcemia
- S/E: Ototoxicity, nephritis, Gout, hypokalemia, hypocalcemia.
- Use ethacyrininc acid if sulfa allergic
5
Q
Hydrochlorothiazide
A
- Diuretic that inhibits Na/Cl transporter in the early DCT.
- Leads to increased luminal Na/Cl concentrations leading to activation of macula densa to release adenosine and constrict afferent to decrease GFR (use for DI)
- All Na gradient generated by Na/K ATPase can be used to reabsorb Ca (given in hypercalcuria and calcium stones)
- Uses: HTN, Calcium stones, Nephrogenic DI, CHF
- Tox: Hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, sulfa allergy.
6
Q
Amilioride
A
- Blocks ENaC in the collecting duct. Leads to decreased Na reabsorption and diuresis
- More K will be absorbed in place of Na thus a K sparing diuretic
- Use: Hyperaldosteronism, Liddle syndrome (Pseudohyperaldosteronism)
- Tox: Hyperkalemia
7
Q
Triamterene
A
- Blocks ENaC in the collecting duct. Leads to decreased Na reabsorption and diuresis
- More K will be absorbed in place of Na thus a K sparing diuretic
- Use: Hyperaldosteronism, Liddle syndrome (Pseudohyperaldosteronism)
- Tox: Hyperkalemia
8
Q
Spironolactone
A
- Non steroid inhibitor of mineralocorticoid receptor leads to decreasd transcription of ENaC channels.
- Decreased Na reabsorption leading to increased K reabsorption
- Use: Hyperaldosteronism (not used in Liddles), also used to block AR in PCOS
- S/E: Block AR leads to gynecomastia etc.
9
Q
Lisinopril, catopril, enalopril
A
- Block ACE in the lungs (protease that activates Ang 1 to Ang 2) Leading to decreased Ang 2 effects.
- Prevents Ang 2 action on efferent arteriole leading to decreased filtration pressure (Given to all diabetics, and very useful in preventing renal disease in HTN as well)
- Prevents aldosterone, ADH, and systemic vasoconstricion preventing HTN
- Prevents pathogenic remodelling of the heart in prolonged HTN
- Prevents hyperfiltartion induced proteinuria
- Tox: ACE also breaks down bradykinin ( potent vasodilator) can lead to angioedema. Use ARB instead. May cause systemic hypotension,
- Major teratogen and causes severe renal malformation, do not use in pregnancy (Methyldopa should be used to prevent HTN in pregnancy)
- Do not use in renal artery stenosis or pre-renal azotemia as Ang 2 mediated efferent arteriole constriction is necessary to maintain GFR in the face of low RPF.
- May also cause elevated Creatinine and hyperkalmeia.
10
Q
Diuretics Causing Alkalosis
A
-Loops and Thiazides cause increase loss of H in the urine leading to a volume contraction metabolic alkalosis
11
Q
Diuretics Causing Acidosis
A
-Acetazolamide: Leads to increased HCO3 secretion and metabolic acidosis
