Renal drugs Flashcards
mannitol mechanism
osmotic diuretic, increases tubular fluid osmolality producing increased urine flow
mannitol site of action
mainly proximal convoluted tubule but also thin descending limb and medullary collecting duct
mannitol use
increased intracranial pressure, shock, drug overdose
mannitol toxicity
pulmonary edema, dehydration; contraindicated in anuria and CHF
acetazolamide mechanism
carbonic anhydrase inhibitor; causes self-limited NaHCO3 diuresis and reduction in total body bicarb stores
acetazolamide site of action
proximal convoluted tubule
acetazolamide use
glaucoma, alkalinization of urine, metabolic alkalosis, altitude sickness
acetazolamide toxicity
hypercholremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
furosemide mechanism
sulfonamide diuretic; inhibits Na/K/2Cl pump ; abolishes hypertonicity of medulla, preventing urine concentration
furosemide site of action
loop of Henle, particularly thin ascending loop
furosemide use
edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, hyperkalemia
furosemide toxicity
ototoxicity, hypokalemia, dehydration, sulfa allergy, interstitial nephritis, gout, increase serum creatinine
ethacrynic acid mechanism
phenoxyacetic acid derivative; inhibits Na/K/2Cl pump ; abolishes hypertonicity of medulla, preventing urine concentration
ethacrynic acid site of action
loop of Henle
ethacrynic acid use
diuresis in patients allergic to sulfa drugs or in patients with gout/hyperuricemia (since it is a furosemide toxicity)
ethacrynic acid toxicity
ototoxicity, hypokalemia, dehydration, sulfa allergy, interstitial nephritis, increase serum creatinine
hydrochlorothiazide mechanism
inhibits NaCl transporter, reducing diluting capacity of early distal tubule; decreases Ca excretion
hydrocholorthiazide site of action
distal convoluted tubule
hydrochlorothiazide use
Ca oxalate stones, hypertension, CHF, nephrogenic DI
hydrochlorothiazide toxicity
hypokalemic metabolic acidosis, hyponatremia and hypotension/hypovolemia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia; sulfa allergy
spironolactone mechanism
competitive aldosterone receptor antagonist
eplerenone mechanism
competitive aldosterone receptor antagonist
triamterene mechanism
block Na channels
amiloride mechanism
block Na channels
spironolactone site of action
distal convoluted tubule
eplerenone site of action
distal convoluted tubule
triamterene site of action
distal convoluted tubule
amiloride site of action
distal convoluted tubule
K-sparing diuretics
spironolactone, eplerenone, triamterene, amiloridie
K-sparing diuretic use
spironolactone and elperenone: hyperaldosteronism; mild diuretic effects but decrease ventricular remodeling in CHF and reduce morbidity and mortality
amiloride toxicity
hyperkalemia
triamterene toxicity
hyperkalemia
spironolactone toxicity
hyperkalemia, gynecomastia
eplerenone toxicity
hyperkalemia, endocrine effects?
ACE inhibitors
lisinopril, captopril, enalapril
ACE inhibitior mechanism
inhibit angiotensin converting enzyme, reducing levels of angiotensin II and preventing inactivation of bradykinin, a potent vasodilator; renin release increased from loss of negative feedback
ACE inhibitor use
hypertension, CHF, diabetic renal disease
ACE inhibitor toxicity
cough, angioedema, proteinuria, taste changes, hypotension, teratogen (fetal renal damage), increased renin, rash, hyperkalemia, increased renin, lower angiotensin II; first dose hypotension
