Renal Drugs Flashcards
What is the name of the CA Inhibitor?
Where does it work?
What does it do?
Acetazolamide
Proximal Tubule
Inhibits CA so that Na wont be reabsorbed bc H can’t be exchanged to go out into lumen
Leads to Acidosis with HypoK. Only drug that does this.
Also bc HCO3- isnt being reabsorbed, Cl- will to keep things neutral…hyperCl-emia
What can acetazolamide be used for?
SEs?
Glaucoma
Alkanalize the urine
Metabolic Alkalosis (ie in altitude sickness)
pseudomotor cerebri
SEs?
Sulfa allergy, parasthesia, metab acidosis
NH3 tox
What kind of diuretic is mannitol?
Where does it work?
What does it do?
Osmotic
Proximal
It draws water out into the lumen (no Na or anything else) by increasing the tubular osmo. This increases urine flow, relieving the high Ps in the eye and cranium
What can Mannitol be used for?
Drug OD
To decrease IOP and ICP
What are the two loop diuretics?
Where do they work?
MOA?
Furosemide, Ethacrynic Acid
Thick Asc Loop
INHIBIT Na/K/2Cl transporter
-blocks Na, K, and Cl from leaving the tubule so medulla not so salty, so now can’t concetrate the urine (bc this creates the gradient for water to leave out of the thin descending
Where else do the Loops work, and what other ion does it excrete?
Work on AFFERENT arteriole causing vasodilation (blocked by NSAIDs)
Excretion of Ca2+
What is the difference btwn Furosemide and Ethacrynic acid?
They do exactly the same but etha used for ppl with a sulfa allergy
Etha is a Phenoxyacetic acid derivative
What are the loops used for?
Edema! EDEMA!! EDEMA!!!
CHF, Cirrhosis, nephOtic syndrome, pulm edema, HTN, hyperCa2+emia
So this can be used for HTN
SEs of loops?
OH DANG Ototoxicity HypoKalemia Dehydration Allergy (sulfa) Nephritis (Interstitial) Gout (due to hyperuricemia) Never use to treat gout or in patients with gout
What is the Thiazide diuretic and where does it work?
MOA?
It is hydrochlorothiazide
Early Distal Tubule
Block the Na/Cl cotransporter, so they are prevented from being reabsorbed. Stay in the tubule
This also means that the nephron cant dilute as well
This one DECREASES Ca2+ excretion, so can cause HyperCa2+emia
What is hydrochlorothiazide used for?
HTN!!
CHF, hyperCa2+URIA (so if someone always have high Ca in their blood for no good reason, ie people with kidney stones)
Nephrogenic diabetes insipidus, Osteoporosis (bc ur keeping Ca in)
SEs of thiazides?
HypoKemia (so dont use with digoxin) Metab Alkalosis Hyponatremia HyperGLYCEMIA (so no diabetic pts, use ACEI or ARBs for them) HyperLIPIDEMIA HyperURICEMIA HyperCALCEMIA Sulfa Allergia
What are the K+ sparing diuretics? Where do they work, and MOA?
The K+ STAEs
Spironolactone & Eplerenone
Triamterene
Amiloride
Work in the Cortical Collecting Tubule
Spironolactone & Eplerenone are COMPETITIVE aldo receptor ANTAGONISTS
Amiloride & Triamterine both block Na channels in CCT
What are the K+ sparing used for?
SEs?
Hyperaldo
K+ depletion
CHF
SEs:
HyperK+emia (arrythmias, elevated T waves)
Endocrine effects with spironolactone (ie gynecomastia, antiandrogen effects so can fix hirsutism in females, but makes men womanly)
What is spironolactone best used for?
Improving mortality in CHF, not HTN
What is the difference btwn spironolactone and eplerenone?
Spironolactone is a NON SELECTIVE androgen receptor antagonist, so in men helps their CHF, but gives them boobs
Eplerenone is a SELECTIVE aldo receptor antagonist, so you get anti CHF, but no androgen issues
What are the ACE Inhibitors and how do they work? What’s the difference btwn ACE I and ARBs?
Captopril, Enalapril, Lisinopril
Inhibit ACE, so no Angio II. Which means…
DECREASE GFR bc no constriction of efferent arterioles, but bc of this Renin will INCREASE!!
Also no bradykinin breakdown so you get angioedema
ACEIs and ARBs do the same thing but with ARBs bradykinin still broken down so no cough or angioedema
What are ACEIs and ARBs used for?
HTN CHF Proteinuria Diabetic Nephropathy Prevent heart remodeling due to chronic HTN
SEs of ACEIs and ARBS?
CATCHH Cough Angioedema Teratogen Creatinine (Increased, bc GFR went down) HyperKalemia HypoTN
Dont give to patients with bilateral renal artery stenosis bc these drugs will further decrease GFR and kidney function will fall off
DDIs with Loops?
Aminoglycosides (mycins, amikacin) because increase the ototox
Li+–>Loops increase Li+ clearance bc it looks like Na
Digoxin: Loops cause K excretion–>Hypokalemia. Digoxin competes with K for a spot on ATPase. Without K, get digoxin toxicity
What are the DOCs in acute pulmonary edema? (ie CHF)
Loops for diuresis
Digoxin (increased contractility)
ACEIs/ARBs
What other way can loops help with HTN?
Loops also vasodilate by increasing PGs. PGs vasodilate the afferent arteriole. NSAIDs block this bc they block PGs
THEREFORE NSAIDS WILL BLOCK(!!!) THE HTN LOWERING EFFECTS OF LOOPS
Why do loops cause gout or hyperuricemia?
Bc urate has its own pump in the proximal tubule, it can be excreted. but if there is a weak acid ie penicillin, cephalosporin, loops, they will compete for that weak acid pump thats for urate and win. therefore urate will be reabsorbed
How do thiazides treat nephrogenic diabetes insipid?
The free water created in the thin limb is rejoined with the salt from distal tubule that the thiazides prevented from being absorbed. Kidney adapts to this and will create an increase in aldo which then create more Na reabsorption; then as a consequence, water will follow the Na.
So basically the aldo creates another door for water to go thru bc its own door is messed up.
What is the change seen in Ca2+ with loops and thiazides?
Loops–>Increase it in urine, decrease in serum
Thiazide–>Decreased in urine, incr in serum
