Renal drugs

Question 1

which class of diuretics would be most useful for

acute pulmonary edema (classically seen in HF)

Answer 1

loop diuretics

Question 2

which class of diuretics would be most useful for idiopathic hypercalciuria (–> calcium stones)

Answer 2

thiazide to decrease renal ca excretion

not loops (loops loose ca)

Question 3

which class of diuretics would be most useful for glaucoma?

Answer 3

acetazolamide

mannitol

Question 4

which class of diuretics would be most useful for mild to moderate CHF with expanded ECV

Answer 4

loop diuretics

Question 5

which class of diuretics would be most useful in conjunction with loop or thiazide diuretics to retain K?

Answer 5

postassiujm sparing diuretics

Question 6

which class of diuretics would be most useful for edema associated w/ nephrotic syndrome

Answer 6

loop

Question 7

which class of diuretics would be most useful for increased ICP?

Answer 7

mannitol!!!

not for its diuretic action but bc of it acts as osmotic load to draw fluid out of brain interstitium

Question 8

which class of diuretics would be most useful for mild to mod HTN

Answer 8

HCTZ

Question 9

which class of diuretics would be most useful for​hypercalcemia

Answer 9

loop

Question 10

which class of diuretics would be most useful for attitude sickness

Answer 10

acetazolamide

Question 11

which class of diuretics would be most useful for

hyperaldosteronism

Answer 11

spironolactone

eplerenone

both are aldosteron antagonist

Question 12

pt with HF exacerbation needs diuretics but has a sulfa drug allergy. dam what drug should you use now?

Answer 12

loop and thiazides are bot sulfa drugs

EXCEPT

ethacrynic acid (loop)

Question 14

what in the nephron does Mannitol work?

Answer 14

PCT and Descending limb, loop of henle

Question 15

what is mannitols MOA

Answer 15

Osmotic diuretic. –> inc tubular fluid osmolarity –> inc urine flow, dec intracranial/intraocular pressure.

combank

it inhibits Na and H20 reabsorption

Question 16

what can mannitol be used for

Answer 16

drug overdose

elevated ICP

Acute angle CLOSURE glaucoma.

also combank

cystic fibrosis, bronchiectasis as dry mannitol which is inhaled drawing fluid into lung.

Question 17

mannitol AE:

CI in?

Answer 17

pulmonary edema,

dehydration

CI: in anuria, HF

Question 18

.where does Acetazolamide work and whats its MOA

Answer 18

PCT

MOA: Carbonic anhydrase inhibitor

causes self limitied NaHCO3- diuresis and dec total body HCO3- stores.

Question 19

Acetazolamide

clinical indications

Answer 19

glaucoma (bc hco3 draws water into eye to form aquamous humor thus if block BICARB formation then no aquaous humor production

altitude sickness****

metabolite alkalosis

pseudotumor cerebri (idiopathic intracranial HTN)

Question 20

name the 4 loop diuretics and which one out of the 4 is NOT a sulfa drug

BFT E

Answer 20

bumetanide

Flurosemide

torsemide

Ethacrynic acid (not a sulfa drug)

Question 21

what are the side effects of loops?

OHH DAANG

Answer 21

Ototoxicity

Hypokalemia

Hypomagnesemia

Dehydration

Allergy (sulfa)

metabolic Alkalosis

Nephritis (interstitial

Gout

Question 22

Which loop diuretic is most ototoxic?

Answer 22

ethacrynic acid.

Question 23

where do loops work in nephron

what there MOA

Answer 23

Thick ascending limb

(sulonamide loops):

• inhibit cotransport system (NA/K/2Cl) of thick ascending limb of LOH.
• Abolish hypertonicity osmotic gradient) of the medulla thus preventing concentration of urine in thin descending limb
• stimulate PGE release (vasoDILATORY effect on aff arterioles); inhibited by NSAIDS.
• inc Ca excretion.

Question 24

name the thiazides

Answer 24

hydrochlorothiazide,

chlorthalidone

metolazone

Question 25

what in the nephron do thiazides work and what is their moa

Answer 25

**(distal convoluted tubule)** Inhibit **NaCl reabsorptioin** in **early** DCT --\> **dec diluting capacity** of the nephron. **DEC CALCIUM excretion** INC K excretion, **block Na reabsorption** in DCT (nacl cotransporter)

Question 26

thiazide Adverse effects remember Hyper**GLUC**

Answer 26

* Hyper**glycemia** * Hyper**L****ipidemia** * hyper**Uricemia** * hyper**Calcemia** **hyponatremia** **sulfa allergy**

Question 27

name the potassium sparing diuretics ta**k**e a **SEAT**

Answer 27

**S**pironolactone and **E**plernone = aldosterone antagnosist **A**miloride and **T**riamterene (act at same part of tubule by blocking Na channels in the **cortical collecting tubule)**

Question 28

where do K sparing diuretics work

Answer 28

**cortical collecting tubules**

Question 29

what are the K sparing diuretics used for

Answer 29

**Hyperaldosteronism** **K depletion, HF** **ascite (spirnonlactone)** **Nephrogenic DI (Amiloride** **antiandrogen.**

Question 30

AE of K sparing diuretics

Answer 30

hyperkalemia (can lead to V-tach, V fib) endocrine effects w/ sprinonolactone (**gynecomastia, antiandrogen effects)** in progesterone activity

Question 31

what drug is the **direct renin inhibitor,** blocks conversion of angiotensinogen to angiotensins I

Answer 31

**aliskiren**