Renal Drugs Flashcards
Drugs that act on PCT
Mannitol, Acetazolamide
Mannitol: Mechanism
Can’t be reabsorbed. Osmotic diuretic. Increase tubular fluid osmolarity, producing increased urine flow, decrease intracranial/intraocular pressure
Mannitol: Clinical Use
Drug overdose, elevated intracranial/intraocular pressure
Mannitol: Toxicity
Pulmonary edema, dehydration.
Acetazolamide: Mechanism
Carbonic anhydrase inhibitor. Causes self-limited NaHCO3 diuresis and reduction in total body in HCO3 stores
Acetazolamide: Clinical Use
AGMAP
Acetazolamide: Toxicity
ACIDazolamide caused ACIDosis
Drug(s) that act on Loop of Henle
Furosemide, Ethracrynic Aid
Furosemide: Mechanism
Sulfonamide loop diuretic. Inhibits co-transport system (Na, K, 2CL) of thick ascending limb of loop of Henle.
How does furosemide affect prostaglandins?
Stimulates PGE release (vasoldilatory effect on afferent arteriole) –> decreased GFR
How does furosemide affect Ca excretion?
It promotes Ca excretion.
Furosemide: Clinical Use
Edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema)
Furosemide: Toxicity
*OH DANG!
Ethacrynic Acid: Mechanism
Phenoxyacetic acid derivative (not a sulfonamide).
Ethacrynic Acid: Clinical Use
Diuresis in patients allergic to sulfa drugs
Ethacrynic Acid: Toxicity
Ototoxicity
Hydrochlorothiazide: Mechanism
Thiazide diuretic. Inhibits NaCl reabsorption in early DCT, reducing diluting capacity of the neprhon.
Hydrochlorothiazide: Clinical Use
Hypertension, CHF, idiopathic hypercalciuria, nephrogenic diabetes insipidus
Hydrochlorothiazide: Toxicity
Hypokalemic metabolic alkalosis
K+ sparing diuretics
Spironolactone and eplerenone; Triametereme, Amiloride
Spironolactone & Eplerenone
Competitive aldosterone receptor antagonists in the cortical collecting tubule
Triamterene & Amlioride
Block Na channels in the CCT
K+ sparing diuretics: Clinical Use
Hyperaldosteronism, K+ depletion, CHF
K+ sparing diuretics: Toxicity
Hyperkalemia (can lead to arrhythmias)
Spironolactone Toxicity.
Aside from hyperkalemia (can lead to arrhythmias). It can cause endocrine effects (e.g. gynecomastia, antiandrogen effects)
After diuretic use: Urine NaCl
Increases in all diuretics . Serum NaCl may result
After diuretic use: Urine K
*Increase (all except K+ sparing diuretics). Serum K may decrease as a result
Diuretics that cause acidemia (decreased blood pH)
Carbonic anhydrase inhibitors –> decreased HCO3 reabsorption.
Diuretics that cause alkalosis (increased blood pH)
LOOP DIURETICS & THIAZIDES cause alkalemia via several mechanisms:
Diuretics increase urine Ca
Loop diuretics: Decreased paracellular Ca reabsorption –> hypcalcemia
Diuretics that decrease urine Ca
Thiazides: Enhanced paracellular Ca reabsorption in proximal tubule and loop of Henle
ACE Inhibitors
Captopril, Enalaprill, Lisinopril
ACE Inhibitors: Mechanism
Inhibit angiotensin-converting enzyme (ACE) –> decreased angiotensin –> decreased GFR by preventing constriction of efferent arterioles.
ACE Inhibitors: Clinical Use
Hypertension, CHF, proteinuria, diabetic renal disease. Prevent unfavorable heart remodeling as a result of chronic hypertension
ACE Inhibitors: Toxicity
CATCHH
