Renal Drugs Flashcards by Mikayla Chang

Diuretic that is preferred in patient with mild renal insufficiency

HCTZ

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JNC8 guidelines for treating HTN

treat when 150/90 in 60+ or 140/90 in <60 y/o

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what can be used for kidney stone prevention

thiazide diuretics

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S/E of thiazide diuretics

hypokalemia

2. drug interaction with bile acid binding resins

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what labs and how often do you check them when on thiazide diuretic

BMP, CBC every 3-4 months

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loop diuretics increase renal excretion of what?

water, Na, Cl, Mg, K, Ca

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what do you have to give in addition to loop diuretic

PO potassium

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What labs do you check with loop diuretics and when?

prior to starting and regularly throughout treatment

electrolytes, BUN, creatinine, LFTs, uric acid, glucose

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diuretics increase risk of….

gout

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potassium sparing diuretics can be used off label for…

acne

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indications for carbonic anhydrase inhibitors

glaucoma
acute mountain sickness
pseudotumor cerebri

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S/E carbonic anhydrase inhibitors

tingling, kidney stones

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DDAVP is used for…

bedwetting

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DDAVP increases risk for….

clots

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Indications for anticholinergics

symptoms of overactive bladder
urge incontinence (but not stress incontinence)

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Anticholinergic CIs

cognitive impairment

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Anticholinergic S/E

hots as hare
blind as a bat (blurred vision)
dry as a bone (constipation, dry mouth)
red as a beet (flushing)
mad as a hatter (delerium) 
bloated as a toad (ileus)
the heart runs alone (tachycardia)

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labs to check prior to starting anticholinergic

urine and urine culture

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Alpha-1-antagonist examples

tamsulosin / flomax

terazosin / hytrin

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Alpha-1-antagonist indications

BPH

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Alpha-1-antagonist S/E

orthostatic hypotension!
headache
somnolence
nasal congestion
palpitations

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Prazosin is used off-label for

nightmares

PDE5 Inhibitors absolute CI

patients using nitrates

osmotic diuretics example

mannitol

osmotic diuretics MOA

reduces reabsorption of water in proximal convoluted tubule and thin descending Loop of Henle, increases excretion of almost all electrolytes

osmotic diuretics indications

1. increased intracranial pressure, cerebral edema 2. glaucoma 3. acute renal failure

osmotic diuretics CI

1. acute cranial bleeding | 2. continuous administration

osmotic diuretics S/E

1. pulmonary edema | 2. dehydration and hypernatremia

what should be monitored when giving an osmotic diuretic

1. vital signs 2. urinary output 3. pulmonary pressure 4. electrolytes

Desmopressin (DDAVP) MOA

increases resorption of water by increasing the permeability of collecting ducts in kidney, decreasing urinary output

DDAVP Indications

1. decrease urine production | 2. help reduce bleeding

DDAVP CIs

1. hypersensitivity | 2. mild to moderate renal impairment

DDAVP cautions

should be used sparingly (ie overnight trip) | can develop hyponatremia

DDAVP S/E

1. acute MI 2. thrombosis 3. increased BP 4. water intoxication 5. confusion 6. seizures

Anticholinergic examples

1. oxybutynin / ditropan or oxytrol patch 2. tolterodine / detrol 3. solifenacin / vesicare

Anticholinergic indications

overactive bladder w/ urge urinary incontinence, urgency, frequency

Anticholinergic MOA

block muscarinic and parasympathetic nerve endings on detrusor muscle of bladder

Anticholinergic CIs

1. conditions in which cholinergic blockade would exacerbate an already serious problem 2. avoid in Alzheimer's disease

beta-3 adrenergic agonist example

Myrbetriq / mirabegron

beta-3 adrenergic agonist indication

overative bladder w/ urge urinary incontinence, urgency, frequency

beta-3 adrenergic agonist MOA

targets beta-3 adrenergic receptor pathway, impacts storage phase of micturition cycle

beta-3 adrenergic agonist CI

1. caution w/ bladder outlet obstruction | 2. caution with anti-muscarinic medications

beta-3 adrenergic agonist S/E

1. hypertension 2. nasopharyngitis 3. UTI 4. headache 5. angioedema

alpha-1 antagonist MOA

vasodilation and decreased systemic vascular resistance | relax urinary sphincter

alpha-1 antagonist CI

concurrent use w/ any PDE5 inhibitor (ie Viagra) | --> increased risk of severe hypotension

Why is tamsulosin good?

more selective for alpha 1a receptors on bladder sphincter, not vascular smooth muscle --> less risk of orthostatic hypotension

5-alpha-reductase inhibitors example

finasterid / proscar / propecia

5-alpha-reductase inhibitors MOA

reduce production of DHT (active form of testosterone)

5-alpha-reductase inhibitors indications

BPH | male pattern baldness

5-alpha-reductase inhibitors CIs

pregnancy (category X) | women of childbearing age

5-alpha-reductase inhibitors S/E

1. postural hypotension 2. dizziness 3. sexual dysfunction

cautions with 5-alpha-reductase inhibitors

they lower PSA, can mask elevations associated with malignancy

PD5-Inhibitor examples

1. sidenafil / viagra 2. tadalafil / cialis 3. vardenafil / levitra

PD5-Inhibitor MOA

improves ability to attain and maintain an erection by enhancing vasodilating effect of nitrous oxide, increasing cGMP to allow smooth muscle relaxation and inflow of blood