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Renal Drugs Flashcards

1
Q

What is mannitol?

A

Osmotic diuretic

Causes increased tubular osmolarity resulting increased sodium and water excretion

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2
Q

What is mannitol used for?

A

To decrease intracranial pressure
To decrease intraocular pressure
To counteract drug overdose

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3
Q

What is the toxicity of mannitol?

A

Pulmonary edema

Dehydration

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4
Q

What is mannitol contraindicated in?

A

Anuria

CHF

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5
Q

What is acetazolamide?

A

Carbonic anhydrase inhibitor

Causes NaHCO3 excretion and reduces total body stores of Hco3

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6
Q

What is acetazolamide used for?

A 
Glaucoma 
Urinary alkalinization
Metabolic alkalosis
Altitude sickness
Pseudotumor cerebri
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7
Q

What is side effect of acetazolamide?

A 
Hypercholesterolemic metabolic acidosis
Paresthesias
NH3 toxicity
Sulfa allergy 
('ACID'azolamide causes Acidosis)
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8
Q

What do loop diuretics (Furosemide) do?

A

Inhibits co transport in thick ascending limb loop (Na, K, 2 Cl)
Abolishes hypertonicity in the medulla preventing water from moving out into the interstitium and thereby concentrating the urine.
Stimulates PGE release dilating the afferent arteriole
Increases Ca excretion

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9
Q

What are the loops (furosemide) useful for?

A

Edematous states - CHF, cirrhosis, nephrotic syndrome, pulmonary edema
HTN
Hypercalcemia

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10
Q

What is the toxicity of loops (furosemide)?

A 
OH DANG
Ototoxicity 
Hypokalemia 
Dehydration
Allergy (sulfa drug)
Nephritis (interstitial)
Gout
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11
Q

What is ethacrynic acid used for?

A

Patients who need a loop who are allergic to sulfonamides.
Same mech and side effects as a loop
(Phenoxyacetic acid derivative– not sulfonamide derivative)

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12
Q

What is the MOA of thiazides?

A

Inhibits NaCl reabsorption in early distal tubule

Decreases calcium excretion

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13
Q

What are thiazides used for?

A

HTN
CHF
Idiopathic hypecalciuria
Nephrogenic diabetes insipidus (reduces diluting capacity of the nephron)

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14
Q

What are the side effects of thiazides?

A 
Hypokalemic metabolic alkalosis
Hyponatremia
Hyperglycemia
Hyperlipidemia 
Hyperuricemia
Hypercalcemia
Sulfa allergy 
(HyperGLUC)
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15
Q

What do Spironolactone & Eplerenone (K sparing diuretics) do?

A

Competitively inhibit aldosterone at the cortical collecting tubule

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16
Q

How do amiloride and triamterene work?

A

Block Na channels at cortical collecting tubule

They are also K sparing

17
Q

What are K sparing diuretics used for?

A

Hyperaldosteronism
K depletion
CHF

18
Q

What is the toxicity of K sparing diuretics?

A

Hyperkalemia –> arrhythmia (prolongs phase 3)
Gynecomastia & Anti-antrogen endocrine effects (Spironolactone)
Acidemia (Spironolactone & Eplerenone)

19
Q

What is the treatment for recurrent Calcium stones?

A

Thiazides
Citrate
Fluid intake

20
Q

What is the treatment for Uric Acid Stones?

A

Alkalinization of the urine

fluid intake

21
Q

How do you treat Cystine stones?

A

Alkalinization of the urine

fluid intake

22
Q

What are the side effects of Ethacrynic Acid?

A

OHDNG (same as Loop except sulfa allergy)

Hyperuricemia– CONTRA with gout

23
Q

Which Diuretics cause Acidemia?

A

Carbonic Anhydrase Inhibitors

K+ Sparing inhibitors (Aldosterone R antags)

24
Q

Which Diuretics cause Alkalemia?

A

Thiazides

Loops

25
Q

Which Diuretics cause hypocalcemia?

A

Loops (dec paracellular Ca resorption)

26
Q

Which diuretics ause hypercalcemia?

A

Thiazides (inc paracellular Ca resorption)

27
Q

What are the common ACE-I’s?

A

Captopril
Enalapril
Lisinopril

28
Q

What is the MOA of ACE-I?

A 
Inhibits ACE (angiotensin-converting enzyme) = decrease Ang II = dec GFR (prevents constriction of efferent arterioles)
Lose feedback inhibition = increase renin levels
Prevents bradykinin inactivation = keeps active = potent vasodilator
29
Q

What are ACE-Is used for?

A

Hypertension (prevent unfavorable cardiac remodeling)
CHF
Diabetic renal dz
Proteinuria

30
Q

What is the toxicity of ACE-I?

A 
Cough
Angioedema
Teratogen (fetal renal malformations)
Creatinine increase (d/t dec GFR)
Hyperkalemia
Hypotension

(CATCHH)

31
Q

What is ACE-I contraindicated in?

A

B/L renal artery stenosis

further decrease GFR –> Renal failure

32
Q

What does ethylene glycol cause?

A

Hematocrit
Oliguria
Back pain due to calcium oxalate crystals

33
Q

What are the drugs that can cause hyperkalemia?

A 
Nonselective beta blockers
ACEi
ARBs
K sparing diuretics 
Cardiac glycosides
NSAIDs
34
Q

How do NSAIDs cause hyperkalemia?

A

Impaired local prostaglandin synthesis reduces renin and aldosterone secretion

35
Q

What condition are ACEi contraindicated in?

A

Bilateral renal artery stenosis because can cause ARF due to decreased GFR from efferent arteriole dilation

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