Renal Drugs

Question 1

The cortex of the kidney is (inside/outside) and the medulla of the kidney is (inside/outside).

Answer 1

• outside

- inside

Question 2

The Cortex has ______ salt concentration.

The Medulla has ______ salt concentration.

Answer 2

• normal (isosmotic)

- high (hyperosmotic)

Question 3

What type of filter does the glomerulus have?

Answer 3

A size exclusion filter

Question 4

The glomerulus filters (Select all that apply):

• Water
• Sodium
• Proteins
• Chloride
• Potassium
• Urea
• Protein-bound Drugs

Answer 4

Water
Sodium
Chloride
Potassium
Urea

Question 5

What is reabsorbed in the Proximal tubules?

Answer 5

Water, Na+, Cl-, K+, Bicarbonate, Urea

Question 6

The loop of Henle is made up of the ___ _____ limb and ____ _____ limb. What is reabsorbed in each portion?

Answer 6

• thin descending: reabsorbs water

- thick ascending: reabsorbs NaCl

Question 7

What is reabsorbed in the Distal Convoluted tubule?

Answer 7

NaCl

Question 8

What is reabsorbed in the Late Distal tubule?

Answer 8

Na+

Question 9

What causes K+ to be transported into the nephron lumen?

Answer 9

Electrochemical gradient made by N+ reabsorption

Question 10

Fluid entering the collecting duct is ________ compared to the blood.

Answer 10

hypo-osmotic

Question 11

Where does vasopressin act on the nephron?

Answer 11

Medullar collecting ducts

Question 12

What is another name for vasopressin?

Answer 12

Anti-Diuretic Hormone (ADH

Question 13

What causes the release of vasopressin in the body?

Answer 13

Vasopressin is released in response to low pressure or high salt concentration in circulating fluids. Vasopressin trys to prevent dehydration.

Question 14

Acetazolamide

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 14

1) Carbonic Anhydrase Inhibitor-inhibits carbonic anhydrase in the lumen and cells of the PROXIMAL TUBULE
2) Increased Na+, Bicarb, K+ excretion, Decreased H+ excretion (can cause metabolic acidosis)
3) Counteract other drugs that cause metabolic alkalosis
* Low efficacy as single diuretic agent

Question 15

Glycerin (oral)

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 15

1) Osmotic Diuretic-in tissues draws water into the blood, in kidney increases GFR and washing out the medullary salt gradient
2) Excretion of Everything INCREASES
3) Acute Renal Failure, Acute Tubular Necrosis

Question 16

Mannitol

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 16

1) Osmotic Diuretic-in tissues draws water into the blood, in kidney increases GFR and washing out the medullary salt gradient
2) Excretion of Everything INCREASES
3) Acute Renal Failure, Acute Tubular Necrosis

Question 17

Furosemide

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 17

1) Loop Diuretics-inhibitor of Na+/K+/2Cl- Symporter in the THICK ASCENDING LIMB of the Loop of Henle
2) Excretion of Everything INCREASES, Especially Na+
3) Acute Pulmonary edema, CHF, Nephrotic syndrome (inorder to slow down GFR), HTN (Thiazides preferred)
* Acutely increases systemic venous capacitance

Question 18

Bumetanide

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 18

1) Loop Diuretics-inhibitor of Na+/K+/2Cl- Symporter in the THICK ASCENDING LIMB of the Loop of Henle
2) Excretion of Everything INCREASES, Especially Na+
3) Acute Pulmonary edema, CHF, Nephrotic syndrome (inorder to slow down GFR), HTN (Thiazides preferred)

Question 19

Ethacrynic Acid

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 19

1) Loop Diuretics-inhibitor of Na+/K+/2Cl- Symporter in the THICK ASCENDING LIMB of the Loop of Henle
2) Excretion of Everything INCREASES, Especially Na+
3) Acute Pulmonary edema, CHF, Nephrotic syndrome (inorder to slow down GFR), HTN (Thiazides preferred)

Question 20

Torsemide

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 20

1) Loop Diuretics-inhibitor of Na+/K+/2Cl- Symporter in the THICK ASCENDING LIMB of the Loop of Henle
2) Excretion of Everything INCREASES, Especially Na+
3) Acute Pulmonary edema, CHF, Nephrotic syndrome (inorder to slow down GFR), HTN (Thiazides preferred)

Question 21

Hydrochlorothiazide

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 21

1) Thiazide Diuretic-inhibitor of the Na+/Cl- symporter in the DISTAL CONVOLUTED TUBULE
2) DECREASED Ca2+ excretion, Increased K+, Na+, H+
3) HTN, d/t Ca2+ reabsorption can treat Ca2+ Nephrolithiasis (Ca2+ stones) and aid in Osteoporosis treatment

Question 22

Chlorothiazide

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 22

1) Thiazide Diuretic-inhibitor of the Na+/Cl- symporter in the DISTAL CONVOLUTED TUBULE
2) DECREASED Ca2+ excretion, Increased K+, Na+, H+
3) HTN, d/t Ca2+ reabsorption can treat Ca2+ Nephrolithiasis (Ca2+ stones) and aid in Osteoporosis treatment

Question 23

Metolazone

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 23

1) Thiazide Diuretic-inhibitor of the Na+/Cl- symporter in the DISTAL CONVOLUTED TUBULE
2) DECREASED Ca2+ excretion, Increased K+, Na+, H+
3) HTN, d/t Ca2+ reabsorption can treat Ca2+ Nephrolithiasis (Ca2+ stones) and aid in Osteoporosis treatment

Question 24

Amiloride

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 24

1) Renal Na+ Channel Inhibitor-inhibits the Na+ channels in the late distal tubule and collecting duct which in turn inhibits K+secretion
2) Decreased excretion of K+, H+, Ca2+, Mg2+, Increased excretion of Na+, Cl-
3) Co-administration with Thiazides and Loop diuretics to reduce K+ loss

Question 25

Triamterene

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 25

1) Renal Na+ Channel Inhibitor-inhibits the Na+ channels in the late distal tubule and collecting duct which in turn inhibits K+secretion
2) Decreased excretion of K+, H+, Ca2+, Mg2+, Increased excretion of Na+, Cl-
3) Co-administration with Thiazides and Loop diuretics to reduce K+ loss

Question 26

Spironolactone

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 26

1) Mineralocorticoid Antagonist-prevents aldosterone from binding to intracellular mineralocorticoid receptor and prevents the change in expression of aldosterone induced proteins which inhibits Na+ resorption in the late distal tubule and collecting duct
2) Decreased K+ excretion, Increased Na+ excretion
3) Hyperaldosteronism, Co-administration with Thiazides and Loop diuretics to reduce K+ loss

Question 27

Eplerenone

1) Mechanism of Action
2) Effects on Excretion
3) Indications

Answer 27

1) Mineralocorticoid Antagonist-prevents aldosterone from binding to intracellular mineralocorticoid receptor and prevents the change in expression of aldosterone induced proteins which inhibits Na+ resorption in the late distal tubule and collecting duct
2) Decreased K+ excretion, Increased Na+ excretion
3) Hyperaldosteronism, Co-administration with Thiazides and Loop diuretics to reduce K+ loss

Question 28

Desmopressin

1) Mechanism of Action
2) Indications

Answer 28

1) Antidiuretic-binds V2 receptor to stimulate reabsorption in distal tubule and collecting ducts by stimulating the production of aquaporins in the epithelium
2) Central Diabetes Insipidus

Question 29

Vasopressin

1)Mechanism of Action

Answer 29

1)Antidiuretic hormone- binds V1 and V2 receptor to stimulate reabsorption in distal tubule and collecting ducts by stimulating the production of aquaporins in the epithelium

Question 30

Allopurinol

1) Mechanism of Action
2) Indication

Answer 30

1) Uricosuric agent-inhibits xanthine oxidase (enzyme that converts xanthine to uric acid)
2) Gout

Question 31

Colchincine

1) Mechanism of Action
2) Indication

Answer 31

1) Uricosuric agent-reduces neutrophil activity (unknown actual mechanism of action)
2) Gout

Question 32

Probenecid

1) Mechanism of Action
2) Indication

Answer 32

1) Initially, decreases excretion of uric acid by blocking organic acid transporter (OAT), once drug is in nephron lumen urate reabsorption pump inhibited resulting in increased excretion of uric acid
2) Gout