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Tom > Renal, Endo and GU Drugs > Flashcards

Renal, Endo and GU Drugs Flashcards

1
Q

Furosemide

A

Loop Diuretic:
NKCC2: Thick ascending limb of loop of henle; this channel is used in Tubuloglomerular Feedback thus this drug inhibits TGF.
SEs: K, H+, Mg+, Ca2+ wasting; tinnitus, vertigo, hearing impairment, deafness
Also increases renal PG synth=more diuresis.
SHORT ACTING=USED FOR PULM EDEMA not for HTN management. And CHF (LMNOP=lasix, morphine, nsaids, Oxygen, posture)

TOX: SULFA ALLERGY, ototox, hypoK met alkylosis, hyperuremica, impaired Carb tolerance (hyperurecemia, hypomagnesmia

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2
Q

Ethacrynic Acid

A

Loop Diuretic:
NKCC2: Thick ascending limb of loop of henle; this channel is used in Tubuloglomerular Feedback thus this drug inhibits TGF.
K, H+, Mg+, Ca2+ wasting.
Also increases renal PG synth=more diuresis.
SHORT ACTING=USED FOR PULM EDEMA not for HTN management.
TOX: NO SULFA ALLERGY BUT MORE OTOTOXICITY, hypoK met alkylosis, hyperuremica, impaired Carb tolerance (hyperurecemia, hypomagnesmia

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3
Q

Acetazolemide

A

Carbonic Anhydrase Inhibitor (Diamox)–Inhibts bicarb absorption in the Prox tubule causing bicarb diuresis (this causes Bicarb dumping and LACK of H+ secretion from not making more bicarb).

Tx: Glucoma and CNS pressure, and altidude sickenss

Decreases Aqueos Humor Secretion.

CSF becomes acidotic causing CNS induced hyperventilation.

Hypokalemic, hyperchloremic (Aldo induced) met acidosis

AVOID IN HEP CIRRHOSIS from poor ammonia clearance (cuz you’re keeping H, thus you are dumping the NH3 counter ions)

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4
Q

HCTZ

A

Potassium wasting CALCIUM SPARING diuretic actingin the Distal Convulated tubule by inhibiting NCC.

Used in HTN, HF, Nephrolithiasis, Nephrogenic DI (reduces GFR allowing kidney a chance to absorp)

Inhibited by NSAIDs

Tox: RISK OF SULFA ALLERGY, Hyponatremia (Genetic idiosyncracies), hypokalemia, hyperglycemia, hyperlipidemia, hypomagnesia (in elderly).

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5
Q

Spironolactone and Epleronone

A

Aldosterone Receptor Antagonist: Potassium Sparing Diuretics, acting in the cortical collecting tubule.

Used in Conn’s Syndrome (hyperaldo)

Spironolactone can cause _Gynecomastia from week Antiandrogen receptor effects (WHY USED IN PCOS for Hirtuism)***; Eplerenone does not have this effect_

Tox: Hyperkalemic–cautionable use with other aldo antagonists (ACEI, ARBs…)

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6
Q

Amiloride

A

K Sparing diruetic by blocking ENaC channel (Na/K exchanger) on epithelial side of Collecting duct.

Tx: Used to counter hyperaldo, can be used in Diabetes inspidus (counter intuitive–used to dump Na preventing HyperNa and telling body to conserve water)

Tox: Hyperkalemic Met Acidosis

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7
Q

Triamterene

A

K Sparing diruetic by blocking ENaC channel (Na/K exchanger) on epithelial side of Collecting duct.

Used to counter hyperaldo

Tox: Hyperkalemic Met Acidosis, Kidney stones (not with amiloride)

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8
Q

Mannitol

2 majors SEs?

A

Osmotic Diuretic, Given IV and freely filtered by the kidney. Most effect on the proximal convulted tubule. _ REDUCES BRAIN VOLUME_ (lower Intracranial pressure and glaucoma tx).

PULM EDEMA: initally from rapid increase in fluid volume causing increase pulm pressure=pulm edema

Used to retain urine flow to remove toxins (ie Rhado/hemolysis)

Can worsen CHF; don’t give to anuric patients–causes HTN by pulling fluid from tissue to blood

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9
Q

Desmopressin

A

V2R agonist (ADH agonist) causing AC–>cAMP–>insertion of aquaporin channels.

Given paraentarally

ETOH inhibtis release of ADH

Also causes increase in vWF production

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10
Q

Colvaptan/Tolvaptan

A

“vaptans–like evaporate—to dry out”

ADH ANTAGONISTS–used for SIADH and paraneoplastic syndromes (Small Cell carcinoma)

Colvaptan–l V1a/2

Tolvapatan –lV2R

CAN CAUSE CENTAL PONTINE MYLOSIS from too rapid correction of hyponatremia

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11
Q

Bevacizumab

A

Anti-VEGF Antibody

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12
Q

Sorafenib

A

VEGF Inhibitor Small molecule

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13
Q

Sunitinib

A

VEGF inhibitor small molecule

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14
Q

Somatotropin/Somatropin

A

Growth Hormone, used to fix short stature in hypoGH kids and restore metabolic effects of GH

Tox: Pseudotumor cerebri, progession of scoliosis, edema, hyperglycemia

SLEEP APENEA in obese pnts.

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15
Q

Mecasermin

A

Recombinant IGF-1

Improves growth

Tox is Hypolgycemia (cuz IGF-1 has minor insulin activity)

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16
Q

Octreotide/Lanreotide

A

Somatostain Analogs.

Used to inhibit GH production in acromegaly/ GH tumors. Tx for some diarrheas. STOPS SPLANCHNIC CIRULATION THUS GOOD FOR GI BLEEDING (EG ESOPHAGEAL VARICES)

Tox: Nausea, vomiting, GI isues, Gall stones, Sinus brady

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17
Q

Pegvisomant

A

GH receptor Antagonist

Used for Acromegaly

Not real tox

“Peggy is short”

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18
Q

Urofollitropin

Follitorpin Alpha/Beta

A

FSH analogs

Used to control ovarian hyperstimulation (control levels and get feedback loop under control)

Infertility due to hypogonadotropic hypogonadism in men

Can cause multiple pregs

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19
Q

Lutropin Alpha

Choriogonadotropin Alpha

A

LH Receptor Agonist

Used in combo to stim follicular devo

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20
Q

Leuprolide, Goserlin

“relins”

A

GnRH agonists

Pulsatile Admin caues increase in FSH/LH

Continous admin cause knock down of FSH/LH

Prostate, Breast, Cehmical Castration, Fibriods and Precocious puberty Tx

Can cause bronchospasms and anaphylaxis type hypersenstivity Rxns

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21
Q

Ganirelix

“-relix”

A

GnRH receptor ANTAGONISTS

Lowers LH/FSH levels

Helps control female cycle and used for symptomatic advance prostate cancer

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22
Q

Bromocriptine

Cabergoline

A

D2 Recptor Agonists

Used to supress Prolactin secretion and for PD

Tox: nausea, headache, orthostatic hypotension

CABERGOLINE good because nasuea is lessened (particularly by vaginal administration) but associated with Cardiac Valvulopahty

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23
Q

Pitocin

A

Oxytocin Agonist (causing increase in Calcium which turns on myosin light chain kinase of myometrial smooth muscle)

Used to induce uterine contraction and control hemorrhage

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24
Q

Raloxifene

A

SERM: Selective EstroR modulator (antiER in breast/uterus, PROER in Bone)

Indicated for Osteoporosis and Prevention/Tx of Breast Cancer in post menopausal women

Venous thrombosis, and Teratogenic (any estrogen = increased coagulation)

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25
Q

Anastrozole

A

Reversible Aromatase competitve inhbitor

Used in women with ER+ Breast Cancer

Tox: Osteporosis

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26
Q

Clomiphene Citrate

A

SERM–inhibits ER of hypothalums thus disregulating E’s negative feedback

Infetility, PCOS, Male secondary hypogonadism (off-label)

Can result in multiple pregnancies

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27
Q

Norethindrone

A

Progestin pill only. Need to be on strick schedule (need to be within 3 hours each day)

Used for contraception, endometriosis, and abnormal periods.

Thickens Vaginal Fluid. Also stops ovulation in 50% of ppl (idiosyncratic)

Stop LH peak by inhibiting pituitary PR.

SMOKING INCREASES CV events

“Nothing but gestrone; and cuz its only half of the hormones, it stops ovulation in 50% of pnts”

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28
Q

Sprintec

A

E and P analog.

Used for Acne, decrease heavy/painful periods, decreases risk of ovarian cysts.

PE, MI, Thrombophlebitis, HTN, Gall bladder disease, depression

Increase CV risk w/ Smoking

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29
Q

Levonorgestrel

A

Plan B. Not effective once implantation has begun.

Synthetic progesterone—Inhibits ovulation by negative feedback on Hypothalamus.

Decreases FSH/LH

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30
Q

Mifepristone

A

Abortifacient (RU486) for first 49 days. (“mife has F for fuck it”)

PR antagonist (stronger than P4), causing endometrial degeneration and cervical softening and finally trophoblast detachment and uterine contraction–bascially simulating ovulation (via decrease P4).

ALSO competitive inhibitor for glucocorticoid receptor

Vaginal Bleeding***, infection

31
Q

Tertbutaline

A

B2 agonist. “Relaxes uterus just like airway”

Used for Preterm Labor by slowing uterine contractions (only for 72 hours). Asthma tx too

Can cause breathing issues, fast pounding irregular heart, chest pain, seizures.

32
Q

Nifedipine

A

Calcium channel blocker

Used to treat preterm labor by slowing uterine contractions.

don’t combine with MgS04. Constipation, dizziness, nausea. Prolonged vaignal bleeding.

33
Q

Indomethacin

A

NSAID used to decrease PGs that normally produce uterine contractions.

Limitations on Dose due to fetal effects=Causes premature closure of ductus arteriosus (lack of PGE2), and Oligohydramnios (loss of fetal PGs causes dysregulation of kidneys)

34
Q

Magnesium Sulfate

A

Thought to block calcium

Used for neuroprotective (Cerbral Palsy) effects in preeclampsia (does not really slow contractions in RCTs)

First sign of trouble is loss of patellar reflex

35
Q

Misoprostol

A

Labor induction (“prostol pushes”). PGE1

Miscarriage, teratorgenic, uterine rupture, hyperstimulation, HTN, anaphhylaxis, HTN, MI, Arrhtymias, Thromboembolism

36
Q

Methergine

A

(“erg”=ergot) ERGOT alkalyoid used for uterine atony and post partum hemorrhage.

Cramps, Respiratory depression, coma

37
Q

Carboprost

A

“prost pushes”

PG2 analog that binds PG E2 rectpeor.

Uterine contractor, post partum hemorrhage, 2nd trimester aborptions.

Transient bronchoconstrictions

38
Q

Doxycyline

A

Tetra type antibiotic. Inhibits protein synth by binding to the 30s ribo.

UTI, Acne, gonorhea, chlamydia, lymes, periodonitis

Calcium chelotar (binds to bones/teeth). Can cause RTA** and sever skin reaction

39
Q

Terconazole

A

azole. Candida albicans in vagina.

Disrupts fungal Cyp450 inhibiting erogsterol production

Flu like sxs

40
Q

Valacyclovir

A

Prodrug converted into acylcovir (purine analog guonsine derivative.)

Tx for HSV1/2, Herpes Zoster

Herpes simplex prophyalxis/reduction of transmission.

Prevention of CMV following an organ transplant

Mono

Herpes B virus exposure

41
Q

Metronidazole

A

Flagyl. Reduced in organism causing anion to bind to DNA.

Requires mitochondria or organisms that have PFOR

Acts like Dilsulfiram. Severe skin reactions.

Don’t use with ppl with Severe CNS diseases (neutropenia, pancreatitis, ataxia, encephalopathy)

42
Q

Insulin Preps

A

Rapid Acting: 5-15 min: Lispro, aspart, glulisine

Long acting: Glargine and Detemir

43
Q

Glimperide

Glipizide

Glyburide

A

Sulfonylureas: inhbit Beta cell potassium channel which increases depolarization and Insulin release

Not indicated for heaptic dieases

Glipizide and glybruide also not indicated for renal disease

44
Q

Repaglinide

A

(Prandin) Meglinitides: Fast and brief stim of insulin secration

“Non-sulfonureas”

Nateglinidie (Starlix)

45
Q

Metformin

A

Biguianide. Turns on AMPK of liver.

Lowers glucose output of liver and increases liver insulin sensitivity.

Ppl lose weight on it.

GI issues, B12 absorb issues, and SEVERE LACTIC ACIDOSIS

46
Q

Prioglitazone and Rosiglitazone

A

“-glitazones get ya in the zone to respond to insulin”

Thiazolidines. Binds PPARgamma increasing insulin responding proteins

Increase glut uptake and fat repatterning

SEs: Weight gain, fluid retention AND CONGESTIVE HEART FAILURE

47
Q

Exanatide, Laraglutide

A

“Tides produce a tide of GLP1/GIP”

GLP-1 incretins: LOWER BLOOD SUGAR

1) SLOWS GI tract (less absorption), Promote insulins release and glucogaon inhibtion

Inactived by DDP-4.

SEs: GI, Vomitting, Hypoglycemia

48
Q

Sitagliptin, Saxagliptin, Linagliptin, Alogliptin

A

“-Glipins keep GLPs lvls by INhibiting DDP4”

DDP-4 inhibitors preventing the breakdown of GLP-1 and GIPs

49
Q

Canaglifozin, Dapaglifozin

A

“glifozin keeps ya whizzin”

Inhibits Kidney SGLT-2 which causes glucose to be in the urine.

Dehyration, UTIs, and Yeast infections

50
Q

Acarbose

Miglitol

A

“acarbose makes you A-CARBic”

Alpha glucosidase inhbitors: used to process sugar before GI absorption.

This lowers postprandial gluc levels

SEs: GI Issues

51
Q

Pramlinitide

A

“you need PRAMlinitide with your chicken PARM cuz you shotgun it”

Amylin Agonists: Slows stomach emptying, reducing glucagon production.

SEs nausea and hypoglycemia, GI motility issues (no gastroparesis)

52
Q

Colesevelam

A

Bile Acid Binding Resins

53
Q

Bromocriptine

A

Modestly improves glycemic control at lower doses than for AD/Prolactinoma lvls

54
Q

Hydrocortisone

Prednisone

Betamethason

Dexamethasone

A

Lower ones have longer duration of actions.

Corticosteroids acting through the Glucocorticoid receptor (steroid receptor).

1) Cushoiniod Effects: Ups Blood sugar, Central fat depostion, protein catabolism
2) Immunosupressive and antiinflamatory effects: supresses cytokine/chemokine production/response.

Used for: Primary adrenocortical insufficiency (Addison’s Disease), replacement for CAH (can be given to mother if daughter is homorecessive for Cyp21 def to prevent ambigious genitalia).

SEs: Crosses placenta/breast, cushingoid, growth retard, fusing of ephyseal plates (termination of linear growth), osteoporiss, muscle wasting, steroid psycosis

55
Q

Flucortisone

A

“Flu–for fluid” Mineralcorticoid Agonist

Works just like Aldo.

Used for primary adrenal insufficiency (WONT NEED IT FOR SECONDARY CUZ RAAS IS STILL INTACT since adrenals themselves are ok (possibly atrophic, depneding on chronicity of condition)). ALso for CAH (3 def, 21 def, don’t need for 11 def cuz there is still minor mineralcoritcoid agents being produced (precurosors).

SEs: HTN, HYPOK, Met alk

56
Q

Ketaconazole

A

Inhibitor of Steroid biosynth (fungal CYP450 14 and adrenal cyps)

Inhibits Cyp 17, 3, 11 (so you get nothing from adrenals–but apparently in real life you still get minor aldo)

Tx for Cushings

HEPATOTOXIC

57
Q

Metryapone

A

“can still bone on metryapone—cyp 11 inhib thus you still have andro excess and some mineralcoritcoid”

Adrenal Steroid biosyntheis inhibitor

Inhbits Cyp 11 (still get weak mineralcorticoid action)

SEs: Na/H20 retention; Hirtuism

58
Q

Cabergoline

A

D2 Recptor agonist causing supression of pituiary ACTH

Treats Cushing’s DISEASE

SEs: Cardiac Valvulopahty, H/A, Ortho HOTN, Fatigue, psych manifesations

59
Q

Pasireotide

A

Somatostatin Receptor Agonist causing Pit supresion of ACTH

Tx for Cushing’s DISEASE

SEs: GIs, Hyperglycemia, Bradycardia, conduction disturbances

“-eotide” somatostatin analog

60
Q

Phenoxybenazmine

Prazosin

Terazosin

Doxazosin

A

Alpha 1 antagnoists

Phenoxy is irreversible.

zosins are competitive antagonists.

HTN Tx associated with pheo’s

SEs: HOTN; Phenoxy can cause TACHY

61
Q

Metryosine

A

Compeitivley inhibits Tyrosine Hydroxylase

Lowers blood pressure via inhibition of catecholamine production.

Tx for pheos

SEs: Extrapyramidal Sxs, ortho HOTN, crystalluria

62
Q

Levothryoxine

A

Synthetic T4. Long acting, delayed onset.

When initially dosing you might need to give large dose because of unsaturated TBG.

63
Q

Liothyronine

A

Synthetic T3. Short duration and Faster onset of action.

Better used for acute crisis—Myxedema Coma

64
Q

Liotrix

A

Synthetic T4/3. 4:1 T4 to T3 Ratio

65
Q

Propylthiouracil

A

Blocks TPO and 5’deiodinase.

Less hormone production (TPO) as well as blocking peripheral T4–>T3 conversion (5’)

DOES NOT inhibit the iodide transporter

Use PTU in pregnant women ONLY 1st Trimester

SEs: Teratogenic, Agranulocytosis, hepatotox

RASH, AGRANULOCYTOSiS, APLASTIC CRISIS

66
Q

Methimazole

A

Inhibits TPO, NOT iodide tranporter. DOES NOT block peripheral T4–>T3

Longer half life, First line in Non-preggers.

Used to lower thyroid levels presurgery.

If you are going to use in Preggers, use in 2+3 trimesters.

SEs: Teratogenic, Agranulocytosis, hepatotox

RASH, AGRANULOCYTOSiS, APLASTIC CRISIS

67
Q

Cinacalcet

A

Increases sensisitivty of CaSR of chief cells of PThyroid Gland.

Tx for Secondary hyperparathryroidism

68
Q

Furosemide’s Mechanism of Action?

SEs?

A

Thick ascending limb.

1) Messes up countercurrent mechanism
2) Stims PG release causing vasodilation adding to diruresis (THEREFORE NSAIDS INHIBIT THIS EFFECT AND FUROSEMIDE***)

SEs: ototox, hypoK, dehydration, allergy (sulfas), nephrotox, HYPERURICEMIA

69
Q

Sickle cell patient presents with gross hematuria…whats going on?

Other causes of this?

A

Renal Papillary necrosis. (ischemic tubular necrosis is in fluid deprived pnts=oliguria and muddy brown casts)***

Analgesic Nephropathy, DM, Acute pyelonephritis, UTIs

70
Q

1) Rapid onset hematuria vs 2) oligouria with muddy brown casts?

A

1) Renal papillary necrosis
2) Acute/Ischemic Tubular Necrosis

71
Q

Palpable nontender gall bladder with weight loss?

Number 1 risk factor?

A

Courvoisier sign of Pancreatic Head Adenocarcinoma.

Smoking

72
Q
A
73
Q
A

Tom (30 decks)

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