Renal I

Question 1

mannitol MOA

Answer 1

osmotic diuretic

Question 2

adverse mannitol

Answer 2

pulmonary edema
dehydration

CI in heart failure

Question 3

mannitol clinical use

Answer 3

drug overdose

elevated intracranial/intraocular pressure

Question 4

acetazolamide MOA

Answer 4

carbonic anhydrase inhibitor

decrease total body HCO3 stores

Question 5

acetazolamide clinical use

Answer 5

glaucoma
urinary alkalinization
metabolic alkalosis
altitude sickness
pseudotumor cerebri - high pressure in skull

Question 6

acetazolamide adverse

Answer 6

hyperchloremic metabolic acidosis
paresthesia
NH3 toxicity
sulfa allergy

Question 7

furosemide

Answer 7

loop diuretic

Question 8

bemetanide

Answer 8

loop diuretic

Question 9

torsemide

Answer 9

loop diuretic

Question 10

loop diuretic MOA

Answer 10

inhibit cotransport Na/K/2Cl thick ascending limb

prevent concentration of urine

stimulate PGE release - vasodilatory effect
-inhibited by NSAIDs

incrased Ca excretion - hypoCa

Question 11

clinical use loop diuretics

Answer 11

edematous state - HF, cirrhosis, nephrotic syndrome, pulmonary edema

HTN

hyperCa

Question 12

adverse loop diuretics

Answer 12

ototoxicity
hypoK
ehydration
sulfa allergy
nephritis - interstitial
gout

Question 13

ethacrynic acid

Answer 13

non - sulfonamide loop diuretic

Question 14

clinical use ethacrynic acid

Answer 14

sulfa allergy - diuresis tx

Question 15

chlorthalidone

Answer 15

thiazide diuretic

Question 16

thiazide diuretic MOA

Answer 16

inhibit NaCl reabsorption - early DCT
-decreased diluting capacity of nephron

decrease Ca excretion

Question 17

thiazide clinical use

Answer 17

HTN
heart failure
idiopathic hyperCa
nephrogenic DI
osteoporosis

Question 18

adverse thiazide

Answer 18

hypoK metabolic alkalosis
hypoNa
hyperglycemia
hyperlipidemia
hyperuricemia
hyperCa

sulfa allergy

Question 19

spironolactone

Answer 19

aldosterone antagonist - K sparing

Question 20

eplerenone

Answer 20

aldosterone antagonist - K sparing

Question 21

triamterene

Answer 21

Na channel blocker - K sparing

Question 22

amiloride

Answer 22

Na channel blocker - K sparing

Question 23

K sparing MOA

Answer 23

aldosterone antagonist in collecting tubule

or as Na channel blocker collecting tubule

Question 24

K sparing clinical use

Answer 24

hyperaldosteronism
K depletion
heart failure

Question 25

adverse K sparing

Answer 25

hyperK - arrhythmia | endocrine effect - spironolactone - gynecomastia, antiandrogen effects

Question 26

diuretics

Answer 26

``` acetazolaminde mannitol loops thiazides K sparing ```

Question 27

acid base with CAIs

Answer 27

acidemia | -decreased bicarb reabsorption

Question 28

acid base with K sparing

Answer 28

acidemia -aldosteorne block - prevent K secretion and H secretion also - hyperK leads to K entering all cells in exchange for H

Question 29

acid base with loops

Answer 29

alkalemia - volume contraction -increased angiotensin II - more Na/H exchange PCT > more bicarb reabsorption (contraction alkalosis) K loss - leads to K exiting cells exchange for H entering cell low K state - H exchanged for Na in cortical collecting tubule

Question 30

acid base with thiazides

Answer 30

alkalemia - volume contraction -increased angiotensin II - more Na/H exchange PCT > more bicarb reabsorption (contraction alkalosis) K loss - leads to K exiting cells exchange for H entering cell low K state - H exchanged for Na in cortical collecting tubule

Question 31

urine Ca with loops

Answer 31

decreased paracellular Ca reabsorption increased urine Ca

Question 32

urine Ca with thiazides

Answer 32

enhanced Ca reabsorption - DCT decreased urine Ca

Question 33

urine potassium

Answer 33

increased with loops

Question 34

captopril

Answer 34

ACE inhibitor

Question 35

ramipril

Answer 35

ACE inhibitor

Question 36

ACE inhibitor mechanism

Answer 36

inhibit ACE - decreased ANG II > decreased GFR - decreased constriction efferent arterioles renin increase - loss of feedback also prevent inactivation of bradykinin

Question 37

ACE inhibitor clinical use

Answer 37

HTN, HF, proteinuria diabetic nephropathy prevent unfavorable heart remodeling

Question 38

adverse ACE inhibitor

Answer 38

``` cough angioedema - lots of bradykinin teratogen creatinine increase hyperKa hypotension ```

Question 39

avoid in B/L renal artery stenosis

Answer 39

ACE inhibitor - because will further decrease GFR > renal failure

Question 40

losartan

Answer 40

ANG II blocker

Question 41

candesartan

Answer 41

ANG II blocker

Question 42

valsartan

Answer 42

ANG II blocker

Question 43

ANG II blocker MOA

Answer 43

block ANG II binding AT1 receptor

Question 44

clinical use ANG II blocker

Answer 44

HTN HF proteinuria diabetic nephropathy

Question 45

adverse ANG II blocker

Answer 45

hyperK decreased renal function hypotension teratogen

Question 46

aliskiren

Answer 46

direct renin inhibitor block conversion angiotensinogen to ANG I

Question 47

clincal use aliskiren

Answer 47

HTN

Question 48

adverse aliskiren

Answer 48

hyperK decreased renal f unction hypotension CI - diabetic taking ACE I or ARBs