Renal Pharm

Question 1

Acetazolamide

Answer 1

C. A. Inhibitor –> Proximal Convoluted Tubule

Causes Bicarbonate and Na Loss in Urine.

Question 2

Mannitol

Answer 2

Osmotic Diuretic –> Proximal Convoluted Tubule.

Increase Urine Formation with small Na and ions. Used for Dialysis disequlibrium and to reduce ICP and I-Occular-Pressure.

Question 3

Furosemide

Answer 3

Loop Inhibitor –> TALH –> Na-K-Cl symport inhibition.
Make the Macula Densa Inable to sence NaCl. This results in copious diuresis and NaCl loss as well as increased K+/H+ secretion.

Kidney will not be able to concentrate urine.

**Do not give with Li, Indomethacin, Probenecid or warfarin.

Question 4

Bumetanide

Answer 4

Loop Diuretic –> 40x stronger than fluorosamide. Used for patients who are on warfarin which is contraindicated for use with furosemide.

Question 5

How do carbonic Anhydrase Inhibitors work ?

Answer 5

Inhibit CA resulting in bicarbonate loss in the urine. Causes Alkaline urine due to Na+ Bicarbonate Loss.
*Enhances Cl reabsorption resulting in acidosis

Question 6

What are the adverse effects of CA inhibitors ?

Answer 6

Metabolic acidosis and markedly increased K+ loss in the urine.

Question 7

How do osmotic diuretics work ?

Answer 7

Small molecules are filtered not absorbed by the kidney.

Question 8

Where in the kidney do osmotic diuretics work ?

What is their indication for use ?

Answer 8

They have minor effects in the proximal convuluted tubule but their major mechanism of action is in the Loop of Henle

Treatment of dialysis disequlibrium syndrome
Reduce ICP
Reduce Intraoccular pressure

Question 9

How do osmotic diuretics work ?

Answer 9

They increase Urine with small increments of NaCl and other ions.

Question 10

What is a osmotic diuretic in lecture and what are its side effects ?

Answer 10

Mannitol, The side effects are volume overload and they are contraindicated in cardiac failure.

Question 11

How do loop diuretics work ?

Answer 11

They inhibit the Na-K-2Cl symporter in the Thick Ascending Loop of Henle.

This makes the Macula Densa inable to sence NaCl.

Question 12

What will loop diuretics do to the kidney ?

Answer 12

They will increse total renal blood flow. Stimulate synthesis of prostaglandins. Maintain GFR

Question 13

How can loop diuretics increase renin production ?

Answer 13

1. Inhibit the macula densa
2. reflexively activate the sympathetic NS.
3. Stimulate Intrarenal Barioreceptor mechanisms

Question 14

What are the net effects of Loop Diuretics ?

Answer 14

Most potent class in Mobilizing NaCl.
Significant NaCl loss.
Increased Urinary excretion of Ca2+ and Mg2+
Impair the ability of the kidney to concentrate urine.

Question 15

What is Furosemide ?

Answer 15

A loop Diuretic. (X) NaCl reabsorption in TALH.
Given IV / IM.
Wide margin of safety.

• *Dose response curve is altered by renal disease
• *Extensively protein bound and excreted in the urine.

Question 16

What are the pharmalogical effects of Flurosemide ?

Answer 16

Increased Urinary secretion of K+ and H+
Increased urinary secretion of Ca2+ and Mg2+.
Increase Prostaglandins and venous capacitance.

Question 17

What are the adverse effects of Fluorosamide ?

Answer 17

Abnormalities in electrolytes. Hypokalemia and alkalosis.
Elevated BUN hyperglycemia and hyperuricemia.

• *Ototoxicity and Sialadentitis
• *Dont give with Li

Question 18

What is Bemetanide ?

Answer 18

40x stronger of a loop diuretic than Fluorosamide. substituted for patients on Warfarin who need Fluorosamide.

Question 19

What is Torsemide ?

Answer 19

A diuretic loop inhibitor that also lowers Blood Pressure. Has the longest half life and can be given once daily.