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0. Step Ia > Renal Pharm from FA > Flashcards

Renal Pharm from FA Flashcards

1
Q

Mannitol

Mechanism?

A

Osmotic diuretic

Incr tubular fluid osmolarity producing increased urine flow

decreases intracranial/ontraocular pressure

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2
Q

Mannitol

Clinical Use?

A

Drug OD

increased intracranial or intraocular pressure

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3
Q

Mannitol

Tox?

A

Pulmonary edema

Dehydration

Contraindicated in anuria, CHF

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4
Q

Acetazolamide

Mechanism?

A

Carbonic anhydrase inhibitor

Cuases self-limited NaHCO3 diuresis and decreased total-body HCO3- stores

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5
Q

Acetazolamide

Clinical Use?

A
  • Glaucoma
  • Urinary alkalization
  • Metabolic alkalosis
  • Altitude sickness
  • Pseudotumor cerebri (hydrocephalus, occurs w young obese women, decreased CSF outflow at arachnoid villi)
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6
Q

Acetazolamide

Tox?

A

Hypercloremic metabolic acidosis

Paresthesias

NH3 toxicity

Sulfa allergies

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7
Q

Acetazolamide

site of action?

A

Prox convoluted tubule

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8
Q

Mannitol

site of action?

A

Descending tubule

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9
Q

Loop Diuretics: name 2

A
  • Furosemide
  • Ethacrynic acid
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10
Q

Furosemide

site of action?

A

Loop - thick ascending limb

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11
Q

Ethacrynic acid

site of action?

A

Loop - thick ascending limb

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12
Q

Furosemide

Mech?

effect on Ca excretion?

A

Sulfonamide loop diuretic

Inhibits cotransport system (Na/K/2Cl) of thick ascending limb of LOH

abolishes hypertonicity of medulla, preventing concentration of urine.

Stimulates PGE release (vasodilatory effect on afferent arteriole)

Increases Ca excretion

“Loops Lose calcium”

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13
Q

Furosemide

what inhibits it?

A

NSAIDs

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14
Q

Furosemide

Use?

A
  • Edematous states (CHF, cirrhosis, nephrotic syndrome, pulm edema)
  • Hypertension
  • Hypercalcemia
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15
Q

Furosemide

Tox?

A

Ototoxicity

Hypokalemia

Dehydration

Allergy (sulfa)

Nephritis (interstitial)

Gout

“OH DANG”

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16
Q

Ethacrynic Acid

Mech?

effect on Ca excretion?

A

Phenoxyacetic acid derivative (NOT a sulfanamide!)

Same action as Furosemide (inhibits cotransport (Na/K/2Cl).

-> Prevents urine concentration.

Increases Ca excretion

“Loops Lose Ca”

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17
Q

Ethacrynic Acid

Use?

A

Diuresis in patients allergic to sulfa drugs

18
Q

Ethacrynic Acid

Tox?

A

similar to Furosemide (OH DANG)

Can cause hyperuricemia

Never use to treat gout

19
Q

Thiazides

site of action?

A

Distal convoluted tubule

20
Q

Hydrochlorothiazide

Mech?

Effect on Ca excretion?

A

Thiazide diuretic

Inhibts NaCl reabsorption in early distal tubule, decreasing the diluting capacity of the nephron.

Decreases Ca excretion (Ca-sparing)

21
Q

Hydrochlorothiazide

Use?

A

HTN

CHF

Idiopathic hypercalciuria

nephrogenic diabetes insipidus

osteoporosis

22
Q

Hydrochlorothiazide

Tox?

A

Hypokalemic metabolic alkalosis

Hyponatremia

HyperGlycemia

HyperLipidemia

HyperUricemia

HyperCalcemia

Sulfa drug -> allergies

“HyperGLUC”

23
Q

K+ sparing diuretics

Name 4

A

Spironolactone (& Eplerenone)

Triamterene

Amiloride

“The K+ STAyEs”

24
Q

K+ sparing diuretics/Spironolactone and Eplerenone

Mech?

Site of action?

A

Competitive aldosterone receptor antagonists

Cortical collecting tubule

25
K+ sparing diuretics/Trimterene, Amiloride Mech? Site of action?
Cortical collecting tubule Block Na+ channels
26
K+ sparing diuretics Use?
Hyperaldosteronism K+ depletion CHF
27
K+ sparing diuretics Tox?
Hyperkalemia (can lead to arrhythmias) Spironolactone: Endocrine effects (gynecomastia, andiandrogen)
28
Diuretics in general Effect on Urine NaCl?
All **increase Urine NaCl** except Acetazolamide Serum NaCl may decrease as a result.
29
Diuretics in general Effect on Urine K?
Loop and Thiazide diuretics: **Urine K increases** Serum K may decrease
30
Loop diuretics: effect on Urine Ca2+?
**Urine Ca2+ increases with Loop Diuretics** Mech: decreased paracellular Ca2+ absorption -\> hypocalcemia
31
Thiazide diuretics: effect on Urine Ca2+?
**Urine Ca2+ decreases with Thiazides** Mech: enhanced paracellular Ca2+ reabsorbtion in the distal tubule
32
Which diuretics cause acidemia? mech?
Carbonic anhydrase inhibitors (acetazolamide) Mech: **decreases HCO3- absorption. ** - \> K+ sparing aldosterone blockade prevents K+ secretion and H+ secretion. - \> Hyperkalemia leads to K+ entering all cells (via H/K exchanger) in exchange for H+ exiting cells
33
What diuretics cause alkalemia? mech?
Loop diuretics and thiazides. _Mech 1:_ Volume contraction -\> incr AT II -\> incr Na/H exchange in prox tubule -\> incr HCO3- reabsorption (contraction alkalosis) _Mech 2:_ K+ loss leads to K+ exiting all cells in exchange for H+ entering cells _Mech 3_: in low K+ state, H+ is exchanged for Na+ (rather than K+) in cortical collecting tubule -\> alkalosis and "paradoxical aciduria"
34
ACE inhibitors name 3
Captopril Enalapril Lisinopril
35
ACE inhibitors mech?
inhibit ACE -\> decr At II -\> decr GFR by preventing constriction of efferent arterioles. Renin increases due to loss of feedback inhibition. ACE inhibition also prevents inactivation of bradykinin (vasodilator)
36
AT II blockers (-sartans) effect?
similar to ACE inhibitors do not increase bradykinin so there is decr risk of cough or angioedema
37
ACE inhibitors use?
HTN CHF proteinuria diabetic nephropathy **Prevent heart remodeling** as a result of chronic HTN
38
ACE inhibitors Tox?
**C**ough **A**ngioedema **T**eratogen incr **C**reatinine (decr GFR) **H**yperKalemia **H**ypotension "Captoprils CATCHH"
39
ACE inhibitors teratogenic effect?
fetal renal malformations
40
ACE inhibitors contraindications?
- C1 esterase inhbitor deficiency - Bilateral renal artery stenosis (because ACE inh will further decr GFR -\> renal failure)

0. Step Ia (28 decks)

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