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Pharmacology > Renal Pharmacology > Flashcards

Renal Pharmacology Flashcards

0
Q

Loop diuretics: Site of action and effectiveness

A

Ascending loop of Henle

Most effective diuretics

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1
Q

Loop diuretics: Drugs

A

Furosemide, Torsemide, Bumetanide

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2
Q

Loop diuretics: Mechanism

A

Inhibits NaCl reabsorption at the thick ascending loop of Henle

  • Block Na reabsorption, furosemide prevents passive reabsorption of water
  • More than 20% of NaCl reabsorbed in TAL so block here -> profound diuresis
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3
Q

Loop Diuretics: Pharmacokinetics

A

Both oral and parenteral
- Oral onset: 1-2 hour; IV onset: 5 min
- Duration: 2-3 h
Extensively bound to plasma protein
Elimination
- GF and tubular secretion (organic acid secretory system)
- Includes uric acid

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4
Q

Loop Diuretic: Action

A

High diuresis
- Rapid onset
- Wide use in emergency information
- Treatment of edematous conditions refractory to thiazide diuretics (Chronic renal failure)
- Also may produce a greater K loss than thiazides if continuous action
- K loss from increased Na in tubules reaching late DCT/ Collecting Duct
- Shorter duration than thiazides
- Allows for wash out
Loss of K, Cl, and H can result in hypokalemic or hypochloremic alkalosis
Increase in renal blood flow and increase in GFR
Can increase loss of Ca and Mg

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5
Q

Loop diuretics: Use

A

Pulmonary edema associated with CHF
Acute renal failure
- Promotes diuresis even when renal blood flow and GFR are low; flushes intratubular casts
Hypercalcemic states
- Hyperparathyroidism, malignancies
Hyperkalemia
- Caused by potassium sparing diuretic

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6
Q

Loop Diuretics: Adverse effects

A

Hyponatremia, hypochloremia, and dehydration
- Dry mouth, thirst, oliguria, dehydration
- May promote thrombosis and embolism
Hypotension
- Loss of volume, relaxation of smooth muscle
- Monitor
Hypokalemic metabolic alkalosis
Ototoxicity
Hyperuricemia (gout)
Hyperglycemia
Lipid abnormalities
- Increase in LDL and total cholesterol,even triglycerides
- Often times not bad enough to be concerned
Hypomagnesemia
- pretty rare

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7
Q

Loop diuretics: Drug interactions

A

Aminoglycosides
- Ototoxic
- Can cause irreversible deafness
Digoxin
- Arrhythmia
- Activity and toxicity of digoxin increases when K is decreased
- Increased digoxin binding on Na-K-ATPase
Lithium
- Lower Na, suppresses lithium excretion; reduce lithium dosage
Potassium-sparing diuretics
- Nullifies the potassium wasting effects of loop diuretics

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8
Q

Thiazide diuretics: mechanism

A

Inhibits reabsorption of Na, Cl, K and water
- Less effective than loop diuretics
Elevates plasma uric acid and glucose
Increase cholesterol

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9
Q

Thiazide diuretics: Differences from Loop Diuretics

A

Ineffective when GFR low

Enhances calcium reabsorption

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10
Q

Thiazide: clinical uses

A

Essential hypertension
Edema
Nephrogenic diabetes insipidus (ADH deficiency, or lithium toxicity)
- Reduces urine production
- Decrease in effective plasma volume resulting in decreased GFR causing a decrease in urine production
Nephrolithiasis
- Reduces hypercalcuria

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11
Q

Thiazide: Adverse effects

A 
Hyponatremia, hypochloremia, and dehydration
Hypokalemia
   - Biggest concern especially if digoxin is present
   - Correction
        - High K diet
        - Could lower the dose
        - Possibly use potassium supplements
        - Add spironolactone
Hyperglycemia
   - Concerns with people with diabetes
Hyperuricemia
   - Gout
Hyper-lipidemia
   - Hypercholesterolism
Allergic reactions
   - Structure has a sulf group in it so sulfa allergy is a concern
Avoid during pregnancy
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12
Q

Potassium-sparing diuretics: Effects

A

Modest increase in urine production

Substantial decrease in K excretion

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13
Q

Potassium-sparing diuretics: Subclasses

A 
Aldosterone antagonists
   - Spironolactone
   - Eplerenone
Non-aldosterone antagonists
   - Triamterene
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14
Q

Spironolactone: Mechanism

A

Blocks the action of aldosterone in the distal nephron

  • Inhibits Na excretion
  • Decreases K excretion
  • Scanty diuresis, delayed action
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15
Q

Spironolactone: Clinical use

A

Liver cirrhosis, hypertension, edema, hyperaldosteronism

Nullify potassium wasting

16
Q

Spironolactone: Adverse effects

A

Hyperkalemic metabolic acidosis
- Serum K > mEq/L causes arrhythmia
- Insulin injection can help lower K levels
- Caution: K supplements, ACE-inhibitors
Inhibition of androgen receptors
- Gynecomastia, BPH, menstrual irregularities
GI disturbances

17
Q

Eplerenone: Benefit over spironolactone

A

Greater receptor selectivity, fewer steroid-like effects

18
Q

Triamterene: Action

A

Inhibits Na channels in the collecting tubule causing Na excretion
K sparing effect
- Doesn’t matter how much aldosterone is present

19
Q

Triamterene: Metabolism

A

Extensively metabolized
Amiloride
- Excreted unchanged

20
Q

Triamterene: Clinical uses

A

Adjunct with thiazide or loop diuretic in CHF or hypertension
Triamterene has low t1/2

21
Q

Triamterene: Toxicities

A

Hyperkalemia, metabolic acidosis
Acute renal failure
- Triamterene in combination with indomethacin
- Decrease the amount of prostaglandin

22
Q

Potassium-sparing Diuretics: C/I

A

K supplements, K rich food
Renin-angiotensin-aldosterone system blunting agents
- ACE inhibitors, beta-blockers
Kidney stones (Triamterene)

23
Q

Osmotic Diuretics: Effect

A

No effect on salt

Water diuresis

24
Q

Mannitol: Mechanism

A

Creates osmotic resistance that limits water reabsorption from the tubules
Stays in the nephron
- Excrete a larger amount of water

25
Q

Mannitol: Use

A

To increase urine volume in renal failure
- Hemolysis, rhabdomyolysis
To reduce intra-cranial and intraocular pressure
- Acute angular glaucoma

26
Q

Mannitol: Toxicities

A 
Extracellular volume expansions
   - Extracts water from cells 
   - Worsens heart failure
   - Pulmonary edema, headache, nausea
Dehydration and hypernatremia
Headache, nausea vomiting
27
Q

Carbonic Acid inhibitors: Drug

A

Acetazolamide

28
Q

CA-I: Drugs

A

Oral: Acetazolamide
Topical: Dorzolamide

29
Q

Acetazolamide: Mechanism

A

Inhibit carbonic anhydrase enzyme
Decrease supply of H resulting in a decrease of Na H exchange
Increase excretion of bicarbonate
- Urine will become alkaline
- Mild systemic acidosis
Increase K excretion
Metabolic acidosis produces a self-limiting action; rapid tolerance decreases use as diuretic

30
Q

Acetazolamide: Uses

A

Glaucoma
- Reduce intra-ocular pressure
Acute mountain sickness [pulmonary/cerebral edema]
- Decrease CSF formation and decrease pH of brain and CSF -> increase ventilation and decrease symptoms
Urinary alkalinization
- For increased excretion of weak acids and acidic drugs
Metabolic alkalosis
- Caused by loop and thiazide diuretics

Pharmacology (13 decks)

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