Renal-Pharmacology Flashcards
What is Mannitol?
an osmotic diuretic that increased tubular fluid osmolarity, thus increasing urine flow and decreasing intracranial/intraocular pressure
What are the clinical uses of Mannitol?
drug OD, elevated intracranial/ocular pressure
What are the AEs of Mannitol?
pulmonary edema
dehydration
contraindictaed in anuria, HF
What is Acetazolamide?
Carbonic anhydrase inhibitor that causes self-limited NaHCO3 diuresis and decreased total body HCO3- stores
What are the clinical uses of Acetazolamide?
glaucoma,
urinary alkalinzation
metaboic alkalosis
altitude sickness
pseudotumor cerebri
What are the AEs of Acetazolamide?
herpchloremia metabolic acidosis
paresthesias
NH3 toxicity
sulfa allergy
What are the loop diuretics?
Furosemide, bumetanide, torsemide
How do loop diuretics work?
sulfonamide loop diuretics that inhibit cotransport NaK2Cl in the thick ascending limb of Henle
this eliminated the hypertonicity of the medulla, preventing urine concentration and stimulates PGE release (vasodilatory effect on the afferent arterioles) and increased Ca2+ loss
What drugs block loop diuretics release of PGE?
NSAIDs
What are the clinical uses of loop diuretics?
edematous states (hF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia
What are the AEs of loop diuretics?
OH DANG!
ototoxicity
hypokalemia
dehydration
allergy (sulfa)
Nephritis (interstitial)
Gout
What is Ethacrynic Acid?
phenoxyacetic acid derivative (not a sulfonamide)- essentially same action as furosemide for induction of diuresis in pts allergic to sulfa drugs
Toxicities are similar to furosemide; can cause hyperuricemia; never use to tx gout
What are the thiazide diuretics?
Chlorthalidone, Hydrochlorohiazide
How do thiazide diuretics work?
they inhibit Nacl reabsorption in the early DCT
also decrease Ca2+ excretion/loss
What are the clinical uses of thiazide diuretics?
HTN
HF
idiopathic hypercalciuria
nephrogenic dabetes insipidus
osteoporosis
What are the AEs of thiazide diuretics?
hypokalemia metabolic alkalosis
hyponatremia
hyperGlycemia, hyperLipidemia hyperUricemia, hyperCalcemia
sulfa allergy
What are the K+ sparing diuretics?
Spironolactone and eplerenone
Trimterene and Amiloride
What are Spironolactone and eplerenone?
competitive aldosterone receptor antagonists in the cortical CT
What are Triamterene and Amiloride?
ENaC channel blockers
What are the clinical uses of K+-sparing diuretics?
hyperaldosteronism, K+ depletion, HF
What are the AEs of K+-sparing diuretics?
hyperkalemia (can lead to arrhyhtmias)
endocrine effects with spironolactone (e.g. gynecomastis, antiandrogen effects, spironolactone bodies-below)
Spironolactone bodies Long-term administration of spironolactone gives the histologic characteristic of spironolactone bodies in the adrenal cortex. Spironolactone bodies are eosinophilic, round, concentrically laminated cytoplasmic inclusions surrounded by clear halos in preparations stained with hematoxylin and eosin
What urine NaCl changes are seen with diuretics?
icnreased with all except acetazolamide; serum NaCl may decrease as a result
What urine K+ changes are seen with diuretics?
increased with loop and thiazide diuretics; serum K+ may decrease as a result
What blood pH changes are seen with diuretics?
acidemia with: CA inhibitors (Decreased HCO3- reabsorption), K+ sparing diuretics (aldosterone blockade prevents K+ secretion and H+ secretion). Additionally hyperkalemia lead to K+ entering cells in exchnage for H+
Alkalemia with: loop diuretics and thiazides via volume contraction (increased AT II leading to increased NaH exchange action in the PCT, resulting in increased HCO3- reabsorption), hypokalemia promotes inward shift of H+, and in low K+ states, H+ rather than K+ is exchanged for Na+ in the cortical CT
What urine Ca2+ changes are seen with diuretics?
increased with loop diuretics via decreased paracellular Ca2+ reabsorption
decreased with thiazides via enhanced Ca2+ reabsorption in the DCT
What are some ACEIs?
Captopril, Enalapril, Lisinopril, and Ramipril
How do ACEIs work?
they inhibit ACE (which converts AT I to II), this decreased GFR by preventing constriction of efferent arterioles.
Renin levels increase as a result of loss of feedback inhibiton
Inhibition of ACE also prevents inactivation of ______, a potent vasodilator
bradykinin
What are the uses of ACEIs?
HTN, HF, proteinuria,
diabetic nephropathy (slows GBM thickening but decreasing intraglomerular pressure)
prevent unfavorable heart remodeling as a result of chronic HTN
What are the AEs of ACEIs?
CATCHH
Cough
Angioedeama (contraindicated in C1 esterase inhibitor deficiency)
Teratogen (fetal renal malformations)
elevated creatinine (decreased GFR)
Hyperkalemia
Hypotension
What are the ARBs?
Losartan, Candesartan, Valsartan, etc. (effects similar to ACEis, but ARbs do not increase bradykinin)
What are the clinical uses of ARBs?
HTN, HF, proteinuria, or diabetic nephropathy with intolerance to ACEIs (e.g. those with cough, angioedema, poorly controlled)
What are the AEs of ARBs?
hyperkalemia
decreased renal function
hypotension
teratogen
What is Aliskiren?
direct renin inhibitor, blocks conversion of angiotensinogen to angiotension I for tx of HTN
What are the AEs of Aliskiren?
Hyperkalemia
decreased renal function
hypotension
contraindicated in diabetics taking ACEIs or ARBs
