Renal Pharmacology

Question 1

What type of diuretic is mannitol?

Answer 1

Osmotic diuretic (it’s a sugar that pulls water into tubules)

Question 2

Where is mannitol’s site of action?

Answer 2

Proximal convoluted tubule and descending LOH

Question 3

Describe mannitol’s mechanism

Answer 3

Increase tubular fluid osmolarity and increase urine flow. Decrease intracranial/intraocular pressure

Question 4

What clinical circumstances use Mannitol?

Answer 4

Drug overdose, elevated intracranial/intraocular pressure (head trauma)

Question 5

What are some adverse effects of mannitol?

Answer 5

Pulmonary edema, dehyrdration

Question 6

What are contraindications for mannitol?

Answer 6

Anuria, CHF, active cerebral hemorrhage

Question 7

Where does Acetazolamide function?

Answer 7

PCT

Question 8

Describe the mechanism of Acetazolamide

Answer 8

Carbonic anhydrase inhibitor in the PCT. Decreases NaHCO3 synthesis and thus decreases total body HCO3- stores

Question 9

What clinical uses does Acetazolamide have?

Answer 9

Glaucoma (decrease aqueous humor production), urinary alkalinzation, metabolic alkalosis, altitude sickness, pseudotumor cerebri

Question 10

What are adverse effects of Acetazolamide

Answer 10

Proximal Renal Tubular Acidosis (Type 2), Paresthesias, NH3 toxicity (more NH3 is retained), sulfa allergy

Question 11

List three common Loop diuretics (FuTor Bum)

Answer 11

Furosemide, Bumetanide, Torsemide

Question 12

Describe the mechanism of loop diuretics (where they act, what they do)

Answer 12

Act on Thick Ascending LoH. Inhibit Na/K/2Cl cotransporter. Abolish hypertonicity, preventing concentration of urine. Stimulate PGE release (vasodilate AA). Increase Ca+2 excretion

Question 13

When are loop diuretics used?

Answer 13

Edematous states (HF, cirrhosis, nephrotic syndrome, pulm edema), hypertension, hypercalcemia

Question 14

Adverse Effects of Loop diuretics (OH DANG A)

Answer 14

Ototoxicity
Hypokalemia
Dehydration
Allergy (sulfa)
Nephritis (interstitial)
Gout 
Alkalemia

Question 15

When do you use Ethacrynic acid?

Answer 15

When a patient needs loop diuretic but has sulfa allergy

Question 16

What are the adverse effects of Ethacrynic acid?

Answer 16

Similar to furosemide but more ototoxic

Question 17

Where do thiazide diuretics act?

Answer 17

Distal convoluted tubule

Question 18

Mechanism of thiazide diuretics (HCTZ, chlorthalidone, metolazone)

Answer 18

Inhibit NaCl reabsorption in DCT. Inhibit Ca+2 excretion.

Question 19

Clinical use of Thiazide diuretics

Answer 19

Hypertension, HF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis

Question 20

Adverse effects of thiazide diuretics (HyperGLUC)

Answer 20

Hypokalemic metabolic acidosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia. Sulfa allergy

Question 21

List three potassium-sparing diuretics (The K+ STAys)

Answer 21

Spironolactone and eplerenone; Triamterene, Amiloride

Question 22

Mechanism of spironolactone and epleronone?

Answer 22

competitive aldosterone receptor antagonists in cortical collecting tubule

Question 23

Mechanism of Triamterene and Amiloride

Answer 23

Block Na+ channels in cortical collecting tubule

Question 24

Clinical use of K+-sparing diuretics

Answer 24

Hyperaldosteronism, K+ depletion, HF, hepatic ascites (spironolactone), nephrogenic DI (amiloride)

Question 25

Adverse effects of K+sparing diuretics

Answer 25

Hyperkalemia (arrythmias), endocrine effects with spironolactone (gynecomastia, antiandrogen effects)

Question 26

How does ATII act on the PCT?

Answer 26

Increases Na/H+ exchange, leading to increased HCO3- reabsorption (contraction alkalosis)

Question 27

Describe paradoxical aciduria with loop and thiazide diuretics

Answer 27

K+ loss leads to K+ depleted state. In cortical collecting tubule, H+ (rather than low K+) is exchanged for Na+ leading to alkalosis and paradoxical aciduria

Question 28

Describe the mechanism of ACEIs

Answer 28

Inhibition of ACE and conversion of AI to AII. Acts on efferent arterioles. Decreases AII, leads to increase of renin due to loss of negative feedback. Prevents inactivation of bradykinin so increased vasodilation

Question 29

What is the effect of ACE inhibitors on GFR?

Answer 29

Decreased GFR

Question 30

Clinical use of ACE inhibitors (-prils)

Answer 30

Hypertension, heart failure (decreases mortality), proteinuria in diabetic neuropathy. Prevents unfavorable heart remodeling as a result of chronic hypertension

Question 31

Which electrolyte abnormalities do you get with loop diuretics?

Answer 31

Hypokalemia, metabolic alkalosis and hypocalcemia

Question 32

Which electrolyte abnormalities do you get with thiazide diuretics?

Answer 32

Hyponatremia, Hypokalemia, metabolic alkalosis, Hypercalcemia

Question 33

Which electrolyte abnormalities do you get with Acetazolamide?

Answer 33

Metabolic acidosis, hypokalemia

Question 34

Which electrolyte abnormalities do you get with K+ sparing diuretics?

Answer 34

Hyperkalemia, metabolic acidosis

Question 35

What are common side effects of chlorthalidone?

Answer 35

Muscle weakness, cramps and possible rhabdomyolysis

Question 36

Which medications help with reducing progression to renal failure in patients with diabetes?

Answer 36

ACE inhibitors

Question 37

Why do ACEIs lead to coughing?

Answer 37

Inhibit degradation of bradykinin

Question 38

Which antiviral can cause renal calcium and magnesium wasting (leading to hypocalcemia and hypomagnesemia)?

Answer 38

Foscarnet

Question 39

Chlorthalidone is what type of diuretic

Answer 39

Thiazide

Question 40

Hypercholesterolemia and hyperglycemia occur with use of thiazide diuretics due to

Answer 40

decreased insulin secretion and increased insulin resistance

Question 41

Hyperuricemia with use of thiazide diuretics occurs because

Answer 41

of increased reabsorption in PT due to decreased renal blood flow

Question 42

Best diuretics for patients in heart failure (increased RAAS, audible S3)

Answer 42

Aldosterone-inhibitors (Spironolactone or eplerenone)