renal pharmacology

Question 1

Invokana (canagliflozin) involves what pathway

Answer 1

SGLT2 inhibitor

Question 2

Inhibition of SGLT 2 results in what kind of plasma and what kind of urine

Answer 2

less glucose in plasma more glucose excretion

Question 3

An adverse affect(s) of taking Invokana would be

Answer 3

Genital Mycotic infections thirst, dry mouth, polydipsia

Question 4

when should Invokana not be taken ?

Answer 4

Low GFR (<45) renal disease dialysis

Question 5

A precaution of Invokana is ?

Answer 5

Hypovolemia Hypoglycemia

Question 6

What is the best way to pull the most volume out of urine?

Answer 6

A loop diuretic such as Lasix

Question 7

Furosemide (Lasix) is a loop diuretic, what mechanism does it involve

Answer 7

inhibition of the NKCC2 pump, resulting in more water left in lumen due to decreased osmotic pressure

Question 8

Lasix adverse affects are:

Answer 8

K depletion Ototoxicity Acute hypovolemia

Question 9

This is the most used class of diuretics, and it acts on the distal tubule…

Answer 9

Thiazide diuretics

Question 10

Thiazide diuretic ( hydrochlorothiazide) involves what mechanism?

Answer 10

Inhibition of the NaCl cotransporter on the lumen side.

Question 11

What will hydrochlorothiazide use cause?

Answer 11

• excretion of Na and Cl
• Loss of K
• Reduced peripheral vascular resistance.

* Note: keep an eye on your patients K+, because this drug can lead to hypokalemia, which can cause arrhythmias.

Question 12

Here is a photo of what thiazide diuretics do:

Answer 12

* We wont get substrate for ATPase. There wont be recapturing as there normally would be, and this leads to increased water in the lumen.

Question 13

What causes central diabetes insipidus?

Answer 13

lack of ADH.

Question 14

What causes nephrogenic diabetes insipidus?

Answer 14

Collecting tubules are resistant to ADH.

Question 15

What are the hormones that act on the collecting tubule, and what are their roles?

Answer 15

ADH: resorption of water by increasing the number of aquaporins in the membrane.

Aldosterone: Regulation of K+ secretion (Na+ gets reabsorbed, K+ gets secreted)

Question 16

What secretes ADH?

Answer 16

posterior pituitary

Question 17

Antidepressants can cause an…………. in ADH release.

Answer 17

increase

Question 18

When it comes to the molecular mechanism of antidiuretic hormone (also known as: ADH, AVP), it stimulates…………….. on the balolateral (blood) side of cells lining the collecting tubules. This leads to insertion of aquaporin-2 channels into the apical (tubular) side.

Answer 18

V2 vasopressin receptors

Question 19

The release of ADH (from the posterior lobe of the pituitary gland) is regulated by the……………. of the blood.

Answer 19

osmotic pressure

Question 20

Hyponatremia can be both dilutional (Na+ in blood is normal but there is too much water) or depletional (low Na+ due to inadequate sodium intake or too much GI sodium loss).

Dilutional hyponatremia is called………………….

Answer 20

Syndrome of innapropriate ADH secretion (SIADH)

Question 21

Dilutional hyponatremia may be from an ectopic source, such as as tumor, or a pharmacological source. What drugs could cause dilutional hyponatremia?

Answer 21

Thiazides

Selective serotonin reuptake inhibitors (SSRIs)

Tri-cyclic antidepressants

Question 22

Joe is taking a thiazide for the treatment of hypertension. In a recent visit his doctor examines Joe’s lab results and then he is also prescribed spironolactone in addition to the thiazide. What is the most likely lab value that led to the changed prescription?

a) Increased BUN levels
b) Decreased plasma Na+
c) Increased plasma Na+
d) Decreased plasma K+

Answer 22

d) Decreased plasma K+

Question 23

Elimination of drugs and their metabolites through the kidney occurs by which of the following processes?

a) Filtration
b) Tubularsecretion
c) Reabsorption
d) Both tubular secretion and filtration

Answer 23

d) Both tubular secretion and filtration

Question 24

A patient with a history of heart disease is having difficulty breathing and is brought into the emergency room. Examination reveals that she has pulmonary edema. Which of the following treatments would result in the most significant removal of water from the system?

a) Furosemide
b) Azetazolamide
c) Hydrochlorothiazide
d) Spironolactone

Answer 24

a) Furosemide

Question 25

HP is a 60-year-old man being treated for type 2 diabetes with Canagliflozin (Invokana®). He is concerned about taking a new drug. Which of the following adverse effects would be most common with this drug?

a) Hypertension
b) Palpitations
c) Mycotic infections
d) Hyperglycemia

Answer 25

c) Mycotic infections

Question 26

Parathyroid hormone and calcitrol causes what to be reabsorbed in the distal tubule?

Answer 26

calcium