renal pharmacology Flashcards
Invokana (canagliflozin) involves what pathway
SGLT2 inhibitor
Inhibition of SGLT 2 results in what kind of plasma and what kind of urine
less glucose in plasma more glucose excretion
An adverse affect(s) of taking Invokana would be
Genital Mycotic infections thirst, dry mouth, polydipsia
when should Invokana not be taken ?
Low GFR (<45) renal disease dialysis
A precaution of Invokana is ?
Hypovolemia Hypoglycemia
What is the best way to pull the most volume out of urine?
A loop diuretic such as Lasix
Furosemide (Lasix) is a loop diuretic, what mechanism does it involve
inhibition of the NKCC2 pump, resulting in more water left in lumen due to decreased osmotic pressure
Lasix adverse affects are:
K depletion Ototoxicity Acute hypovolemia
This is the most used class of diuretics, and it acts on the distal tubule…
Thiazide diuretics
Thiazide diuretic ( hydrochlorothiazide) involves what mechanism?
Inhibition of the NaCl cotransporter on the lumen side.
What will hydrochlorothiazide use cause?
- 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.
Here is a photo of what thiazide diuretics do:
* We wont get substrate for ATPase. There wont be recapturing as there normally would be, and this leads to increased water in the lumen.
What causes central diabetes insipidus?
lack of ADH.
What causes nephrogenic diabetes insipidus?
Collecting tubules are resistant to ADH.
What are the hormones that act on the collecting tubule, and what are their roles?
ADH: resorption of water by increasing the number of aquaporins in the membrane.
Aldosterone: Regulation of K+ secretion (Na+ gets reabsorbed, K+ gets secreted)
What secretes ADH?
posterior pituitary
Antidepressants can cause an…………. in ADH release.
increase
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.
V2 vasopressin receptors
The release of ADH (from the posterior lobe of the pituitary gland) is regulated by the……………. of the blood.
osmotic pressure
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………………….
Syndrome of innapropriate ADH secretion (SIADH)
Dilutional hyponatremia may be from an ectopic source, such as as tumor, or a pharmacological source. What drugs could cause dilutional hyponatremia?
Thiazides
Selective serotonin reuptake inhibitors (SSRIs)
Tri-cyclic antidepressants
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+
d) Decreased plasma K+
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
d) Both tubular secretion and filtration
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
a) Furosemide
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
c) Mycotic infections
Parathyroid hormone and calcitrol causes what to be reabsorbed in the distal tubule?
calcium
