Renal pharmacology

Question 1

what type of transport happnes for the following:

sodium (angiotensin 2), phosphate (PTH and VitD), amino acids, glucose

Answer 1

active reabsorption

glucose and amino acids are co-transported

Question 2

what items are passivly transported?

Answer 2

H2O, urea and cl

Question 4

list the location of SGLT1 and 2

Answer 4

1. SGLT
   
   1. 10% of the glucose reabsorption
2. SGLT
   
   1. 90% of the glucose reabsorption
   2. targeted for diabetics

Question 5

what targets sodium-glucose transporter 2?

1. mech
2. side effects
3. contradiction
   4.

Answer 5

canagliflozin

• mech
  
  • inhibitor of sodium-glucose co-transporter 2
    
    • blocks reabsorption of glucose in the PCT
    • leads to a net loss of glucose
• side effects
  
  • genital mycotic infections
  • thirst (dry mouth, polydipsia)
• contraindication
  
  • severe renal impairment, end stage renal disease, dialysis
  • precautions
    
    • hypovolemia
    • eGFR less than 60
    • hypoglycemia

Question 6

elderly patient with type two diabetes wants to take canagliflozin. What is the mech and contraincication

Answer 6

inhibitor of SGLT2

1. contraindication
   
   1. kidney disease
   2. hypovolemia
      
      1. the medication needs a certain amount of pressure to be affective

Question 7

inhibit the cotransport of NKCC in lumenal membrane

Answer 7

furosemide (lasix)

1. mech
   
   1. inhibits the cotransporter of NKCC
2. affects
   
   1. more water retained in lumen dur to decreased osmotic pressure
   2. more efficacious than blocking Na pumps in the PCT, b/c downstream sites cannot compenstate for Na loss
   3. lose potasium
3. adverse
   
   1. hypovolemia
   2. ototoxicity
   3. K+ depletion

Question 8

where are most drugs secreted into the lumen? (not filtration)

Answer 8

Distal tubule

Question 9

inhibit Na/Cl cotransporter on the lumenal membran of the distal tubule

1. name
2. affect
   
   1. vascular

Answer 9

thiazides

1. affect
   
   1. increased excretion of Na+ and Cl- in tubular fluid
   2. loss of K+
   3. reduced peripheral vascular resistance

Question 10

patient has hypertension and needs to reduce vascular resistance. Which drug will be the best fit for him?

Answer 10

thiazides

1. mech
   
   1. inhibit Na/Cl- cotransporter on the lumenal membrane
   2. increased excretion of Na+ and Cl- in tubular fluid
2. leads to
   
   1. loss in K+
   2. reduced peripheral vascular resistance
   3. most used class

compared to furosemide(NKCC blocker)- leading to excessive water loss

Question 11

a patient administered aldosterone should be monitored for?

Answer 11

loss of potasium

Question 12

What are the proper tests and why for the following

1. central diabetes insipidus
2. nephrogenic diabetes insipidus

Answer 12

both present with 1- hypernaturemia, polyuria, excessive thirst, and hypotonic urine

1. central diabetes insipidus
   
   1. lack of antidiuretic hormone
      
      1. responds to ADH administration by increasing urine osmolality
      2. this then makes less urine
2. nephrogenic diabetes insipidus
   
   1. collecting tubules are refractory to ADH
      
      1. Does not respond to ADH
      2. causes = drug use

Question 13

You want to know what type of diabetes a patient has what test and results could you expect

Answer 13

adh test

1. central diabetes insipidus
   
   1. respond to ADH
      
      1. generating hyperosmotic urine
      2. decreasing plasma osmolality
2. nephrogenic diabetes
   
   1. collecting tubules are refractory to ADH
      
      1. do not respond to ADH
      2. lack the receptor to increase the aquaporins on the lumenal side

Question 14

hyponatremia is a side effect of what type of drugs?

Answer 14

1. depletional
   
   1. your not getting enough sodium in the body
2. dilutional- SIADH
   
   1. something leads to the increase in ADH secretion
   2. associated with drugs
      
      1. thiazides
      2. antidepressants
         
         1. SSRIs
         2. TCA(tri-cyclic antidepressants)
         3. lithium

Question 15

a patient experiences a significant weight gain and blood work shows the Na concentration is 80 (norm:>136mEq/L)

Answer 15