Renal Pharmacology

Question 1

Where does mannitol act?

Answer 1

PCT and descending limb of the LoH.

Question 2

Where does acetazolamide act?

Answer 2

PCT

Question 3

Where do loop diuretics act?

Answer 3

Ascending limb of the LoH and DCT.

Question 4

Where do thiazide diuretics act?

Answer 4

DCT

Question 5

Where do K+-sparing diuretics act?

Answer 5

DCT and collecting duct.

Question 6

Mannitol

MOA
Indication(s)
Adverse-effect(s)

Answer 6

MOA: osmotic diuretic causing increased tubular Osm.

Indication(s): drug overdose, elevated intraocular/intracranial pressure.

Adverse-effect(s): pulmonary edema, dehydration.

Question 7

In which cases is mannitol contraindicated?

Answer 7

Patients with anuria and HF.

Question 8

Acetazolamide

MOA
Indication(s)
Adverse-effect(s)

Answer 8

MOA: CA inhibitor leading to NaHCO3- diuresis and decreased HCO3- stores.

Indication(s): glaucoma, metabolic acidosis, altitude sickness, IIH.

Adverse-effect(s): RTA*, paresthesias, NH3 toxicity, sulfa allergies and calcium phosphate stone formation.

Question 9

Loop diuretics

MOA
Indication(s)
Adverse-effect(s)

Answer 9

MOA: (1) inhibit Na+/K+/2Cl- in the TAL of the LoH; (2) stimulates PGE release (VD of AA); (3) increases Ca++ excretion.

Indication(s): edema, HTN and hypercalcemia.

Adverse-effect(s):
Ototoxicity
Hypokalemia
Hypomagnesemia
Dehydration
Allergy (sulfa)
metabolic Alkalosis
Nephritis
Gout

“OHHDANG”

Question 10

What drugs are loop diuretics?

Answer 10

Furosemide, bumetanide, torsemide

“-ide”

Question 11

What drug is used in patients allergic to sulfa, but would benefit from loop diuresis?

What adverse-effect is common with it?

Answer 11

Ethacrinic acid.

Ototoxicity

Question 12

What drugs are thiazide diuretics?

Answer 12

Hydrochlorothiazide, chlorthalidone, metolazone

Question 13

Thiazide diuretics

MOA
Indication(s)
Adverse-effect(s)

Answer 13

MOA: (1) inhibition of NaCl reabsorption in the early DCT, thus impairing the diluting capacity of the nephron; (2) decreased Ca++ excretion.

Indication(s): HTN. HF, idiopathic hypercalciuria, NDI, osteoporosis.

Adverse-effect(s): 
Hypokalemic metabolic alkalosis
Hyponatremia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Hypercalcemia
"HyperGLUC"
Sulfa allergy

Question 14

What drugs are K+-sparing diuretics?

Answer 14

“Keep your SEAT”

Spironolactone
Eplerone
Amiloride
Triamterene

Question 15

K+-sparing diuretics

MOA
Indication(s)
Adverse-effect(s)

Answer 15

MOA: (1) competitive aldosterone inhibition at the collecting ducts (spironolactone, eplerone); (2) blockage of Na+ channels at the collecting ducts (amiloride, triamterene).

Indication(s): hyperaldosteronism, K+ depletion, HF, ascites, NDI, anti-androgen use.

Adverse-effect(s): hyperkalemia, endocrine effects with spironolactone (gynecomastia, anti-androgenic effects, etc.).

Question 16

Which diuretic drug classes cause metabolic acidosis?

Which diuretic drug classes cause metabolic alkalosis?

Answer 16

Metabolic acidosis: acetazolamide (CA inhibitors) and K+-sparing drugs.

Metabolic alkalosis: loop diuretics and thiazides.

Question 17

What are the adverse-effects of ACE-inhibitors? (6)

Answer 17

Cough
Angioedema
Teratogenic
Creatinine elevation
Hyperkalemia
Hypotension

“CATCHH”

Question 18

Which drugs elevate bradykinin?

Answer 18

ACE-inhibitors; ARBs do not effect [bradykinin].

Question 19

What adverse-effects are associated with ARBs? (4)

Answer 19

Hyperkalemia
Reduced GFR
Hypotension
Teratogenic

Question 20

Aliskiren

MOA
Indication(s)
Adverse-effect(s) (4)

Answer 20

MOA: direct inhibitor of renin; blocks conversion of angiotensinogen to angiotensin I.

Indication(s): HTN.

Adverse-effect(s): hyperkalemia, reduced GFR, hypotension, angioedema.