Renal pharmacology Flashcards
Carbonic anhydrase inhibitor?
Acetazolamide.
Which diuretic decrease total HCO3 stores in body?
Acetazolamide.
Clinical use (4) of azetazolamide?
Glaucoma, metabolic alkalosis, altitude sickness, idiopatic intracranial hypertension.
Which diuretic alkalinizes urine?
Acetazolamide.
Which diuretic causes self-limited NaHCO3 diuresis?
Acetazolamide.
What are 3 sulfo loop diuretics?
Furosemide, bumetanide, torsemide (torasemide).
What is 1 non-sulfo loop diuretic?
Etacrynic acid.
What inhibits loop diuretics?
Na/K/2Cl cotransport system in thick ascending Henle.
Which diuretic group abolish hypertonicity of medulla and prevents concentration of urine?
Loop diuretics.
How loop diuretics affects urine concentration?
Abolish hypertonicity of medulla –> prevents concentration of urine.
Which diuretics stimulate PGE release?
Loop (buvo prie sulfo) diuretics.
What is effect of PGE?
Vasodilatation of afferent arteriole.
Which drug inhibits PGE release?
NSAIDs.
How loop diuretics affects Ca excretion? Why?
Increase.
More Na and Cl come to DCT –> more Na and Cl reabsorbed –> increased Na conc. in cell –> decreased Na/Ca exhanger activity in basolateral (Na in, Ca out) –> less Ca goes into cell via apical membrane –> more Ca in urine.
Ototoxity, Hypokalemia, Hypomagnesemia, Dehydration, Alergy (sulfa), Metabolic alkalosis, Interstitial Nephritis, Gout. Which diuretics?
Loops.
…………………, Hypokalemia, Hypomagnesemia, Dehydration, Alergy (sulfa), Metabolic alkalosis, Interstitial Nephritis, Gout. Which diuretics and what missed adverse effect?
Loops. Ototoxity.
Ototoxity, Hypokalemia, Hypomagnesemia, Dehydration, Alergy (sulfa), Metabolic alkalosis, ………………….., Gout. Which diuretics and what missed adverse effect?
Loops. Interstitial nephritis.
Ototoxity, Hypokalemia, ……………………, Dehydration, Alergy (sulfa), Metabolic alkalosis, Interstitial Nephritis, Gout. Which diuretics and what missed adverse effect?
Loops. Hypomagnesemia.
OHH DAANG - What adverse effects and what diuretics?
Ototoxity, Hypokalemia, Hypomagnesemia, Dehydration, Alergy (sulfa), metabolic Alkalosis, Interstitial Nephritis, Gout.
Looops.
Why there is metabolic alkalosis in Loops?
Increased H+ loss via Na/H carrier in Thick Henle. Increased Na –> more Na reabsorbed, more H secreted.
Which diuretic promotes calcium phosphate stone formation?
Acetazolamide.
Clinical use of Loops?
Edematous states (HF, cirrhosis, nephritic syndrome, pulmonary edema), AH, hypercalcemia.
Why there is Gout when Loops are used?
Excretion of H2O –> more concentrated blood, e.i. increased creatinine and uric acid konc.
Which diuretic is used, if patient has HF and sulfa alergy?
Ethacrynic acid.
Which diuretic is used, if patient has hypercalcemia but not sulfa alergy?
Non-sulfa Loops - furosemide, bumetanide, torsemide.
Which diuretic most ototoxic?
Ethacrynic acid.
Which diuretic is used, if patient has cirrhosis?
Non-sulfa Loops - furosemide, bumetanide, torsemide.
Which diuretic is used in glaucoma?
Acetazolamide.
Which diuretic is used in altitude sickness?
Acetazolamide.
Which diuretic is insolubale at high pH?
Acetazolamide –> causes calcium phosphate stones.
Paresthesias are caused by …………………………
Acetazolamide.
NH3 toxicity is caused by …………………………
Acetazolamide.
Proximal renal tubular acidosis is caused by …………………………
Acetazolamide.
Which diuretic is used in idiopathic intracranial hypertension?
Acetazolamide.
Which diuretic cause increased tubular fluid osmolality?
Mannitol.
Which diuretic is contraindicated in anuria and HF?
Mannitol.
Which diuretic decrease intracranial and intraocular pressure?
Mannitol.
Which diuretic, used p/os can cause diarrhear?
Mannitol (Poor reabsorbtion GI–> increased osmolarity –> diarrhea).
3 adverse affects of mannitol?
Dehydration, pulmonary edema, hypo/hyper natremia.
Drug overdose, elevated intracranial/intraocular pressure. What diuretic is used?
Mannitol.
Which 3 diuretics inhibit Na/Cl?
Thiazides: hydrochlorthiazide, chlorthalidone, matolazone.
Which diuretic groups decrease Ca excretion?
Thiazides.
Which diuretic is used in osteoporosis?
Thiazides.
Which diuretic is used in hypercalciuria?
Thiazides.
Which diuretic is used in nephrogenic diabetes insipidus?
Thiazides.
In which two cardiac states are used thiazides?
HF and AH.
Hyper GLUC - adverse affects and which diuretic?
Hyper: glycemia, lipidemia, uricemia, calcemia. Thiazides.
Electrolite changes due to thiazides?
Hypokalemic metabolic alkalosis, hyponatremia. Also hypercalcemia.
Which K-sparing are competitive aldosterone receptors antagonists?
Spironolactone and eplerenone.
Which K-sparing block ENaC?
Amiloride and triamterene.
Which diuretics are used in hyperaldosteronism?
Spironolactone and eplerenone.
K sparing diuretic for nephrogenic DI?
What other diuretic can be used in this condition?
Amiloride. Thiazides.
Which diuretics have antiandrogen clinical use?
K-sparing.
Keep your SEAT - meaning?
K sparing diuretics —> Spironolactone, Eplerenone, Amiloride, Triamterene.
Which diuretics is used in K-depletion? Why?
K-sparing. They block ENaC –> decresed reabsorbtion of Na, therefore K is not secreted.
Which diuretic is used in hepatic ascites?
Spironolactone.
Adverse affects of K-sparing?
Hyperkalemia (can lead to arrhythmias), endocrine effects with spironolactone –> gynecomastia, antiandrogens affects.
