Renal Rx

Question 1

Mannitol

Answer 1

1) Use: Shock, drug overdose 2) Class/MOA: Osmotic diuretic 3) Side effects/ADEs: Pulmonary edema, dehydration, CHF, contraindicated in anuria 4) Fun Facts:

Question 2

Acetazolamide

Answer 2

1) Use: Glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness 2) Class/MOA: Carbonic anhydrase inhibitor, prevents bicarb reabsorption in PCT 3) Side effects/ADEs: hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy 4) Fun Facts: ACIDazolamide causes ACIDosis

Question 3

Furosemide

Answer 3

1) Use: Edema (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia 2) Class/MOA: Loop diuretic. Inhibits cotransport system (Na, K, 2Cl) of thick ascnding limb, preventing solutes from entering medulla. Prevents concentration of urine. Stimulates PGE release for vasodilation. Increases calcium release. 3) Side effects/ADEs: OH DANG! (Ototoxicity, hypokalameia, dehydration, allergy-sulfa, nephritis, gout) 4) Fun Facts: Inhibited by NSAIDS

Question 4

Ethacrynic acid

Answer 4

1) Use: Diuresis for people with sulfa allergies 2) Class/MOA: Phenoxyacetic acid derivative. Inhibits Na, K, Cl cotransporter in ascending limb 3) Side effects/ADEs: OH DANG! (Same as furosemide) 4) Fun Facts: Same MOA as furosemide. Can be used in hyperuricemia

Question 5

Hydrochlorothiazide

Answer 5

1) Use: HTN, CHF, idiopathic hypercalciuria, nephrogenic DI 2) Class/MOA: Inhibits NaCl reabsorption in early DCT, limiting diluting capacity. Decrease calcium excretion. 3) Side effects/ADEs: HyperGLUC (hyperglycemia, hyperlipidemia, hyperuricemia, hpercalcemia). Hypokalemic matabolic alkalosis, hyponatremia, sulfa allergy. 4) Fun Facts:

Question 6

Spironolactone

Answer 6

1) Use: Hyperaldosteronism, K+ depletion, CHF 2) Class/MOA: K+ sparing diuretic. Spironolactone is a competitive aldosterone receptor antagonist in cortical collecting duct. 3) Side effects/ADEs: Hyperkalemia (arrhythmias), endocrine effects (gynecomastia and other androgen effects) 4) Fun Facts: The K+ STAys (Spironolactone, triamterene, amiloride)

Question 7

Triamterene

Answer 7

1) Use: Hyperaldosteronism, K+ depletion, CHF 2) Class/MOA: K+ sparing diuretic. Triamterene and amiloride block Na channel in CCT. 3) Side effects/ADEs: Hyperkalemia (arrhythmias), endocrine effects (gynecomastia and other androgen effects) 4) Fun Facts: The K+ STAys (Spironolactone, triamterene, amiloride)

Question 8

Amiloride

Answer 8

1) Use: Hyperaldosteronism, K+ depletion, CHF 2) Class/MOA: K+ sparing diuretic. Triamterene and amiloride block Na channel in CCT. 3) Side effects/ADEs: Hyperkalemia (arrhythmias), endocrine effects (gynecomastia and other androgen effects) 4) Fun Facts: The K+ STAys (Spironolactone, triamterene, amiloride)

Question 9

Captopril

Answer 9

1) Use: HTN, CHF, diabetic renal disease, prevent heart remodeling from HTN 2) Class/MOA: Inhibit ACE to reduce angiotensin II/bradykinin and vasodilation. Renin release increases 3) Side effects/ADEs: CAPTOPRIL (Cough, Angioedema, Proteinuira, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower ATII) Hyperkalemia. Avoid with bilateral renal artery stenosis becauase ACE inhibitors reduce GFR. 4) Fun Facts: ATII receptor blockers (sartans) are similar to these without the cough.

Question 10

Enalapril

Answer 10

1) Use: HTN, CHF, diabetic renal disease, prevent heart remodeling from HTN 2) Class/MOA: Inhibit ACE to reduce angiotensin II/bradykinin and vasodilation. Renin release increases 3) Side effects/ADEs: CAPTOPRIL (Cough, Angioedema, Proteinuira, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower ATII) Hyperkalemia. Avoid with bilateral renal artery stenosis becauase ACE inhibitors reduce GFR. 4) Fun Facts: ATII receptor blockers (sartans) are similar to these without the cough.

Question 11

Lisinopril

Answer 11

1) Use: HTN, CHF, diabetic renal disease, prevent heart remodeling from HTN 2) Class/MOA: Inhibit ACE to reduce angiotensin II/bradykinin and vasodilation. Renin release increases 3) Side effects/ADEs: CAPTOPRIL (Cough, Angioedema, Proteinuira, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower ATII) Hyperkalemia. Avoid with bilateral renal artery stenosis becauase ACE inhibitors reduce GFR. 4) Fun Facts: ATII receptor blockers (sartans) are similar to these without the cough.

Question 12

What do all diuretics do to serum/urine NaCl?

Answer 12

Increase NaCl in urine. Decrease NaCl in serum

Question 13

What do all diuretics do to serum/urine K?

Answer 13

Increase urine K. Decrease serum K

Question 14

What do all loop diuretics vs thiazides do to urine calcium?

Answer 14

Loop diuretics increase it. thiazides decrease it from enhanced paracellular calcium reabsorption in PCT and loop of henle.