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Pharma From Sure Success > Renal System > Flashcards

Renal System Flashcards

1
Q

Define diuretics
…….don’t cause natriuresis

A

Drugs which cause net loss of sodium and water in urine.

Osmotic diuretic-mannitol

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2
Q

Describe the diuretics with their site of action.

A

COLT Pee
Carbonic anhydrase inhibitors-PCT
Osmotic diuretic- thin descending LOH
Loop diuretic-thick ascending LOH
Thiazide diuretics- DCT
Potassium sparing - collecting duct

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3
Q

How to reduce the nephrotoxicity of cisplatin? (3)

A
  1. Iv saline
  2. Amifostine
  3. Mannitol
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4
Q

Why are loop diuretics called high ceiling diuretics?

A

At certain high dose, the diuretic action seizes and there is no more diuresis no matter how much dose is increased

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5
Q

Egs of medium ceiling diuretics and weak ceiling

A

Medium: thiazides and thiazide like-chlorthalidone, metolazone, indapamide

Weak: carbonic anhydrase inhibitor
Osmotic diuretics
K+ sparing

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6
Q

Which are the aldosterone antagonists of k+ sparing and which are renal epithelial sodium channel inhibitors?

A

Aldosterone antagonist :
spironolactone
Epleronone

Renal epithelial sodium channel inhibitor:
Amiloride, triamterene

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7
Q

MOA of furosemide

A

Uses uric acid transporter to get inside the epithelial cell from Basolateral side and inhibit Na+K+2cl- cotransporter on luminal side.
Therefore: water follows na+, there is loss of water, sodium, calcium,magnesium are also lost in the lumen and coz furosemide uses uric acid transporter; there is hyperuricemia

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8
Q

Uses of furosemide

A

HEAMTT
HTN- decrease plasma volume->decrease CO—>decrease Bp

Edema-all types

CHF: decrease preload and afterload

Hypercalcemia of Malignancy
Chemical inToxication
Blood transfusion

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9
Q

Adverse effects of furosemide

A
  1. Hypokalemia
    Hyponatremia
    Hypomagnesemia
    Hypocalcemia
    Dehydration
  2. Hyper glycemia
    Hyperlipidemia
    Hyperuricemia
  3. Sulfonamide toxicity
    Not given to pregnant females
    Ototoxicity.
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10
Q

Max ototoxicity is with …..
Most potent loop diuretic

What does loop diuretic do in medulla?

A

Ethacrynic acid

Bumetanide

Abolish the hypertonicity of medulla preventing concentration of urine

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11
Q

Hyperchloremic acidosis seen in …..diuretic

Use (2)

A

Acetazolamide

  1. Epilepsy
  2. Acute mountain sickness- hyperventilation->respiratory alkalosis -rx: acidosis
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12
Q

C/I of acetazolamide (3)

A
  1. Acidosis conditions : asthma, COPD
    CO2 retension
  2. Ascites / cirrhosis
  3. Self limiting diuretic acidosis
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13
Q

Aldosterone acts on ……part of kidney
All diuretic act on luminal side except…

A

Distal tubule

Spironolactone- block na/k+ exchange

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14
Q

Metabolite of spironolactone
S/e of amiloride, triamterene (2)

A

Canrenone

  1. Hyperkalemia - muscle cramps
  2. Anti folate - megaloblastic anemia
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15
Q

In cirrhotic ascites , c/I diuretic is ….
Preferred diuretic is ….

A
  1. Acetazolamide

Spironolactone

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16
Q

Conditions which spironolactone is preferred?

A

Hyperaldosteronism
Primary : conn’s syndrome
Secondary : ascites - edema
Initially- furosemide
Later on- add- spironolactone

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17
Q

MOA of thiazide

Indications of thiazide (5)

A

Inhibit Na+\cl- cotransporter
1. HTN
2. CHF
3. Hypercalcemia
4. Nephrogenic D.I
5. Osteoporosis

18
Q

Difference between s/e: thiazides and furosemides

A

Thiazide : impotence
Increased calcium reabsorption
—-> hypercalcemia

Loop diuretics: Ototoxic
Increase calcium loss
—> hypocalcemia

19
Q

Longest acting thiazide

Acetazolamide is ……inhibitor

A

Chlorthalidone

Non competitive, reversible carbonic anhydrase

20
Q

DOC for HTN

Conditions where furosemide is used as AntiHTN (2)

A

Thiazide - sustained Bp decrease

  1. HTN crisis
  2. HTN with low GFR -acute renal failure
21
Q

Usually thiazides have no effect on decreased GFR; Thiazide which has effect on deceased GFR

Potassium sparing duretics act on …..

A

Metolazone

Distal tubule/ Cortical collecting duct

22
Q

Aldosterone receptor antagonist act by…..

Triamterene and amiloride act by ……

A

Inhibiting Na+K+ exchange

Blocking sodium channels

23
Q

Menstrual irregularity seen with …..diuretics

Mx diuretic used in heart failure
Mx diuretic used to rx HTN

A

Potassium sparing

Loop diuretics

Thiazide diuretics

24
Q

Use of metolazone.

Name a Uricosuric diuretic . Use .

A

Refractory edema in CKD

Indacrinone
Ethacrynic analogue -used for Rx gout with diuretic rx where loop and thiazides are C/I.

25
Q

Spironolactone acts on ….side of renal tubular cell

Define anti diuretics
They ……….urine volume

A

Interstitial side of renal tubular cell.

Inhibit water excretion without affecting sodium excretion.

Decrease

26
Q

Human ADH is ……
It is a …..secreted by ….

A

8-arginine vasopressin (AVP)
Non apeptide , secreted by posterior pituitary along with oxytocin

27
Q

Vasopressin receptors
Action of the receptors

A

V1a, b: G q
V2: Gs

V1a—>Bv—> vasoconstriction
V1b—> CNS—> increase ACTH
V2—-> collecting duct —> increase water reabsorption in kidney

28
Q

Eg of vasopressin causing vasoconstriction

Different types of D.I

A

Terlipressin- V1 a agonist

Central: decrease ADH secretion
Rx: desmopressin

Peripheral : ADH can’t act on C.D
Rx: thiazide

29
Q

V2 receptors are present on …..
All are vasopressin receptors except….(3)

A

Principle cells of collecting duct of kidney

Renal collecting duct
Thick ascending LOH
Vascular endothelium

30
Q

AVP is inactive orally , inactivated by ….
Which route can AVP be given ?

A

Trypsin

Parenteral , nasal route

31
Q

Egs of synthetic vasopressin analogues (3)

A
  1. terlipressin
  2. Lypressin
  3. Desmopressin
32
Q

MOA and use of lypressin

A

In place of AVP, for V1 mediated action
8-lysine vasopressin

33
Q

Synthetic prodrug of AVP is …..

Drug 12 times more potent than AVP
Available as …(2)

A

Terlipressin

Desmopressin
Oral, nasal spray

34
Q

Drug given for both pituitary and renal DI

Used of vasopressin (4)

A

Hydrochlorothiazide

Uses:
1. DI- neurogenic

  1. Nocturnal enuresis - desmopressin decrease urine volume and control symptoms
  2. Hemophilia,VW disease - AVP can check for bleeding by checking conc of factor 8 and VWF
  3. Renal concentration test
35
Q

Terlipressin is DOC for …..

A

Bleeding esophageal varices

36
Q

Selective V2 antagonists
Uses (4)

A

Tolvaptan, mozavaptan

  1. SIADH
  2. Hyponatremia due to CHF
  3. Cirrhosis of liver
  4. ADPKD ( decrease growth of cysts)
37
Q

MOA of conivaptan

RX for SIADH (3)

A

V1a + V2 receptor antagonist

  1. 3% saline
  2. DOC-V2 blocker- vaptans
  3. Miscellaneous: lithium, demeclocycline
38
Q

Drugs to increase ADH secretion / ADH like action (8)

A

C3 OF VAP
Chlorpropamide
Carbamazepine
Cyclophosphamide
Oxytocin
Fluoroquinolones
Vincristine
Antidepressants: TCA/ SSRI
Procarbazine

39
Q

Define free water clearance

A

Extra water in urine than needed to produce isoosmotic urine

40
Q

Free water clearance of
Positive value
Negative value
Zero

A

Positive: dilute urine
Negative : concentrated urine
Zero: isotonic urine

41
Q

Medications with decreased positive, negative and zero free water clearance

A

Positive : thiazides
Negative : ADH and ADH like drugs
Zero: loop diuretics and mannitol - block both positive and negative-FWC =0

Pharma From Sure Success (10 decks)

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