Reverse Pharm Renal

Question 1

Osmotic diuretic

Incr. tubular fluid osmolarity leads to incr. urine flow leads to decr. ICP/IOP

Drug overdose
elevated ICP/IOP

Pulmonary edema, dehydration
CI: Anuria, HF

Answer 1

Mannitol

Question 2

Self limited NaHCO3 diuresis and decr. total body HCO3 stores

Glaucoma
urinary alkalinization
metabolic alkalosis
altitude sickness
pseudotumor cerebri

Hyperchloremic metabolic acidosis
Paresthesias
NH3 toxicity
sulfa allergy

Answer 2

Acetazolamide

Question 3

1=phenoxyacetic acid derivative (not sulfa)

Inhibit cotransport (Na/K/2Cl) of thick ascending limb of loop of henle.
Abolish hypertonicity of medulla, preventing concentration of urine.
Stimulate PGE release (vasodilatory effect on afferent arteriole)
Incr. Ca excretion

Inhibited by NSAIDS

Edematous states (HF, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, hypercalcemia
1=same but if they are allergic to sulfa drugs

Ototoxicity
Hypokalemia
Dehydration
Allergy (sulfa)
Nephritis (interstitial)
Gout

OH DANG!

Answer 3

furosemide, bumetanide, and torsemide, and ethacrynic acid (1)

Question 4

Inhibit NaCl reaab in early DCT leads to decr. diluting capacity of nephron
Decr. Ca excretion

Hypertension, HF, idiopathic hypercalciuria, NDI, osteoporosis

Hypokalemic metabolic alkalosis
Hyponatremia
Hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
Sulfa allergy

Answer 4

What type of drugs are chlorthalidone and hydrochlorothiazide? Mechanism? Clinical use? Toxicity?

Question 5

potassium sparing diuretic

Competitive aldo receptor antag in cortical collecting tubule

Hyperaldosteronism, K+ depletion, HF

Hyperkalemia (arrythmias)
1=endocrine effects (gynecomastia, antiandrogen effects)

Answer 5

spironolactone (1) and eplerenone

Question 6

potassium sparing diuretic

Blocking ENAC channels in Cort. collecting tubule

Hyperaldosteronism, K+ depletion, HF

Hyperkalemia (arrythmias)

Answer 6

amiloride and triamterene

Question 7

Inhibit ACE which decreases ATII which decreases GFR by preventing constriction of efferent arterioles.
Levels of renin incr as a result.
Also prevents inactivation of bradykinin, a potent vasodilator

Hypertension, HF, proteinuria, diabetic nephropathy
Prevent unfavorable remodeling as a result of chronic hypertension

Cough, angioedema (CI in C1 esterase inhib defic), teratogen (renal malformations), Incr. creatinine (decr. GFR), hyperkalemia, hypotension

Avoid in bilateral renal artery stenosis, because ACE inhib will further decr. GFR leading to renal failure

Answer 7

captopril, enalapril, lisinopril, ramipril

Question 8

Selectively block binding of ATII to AT1 receptor. Effects similar to ARBs but do not decrease bradykinin.

Hypertension, HF, proteinuria, or diabetic nephropathy with intolerance to ACEIs (cough, angioedema)

Hyperkalemia, decr. renal function, hypotension, teratogen

Answer 8

losartan, candesartan, and valsartan

Question 9

Direct renin inh, blocks conversion of angiotensinogen to AT-I

Hypertension

Hyperkalemia, decr. renal function, hypotension

CI in diabetics taking ACEIs or ARBs

Answer 9

aliskiren