Tubules- Pharmacology Flashcards
Carbonic andydrase inhbitors, loop diuretics, thiazide diruetics, and K+ sparing diuretics cause which effect: naturesis or diuresis?
natruresis
What is the 1 diuretic that causes diuresis?
Osmotic diuretics
What is the mechanism of action of CA inhibitors?
↓ CA activity –> can’t form CO2 and H2O –> ↓ Na and HCO3 resorption
How does thiazide blockade of the NCC at the DCT ↑ Ca reabsorption?
By ↑ Na/Ca exchanging
What are the 2 actions of aldosterone to ↑ Na and water reabsorption?
stimulates ENaC and Na/K ATPase
What will happen to K levels if you give CAi’s?
Hypokalemia
What will happen to K levels if you give loop diruetics?
Hypokalemia
What will happen to K levels if you give thiazide diuretics?
Hypokalemia
What will happen to K levels if you give K sparing diuretics?
Hyperkalemia
What will happen to K levels if you give osmotic diuretics?
Hypokalemia
What is the #1 CAi?
Acetazolamide
i took this in peru in preparation for high altitude and i tell you now this stuff totally sucks. makes you weird and sick. like trippin balls type stuff…
CAi’s cause what shift in pH in the blood?
Metabolic acidosis
CAi’s cause what shift in the pH in the urine?
↑ pH
An increase in pH in the urine from CAi’s can lead to the formation of what?
Kidney stones
CAi’s will cause what shift in the [Cl-] in the blood?
Hyperchloremia (cuz of loss of HCO3-)
So since CAi’s shift the acid levels, what can it be used to treat?
Since it causes metabolic acidosis, it can be used to treat metabolic alkalosis (vomiting).
Inhibition of CA in the cilliary process epithelium reduces the secretion of aqueous humor and is therefore used to treat what?
Glaucoma
What are the transporters on the ciliary epithelium of the eye that are subsequently inhibited by using a CAi?
Cl/HCO3
Na/H
Na/HCO3
What is the main liver contraindication to CAi’s due to ↑ NH3 in the blood?
Hepatic encephalopathy (cirrhosis)
If the pt has renal insufficiency, what will be the side effect of CAi’s?
Nervous system toxicity –> paresthesias
Furosemide, ethacrynic acid, bumetanide, and torsemide all inhibit what transporter?
NKCC transporter
loop diuretics
Because of the gnarly inhibition of loop diuretics, what are the main side effects?
hypo-mg, ca, cl & na and alkalosis
This is a life-threatening skin condition in which cell death causes the epidermis to separate from the dermis when using loop diuretics.
Steven Johnson syndrome
What moiety in the loop diuretic causes the steven johnson syndrome?
Sulfonamide moeity
What is the side effect that loop diuretics share with aminogycoside antibiotics?
Ototoxicity
When using loop diuretics, there can be upregulation of PCT reabsorption of uric acid, leading to what condition?
Gout
Since loop diuretics are pretty aggressive, what conditions are they used to treat?
Pulmonary and peripheral edema
Case: pt presents with peripheral edema. labs show increased BUN and hypocalcemia. Is it safe to treat with loop diuretics?
NO. loop diuretics already cause hypocalcemia and ↑ BUN as a side effect
So other than acute pulmonary edema, HTN, and ARF, what ionic imbalances can u use loop diuretics for?
acute hypercalcemia
hyperkalemia
Which drug is a contraindication to loop diuretics?
Aminoglycosides (ototoxicity)
Which allergy is a contraindication to loop diuretic use?
sulfonamide
What are the 4 side effects of thiazide use?
Natiuresis
Diuresis
Hypokalemia
Metabolic alkalosis
Thiazides kinda have the same issue as loops in that they upregulate tubular reabsorption of uric acid, leading to what?
Gout
What are thiazides a first-line treatment for?
HTN
What other indications do u use thiazides for?
jusy fyi. i hate them.
Heart failure Nephtolithiasis from hypercalciuria Nephrogenic diabetes insipidus Pt with osteoporosis Pt with diabetes
Which arrythmia agents are contraindications for thiazide use?
agents that prolong the QT
What are the 2 main side effects to all K-sparing diuretics?
Hyperkalemia and metabolic acidosis (↓ H secretion)
What is the main hormonal side effect of spironolactone?
It inhibits the androgen receptor and can cause impotence and gynecomastia in men.
What is the main indication of K sparing diuretics?
to treat hypokalemic alkalosis secondary to mineralcorticoid access due to heart failure and hepatic failure
Which drug is used in monotherapy for ascites and edema with impaired plasma protein biosynthesis, as well as obesity assocaited HTN (mineralcortioids or Na-channel blocker)?
Mineralcorticoids
Direct Na channel inhibitor monotherapy is used to treat which syndrome, which is characterized by low levels of aldosterone, HTN, and is AD?
Liddles syndrome
All K-sparing diuretics except eplerenon can be gives ina combined formulation with which drug?
hydrochlorothiazide
What is the most commonly used osmotic diuretic?
mannitol
What is the primary indcation for mannitol?
increased intracranial pressure due to head trauma, brain hemorrhage, or symptomatic cerebral mass.
This is the excessive secretion of ADH.
SIADH
This is the decreased responsiveness to ADH?
Diabetes insipidus
What are the 2 ADH R antagonists?
Conivaptan and tolvaptan
“ya’ ADH scallywag! aye aye -aptan!”
What is the 1 indication for ADH R antagonists?
SIADH
Which ADH R antagonist blocks V2 and is available orally?
Tolvaptan
How do demeclycycline and lithium block ADH?
they block adenylate cycle in the CD and antaonize the fxn of ADH
Why is Li no longer used to treat SIADH?
it causes tubulointerstitial nephritis
What are the indications to demeclocycline?
Persistent chronic SIADH
What is the DOC for neurogenic diabetes insipidus?
Desmopressin
What is the MOA for desmopressin
V2 agonist
Why can thiazides but not loop diuretics used for the treatment of nephrogenic DI?
because thiazides dont affect medullary tonicity
How does Li induces downregulation of AQP2 by inhibiting ADH, leading to what condition?
Nephrogenic DI
What is the DOC for Li-induced nephrogenic DI?
Amiloride
How do NSAIDs treat nephrogenic DI?
They inhibit the formation is PGE2 –> ↓ GFR –> ↑ resorption of water and electrolytes in the PCT
