Renal

Question 1

What are the 2 aquaretic diuretics? How do they work?

Answer 1

Conivaptan
Tolvaptan
-ADH blockers

Question 2

What drug is used to reduce urine output in patients with central diabetes insipidus?

Answer 2

Desmopressin (ADH analog)

Question 3

What area of the kidney do Thiazide diuretics act on? What symport do they inhibit?

Answer 3

block solute reabsorption in the early distal tubule by inhibiting Na+Cl- symport

Question 4

Which 2 classes of diuretics work in the proximal tubule?

Answer 4

Carbonic anhydrase inhibitors (acetazolamide, methazolamide, dichlorphenamide) & osmotic diuretics (mannitol, urea, isorbide)

Question 5

Which class of diuretics work in the thick ascending limb? Which symport system do they inhibit?

Answer 5

• Loop diuretics (furosemide, bumetanide, torsemide, ethacrynic acid)
• inhibit Na+K+2Cl- symport

Question 6

Which class of drugs act in the late distal tubule?

Answer 6

Na+ channel inhibitors / K+ sparing (amiloride, triamterene)

Question 7

What is the mechanism of acetazolamide and others in its class?

Answer 7

Carbonic anhydrase inhibitors–>

increase intracellular H+ –> decrease Na/H+ exchanger –> decrease Na+ & HCO3- reabsorption

Question 8

What are 4 uses of Mannitol? 1 risk?

Answer 8

USE:
drug overdose; shock or major surgery; differential diagnosis of oliguria; reduce intraocular or intracranial pressure
RISK:
increased hydrostatic pressure may induce pulmonary edema

Question 9

What are some possible plasma level complications from loop diuretics and thiazide diuretics?

Answer 9

• Hyponatremia, hypokalemia (w/chronic use), hypomagnesemia
• hyperbicarbonatemia (contraction alkalosis), hyperuricemia (stones, gout), increase in BUN w/ or w/o increase in creatinine (hepatic encephalopathy)
• hypercalciuria

Question 10

What are 2 important risks of loop diuretics?

Answer 10

1. onset or unmask diabetes mellitus (hypokalemia affects beta cells of pancreas)
2. ototoxicity (pts with renal failure are at most risk due to higher doses needed)

Question 11

Which class can be used in the treatment of hypercalciuria?

Answer 11

thiazides (can combine with amiloride - K+ sparing which also increases Ca++ reabsorption)

Question 12

What class may be used to treat nephrogenic diabetes insipidus? How?

Answer 12

Thiazides- contract ECF volume leading to decreased tubular fluid and decreased volume of voided urine (Allow for more concentrated urine to form)

Question 13

What drug is used to treat Li-induced polyuria?

Answer 13

Amiloride (aldosterone-independent K+ sparing diuretic)

Question 14

What is the main clinical complication of K+ sparing diuretics? For what patients are they contraindicated?

Answer 14

• hyperkalemia

- contraindicated in renal failure; pts on ACE inhibitors; liver cirrhosis

Question 15

What are some side effects of spironolactone?

Answer 15

competitive antagonist of androgen receptors –>

• males: gynecomastia, erectile dysfunction, libido loss
• females: menstrual irregularities, breast soreness

Question 16

What are 3 carbonic anhydrase inhibitors?

Answer 16

Acetazolamide
Methazolamide
Dichlorphenamide

Question 17

What are 4 loop diuretics?

Answer 17

Furosemide (Lasix)
Bumetanide
Torsemide
Ethacrynic acid

Question 18

What are the 6 thiazide diuretics?

Answer 18

Chlorothiazide
Hydrochlorothiazide 
Chlorthalidone 
Quinethazone
Metolazone 
Indapamide