547-549 - Renal Drugs Flashcards Preview

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Flashcards in 547-549 - Renal Drugs Deck (34):
1

Describe the effects of mannitol on:
1. tubular fluid osmolarity
2. urine flow
3. intracranial/intraocular pressure

1. ↑ tubular fluid osmolarity
2. ↑ urine flow
3. ↓ intracranial/intraocular pressure

2

What are the clinical uses of mannitol?

1. Drug overdose
2. ↑ intracranial/intraocular pressure

3

What are the toxicities of mannitol?

1. pulmonary edema
2. dehydration

4

Contraindications of mannitol use?

1. anuria
2. CHF

5

What is the mechanism of acetazolamide?

carbonic anhydrase inhibitor -- causes self-limited NaHCO3 diuresis and ↓ total body HCO3- stores

6

What are 5 clinical uses of acetazolamide?

1. Glaucoma
2. Urinary alkalinization
3. Metabolic alkalosis
4. Altitude sickness
5. Pseudotumor cerebri

7

What are the toxicities of acetazolamide?

1. Hyperchloremic metabolic acidosis
2. Paresthesias
3. NH3 toxicity
4. Sulfa allergy

"ACID"azolamide causes ACIDosis

8

What is furosemide?

A sulfonamide loop diuretic that inhibits N/K/2 Cl cotransporter of TAL

9

What effect do loop diuretics on the tonicity of the medulla of the kidney?

abolish the hypertonicity of the medulla → prevents concentration of urine

10

What effects do loop diuretics have on PGE release?

stimulates PGE release → vasodilation of afferent arteriole (inhibited by NSAIDS)

11

What effect do loop diuretics have on Ca2+?

↑ Ca2+ excretion (Loops Lose Calcium)

12

What are the clinical uses of loop diuretics?

1. Edematous states: CHF, cirrhosis, nephrotic syndrome, pulmonary edema
2. Hypertension
3. Hypercalcemia

13

What are the toxicities of loop diuretics?

1. Ototoxicity
2. Hypokalemia
3. Dehydration
4. Allergy (sulfa)
5. Nephritis (interstitial)
6. Gout
OH DANG

14

What is ethacrynic acid?

A loop diuretic with the same action as furosemide, but derived from phenoxyacetic acid (so not a sulfonamide). It's used for diuresis in patients allergic to sulfa drugs.

15

What are the toxicities of ethacrynic acid?

similar to furosemide (OH DANG) - can cause hyperuricemia -- do not use to treat gout

16

Where do thiazides work?

early distal tubule

17

What effect do thiazides have on Ca2+?

↓ Ca2+ excretion

18

What are the toxicities of hydrochlorothiazide?

1. Hypokalemic metabolic alkalosis
2. hyponatremia
3. hyperGlycemia
4. hyperLipidemia
5. hyperUricemia
6. hyperCalcemia
7. Sulfa alergy

HyperGLUC

19

What are the K+ sparing diuretics?

1. Spironolactone
2. Eplerenone
3. Triamterene
4. Amiloride

20

Which drugs are competitive aldosterone receptor antagonists in the cortical collecting tubule?

1. Spironolactone
2. Eplerenone

21

Which drugs block Na+ channels in the CCT?

1. Triamterene
2. Amiloride

22

What is the clinical use of K+ sparing diuretics?

1. Hyperaldosteronism
2. K+ depletion
3. CHF

23

What are the toxicities of K+ sparing diuretics?

1. Hyperkalemia (can → arrhythmias)
2. Endocrine effects (spironolactone → gynecomastia, antiandrogen effects)

24

Which diuretics increase urine K+?

loop and thiazides

25

Which diuretics increase urine NaCl?

All except acetazolamide

26

Which diuretics cause acidemia?

1. CA inhibitors (↓ bicarb reabsorption)
2. K+ sparing (aldosterone blockade prevents K+ secretion and H+ secretion; also, ↑ K+ → exchange for H+ exiting cells)

27

Which diuretics cause alkalemia?

1. loop diuretics
2. thiazides

28

What are the 3 mechanisms by which loop and thiazide diuretics can cause alkalemia?

1. contraction alkalosis
2. K+ loss from body → loss from cells in exchange for H+ uptake
3. K+ loss from body → H+ is exchanged rather than K+ for Na+ in CCT → alkalosis and "paradoxical aciduria"

29

Which diuretics cause increased urine Ca2+?

loop diuretics (↓ paracellular Ca2+ reabsorption → hypocalcemia)

30

Which diuretics cause ↓ urine Ca2+?

thiazides (enhanced paracellular Ca2+ reabsorption in distal tubule)

31

Name 3 ACE inhibitors:

1. Captopril
2. Enalopril
3. Lisinopril

32

What is the mechanism of action of ACE inhibitors?

Inhibit ACE → ↓ angiotensin II → ↓ GFR by preventing constriction of efferent arterioles

33

What are the clinical uses of ACE inhibitors?

1. HTN
2. CHF
3. proteinuria
4. diabetic nephropathy
5. prevent unfavorable heart remodeling as a result of chronic HTN

34

What are the toxicities of ACE inhibitors?

1. Cough
2. Angioedema (contraindicated in C1 esterase inhibitor deficiency)
3. Teratogen (fetal renal malformations)
4. ↑ Creatinine (↓ GFR)
5. Hyperkalemia
6. Hypotension
7. Renal failure if used in bilateral renal artery stenosis (↓ GFR)

Captopril's CATCHH