ACE INHB and Nephrotoxic DRUGS

Question 1

Type of drug

Hydroclorothiazide,Clorothiazide,chlorthalidone

Answer 1

Thiazide Diuretic

Question 2

Special use of Thiazide diuretic (2)

Answer 2

-Hypertension+osteoporosis
-Hypertension+Kidney stone(Ca++ related)

Question 3

Thiazide promotes:
excretion :
reabp:

Answer 3

-Hypokalemia,Hypocloremia,HYPERTG and HYPERCHOLESTEROL
-Hypercalcemia,Hyperurecemia,metabolic alkalosis

Question 4

Indapamide?

Answer 4

-Thiazide diuretic used for patients with Hyper TG and Hyper-cholesterol.
-ONLY thiazide that dosent incr TG and cholesterol in blood.

Question 5

-Torsemide,Bumetanide
-use

Answer 5

Loop Diuretics (Furosemide)
-Edematous states, Hypercalcemia (since promotes excretion of Ca++)

Question 6

A.E Loop Bumetadine,Furosemide,Tosemide

Answer 6

-Ototoxicity
-Sulfa Drug
-metabolic alkalosis
-Hypokalemia
-Hypocalcemia

Question 7

What drug should be carefully adm with Fursemide? (2)

Answer 7

-Aminoglycoside(ototoxicity)
-Digoxin (hypokalemia)

Question 8

Mannitol type of drug?
-Use for..

Answer 8

-Osmotic diuretic
-Intra-occular pressure increased (ACUTE Glaucoma)
-Intra-cerebral pressure increased.

Question 9

-Acetezolamide use?
-Adverse effects

Answer 9

-High altitude sickness
-Not ACUTE Glaucoma
-Metabolic alkalosis
-Hypokalemia, Precipitation of Ca++-phosphate stones–>alkalanization of pH.

Question 10

Amiloride use and mechanism.

Answer 10

-Direct Enac channel inhb. (K+ sparring diuretic)
-Used for **Diabetus Insipidus relating Lithium. **

Question 11

K+sparring diuretic A.E?

Answer 11

-Hyperkalemia
-Nephrolithiasis
-Gynecomastia in MALES(anti-androgenic)

Question 12

Spironolactone + Loop diuretics used in…

Answer 12

Congestive Heart Faliure.

Question 13

ACE INHB+Spironolactone used for…

Answer 13

Incr survival in HF.

Question 14

Patiromer used?

Answer 14

Treats HYPERKALEMIA
-Bind K+ in interstine–>incr excretion in feces

Question 15

Conivaptan and Tolvaptan used

Answer 15

-Anti-ADH
-Euvolemic or Hypervolemic Hyponatremia
-A.E:Hypokalemia

Question 16

-Blocks Angiotensinogen to angiotensin 1 (direct renin inhibitor)

Answer 16

Aliskiren

Question 17

Aliskiren use?

Answer 17

-Hypertension, also be used for preventing progression of diabetic nephropathy. Also decr GFR.

Question 18

Contraindication of Aliskiren.

Answer 18

-Given along side ACHE inhb and ARB. Massive decrease in GFR.

Question 19

Angiotensinogen is made where?

Answer 19

Liver.

Question 20

Characteristics

Ethacrynic acid?

Answer 20

-Acts same as Loop diuretic but is NOT sulfa drug
,but is more OTOTOXIC.

Question 21

-ACEH inhb. use (4)
-A.E (4)
-Mecanism action

Answer 21

-Hypertension, Protenuria, Diabetic Neuropathy (releives hyperfiltration–>slows down GBM thickening),HF (decr mortality)

-Cough, Angioedema (INCR. Bradykinin–>Contraindicated in C1 Esterase defc.–>Has incr bradykinin), Teratogen, Hyperkalemia, Renal Injury in bilateral renal artery stenosis,incr creatinine

-Dilate both efferent and afferent renal arterioles.

Question 22

If uric acid is increased think of what 2 drugs?

Answer 22

Loop diuretics (except etharnic acid) and Thiazide Diuretics

Question 23

What drug?

Adverse effects include hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia (hyperGLUC).

Answer 23

-Thiazide
-You differentiate with Loop with TG elevation and hyperglycemia which it DOSENT cause.

Question 24

Furosemide Hydralazine Hydroclorothiazide Nitroglycerin Spironolactone

Answer 24

-Spironolactone
-Based on the musculoskeletal symptoms and the ECG showing peaked T waves (see next image), this patient has been taking a medication that causes hyperkalemia. Peaked T waves and elongation of the PR interval are important early signs of severe (emergent) hyperkalemia, usually with serum potassium >6 to 7 mEq/L,

Question 25

A 56-year-old man comes to the clinic because of excruciating pain in his right great toe for 2 days. Two weeks ago, he was diagnosed with uncontrolled hypertension and prescribed a new medication. Blood pressure is 135/85 mm Hg. Physical examination reveals an erythematous, warm, and exquisitely tender right great toe. Whats the drug?

Answer 25

-Thiazide diuretic

Question 26

-A 75-year-old man is brought to the emergency department with increasing confusion. He has a history of lung cancer and is currently undergoing chemotherapy and radiation therapy. Two weeks ago, he was started on hydrochlorothiazide and enalapril for hypertension. Pulse is 80/min, and blood pressure is 126/78 mm Hg. The physical examination is normal except for disorientation to time and place. Serum studies show a sodium level of 122 mEq/L, potassium of 3.9 mEq/L, and creatinine of 0.9 mg/dL. ADH level is in the low-normal range. Which of the following describes the most likely mechanism of this patient’s hyponatremia? Aldosterone inhibition Decreased glomerular water filtration Decreased urinary diluting capacity Hypovolemia Increased posterior pituitary ADH release Neoplastic secretion of ADH

Answer 26

-Decreased urinary diluting capacity -Euvolemic hyponatremia will cause hyponatremia without signs of volume depletion or excess, and can be due to SIADH, chronic kidney disease, or thiazides. Thiazide diuretics may cause hyponatremia by inhibiting NaCl absorption and limiting the ability of the kidney to dilute the urine.

Question 27

ACHE INHB characteristics

Answer 27

first-line medications for treating hypertension and heart failure. They are **known to cause hyperkalemia**, the risk for which is increased when these medications are prescribed along with potassium-sparing diuretics such as spironolactone.

Question 28

53-year-old woman is brought to the emergency department because of nausea and confusion. She has been preparing for a marathon and just finished a 4-hour run in cool weather during which her only intake was water. Medical history is significant for hypertension, well controlled with medication. Pulse is 86/min and blood pressure is 126/82 mm Hg. She is disoriented to time. The remainder of the physical examination is normal. Serum sodium level is 121 mEq/L. Which of the following is the most likely cause of this patient’s symptoms?

Answer 28

-**Severe hyponatremia** may cause **cramping, confusion, and seizures**. -**Thiazide diuretics can cause severe hyponatremia, especially in the setting of high water and poor solute intake.** -patients on **loop diuretics who have hyponatremia are uniformly hypovolemic (orthostasis, tachycardia, low blood pressure), thiazide-taking patients with hyponatremia usually do not appear hypovolemic. ** -This is because thiazides act in the distal convoluted tubule to **reduce sodium reabsorption**. This **inhibits the generation of a maximally dilute urine (50 mOsm/kg) that normally occurs by the end of this nephron segment**. Their minimum urine osmolality may instead be 150 to 200 mOsm/kg. This** impaired urine dilution combined with excess water intake and poor solute intake**, as seen in this runner, can** cause symptomatic hyponatremia**. High ADH levels released during exercise or due to initial volume depletion may contribute as well (see figure). The **patients drink excess water, which is why they often do not appear volume depleted.**

Question 29

What drug limits diluting capacity of urine?

Answer 29

-Thiazide due there action on last area of tubule that reabsp water.

Question 30

Mechanism of Thiazide and causing Hyponatremia? -Is is usefull to give it in diabetus?

Answer 30

-Thiazide diuretics-->by promoting continous Na+ excretion -->continues H2O excretion-->triggers ADH -->water reabsp-->worsening hyponatremia and even worst if you drink lots of water with few Na+ intake. -**NO, causes hyperglycemia**.

Question 31

NSAIDS causes (4)

Answer 31

-Acute Tubular Necrosis (ischemia) -Interstitial Nephritis (5 P'S) -Renal Papillary Necrosis -Membranous Glomerulonephritis

Question 32

What 2 deugs cause **hypokalemic metabolic alkalosis ** and Why?

Answer 32

-Thiazide and Loop Diuretics because as they promote volume loss you will see RAAS activation--> triggers aldosterone to secrte K+ and H+-->Hypokalemia and metabolic alkalosis.

Question 33

57-year-old man is brought to the emergency department after being found with an empty pill bottle at his bedside. He has diffuse abdominal pain. He has a history of depression and past suicide attempts. He also has a history of type 2 diabetes mellitus, currently managed with medication. His vital signs are stable. Laboratory studies show: Na+: 140 mEq/L K+: 4.8 mEq/L Cl–: 100 mEq/L HCO3–: 18 mEq/L Glucose: 110 mg/dL Blood urea nitrogen: 30 mg/dL Serum creatinine: 3.5 mg/dL Which of the following is the mechanism of the drug most likely causing this patient’s findings? Decreases glucagon release Directly binds insulin receptors Inhibits gluconeogenesis Inhibits intestinal α-glucosidases Triggers insulin release

Answer 33

Metformin** inhibits hepatic gluconeogenesis**, increases insulin sensitivity in peripheral tissues, and increases peripheral glucose utilization to help lower the blood glucose level. More specifically, metformin inhibits mitochondrial enzymes (glycerophosphate dehydrogenase and complex I). This mechanism may also contribute to metformin toxicity by increasing the intestinal production of lactate due to **increased anaerobic glycolysi**s and by reducing the hepatic metabolism of lactate (due to decreased gluconeogenesis). -Promotes acidosis-->decreases HCO-3.

Question 34

# What drug? -Patient with hypertension gicing this drug:then developed -contraction alkalosis + Hyperkalemia

Answer 34

-Loop diuretic -Also promotes incr Na to DCT by inhibiting Cl-/Na+/K+ transporter in asc. limb.

Question 35

Etarcapnet -use -what to check before giving?

Answer 35

TNF alpha inhibitor -->important regulator for Granuloma formation--> check for TB before giving -Used:R.A, psoriasis,ankylosing spondylitis

Question 36

Drugs that cause Pre-Renal azotemia(6)?

Answer 36

-NSAIDS, Loop Diuretics, Anticoagulants and Thrombolytics, ACHE Inhb.,Contrast dyes and Arterial vasodilators (Hydralazine)

Question 37

How does thrombolytics cause Pre-Renal azotemia?

Answer 37

-By dissolving larger Blood clots and promoting smaller which will obstruct renal arteries-->ischemia,infarct or necrosis

Question 38

Intrisnic Renal AKI drugs ?

Answer 38

-ATN:**Aminoglycosides **(Neomycin),Cisplatin and **Amphoterecin B** -Interstitial Nephritis: 5P'S (Penincillin-Chephalosporin, PPI(Omeprazole), Diuretics,Rimfampin,NSAIDS)

Question 39

How does aminoglycosides cause AKI?

Answer 39

-Accumulation in renal cortex in PCT-->obstruction Blood Flow.

Question 40

Drugs that cause Post-Renal AKI?

Answer 40

-Mtx, Acyclovir and Sulfonamides

Question 41

Hemorrhagic cystitis Drugs?

Answer 41

Cyclophosphamide,ifosfamide

Question 42

Sevelamer

Answer 42

-Binds Phosphate in GI tract. -CKD patients.

Question 43

Eplerenone??

Answer 43

-New spironolactone,without breast enlargement.

Question 44

EPO drug in ESRD A.E??

Answer 44

-Hypertension and incr risk Blood Clots -Excessive RBC formation may cause hypertension.

Question 45

ACHE inhb is teratogenic?

Answer 45

-Decr. GFR-->oligohydramnios-->Potter sequence.

Question 46

Where do you use following drugs? -azoles -Nystatin -Amphotericin B

Answer 46

-Less serious systemic infections and local infections of fungus-->any fungus. -Topical use -Severe systemic fungal infections

Question 47

Use of Nystatin and how does it work?

Answer 47

-oral candidiasis (thrush); topical for diaper rash or vaginal candidiasis. -Binds to ergosterol-->membrane pore formation-->leakage. Same as amphoterecin B.

Question 48

Mayor A.E of amphotericin B?

Answer 48

Nephrotoxicity (prevent with hydration).

Question 49

# What drug? Inhibit fungal sterol (ergosterol) synthesis by inhibiting the cytochrome P-450 enzyme that converts** lanosterol to ergosterol.** AE

Answer 49

-Azoles -**Fluconazole** for chronic suppression of cryptococcal meningitis in people living with HIV and candidal infections of all types. **Itraconazole** may be used for Blastomyces,Coccidioides,Histoplasma,Sporothrix schenckii. **Clotrimazole and miconazole** for topical fungal infections. **Voriconazole** for Aspergillus and some Candida. Isavuconazole for serious Aspergillus and Mucor infections. Inhibit testosterone synthesis-->gynecomastia.