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Pharm III - Exam 1 > Nephrology > Flashcards

Flashcards in Nephrology Deck (50)
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1

Which drug classes work on the glomerulus as their site of action?

None!

2

Which drug classes work on the proximal tubules?

-Carbonic anhydrase inhibitors (CAIs)
-Adenosine antagonist (current investigation)

3

Carbonic anhydrase inhibitors (CAIs) MOA

-Inhibits enzyme responsible for dehydration of H2CO3
-Reduces aqueous humor production

4

CAI examples

Acetazolamide
Dorzolamide (ophthalmic)
Brinzolamide (ophthalmic)

5

Indications for CAIs

-Glaucoma
-Urinary acidosis
-Metabolic alkalosis
-Acute mountain sickness

6

ADRs of CAIs

-Renal stones
-K wasting
-Drowsiness
-Hypersensitivity reaction

7

Contraindication of CAIs

Hepatic cirrhosis

8

PK of CAIs

-Absorbs well
-Increases urine pH
-Onset w/in 30 mins
-Duration 12 hrs

9

Which drug classes work on Loop of Henle?

Loop diuretics

10

Loop diuretic MOA

Inhibits Na/K/Cl transporter

11

Indications for loop diuretics

-Edema
-Hypercalcemia
-Hyperkalemia
-Anion overdose

12

ADRs of loop diuretics

-Low Mg
-High uric acid
-Ototoxicity
-Allergic reaction

13

Contraindications of loop diuretics

-Careful in hepatic cirrhosis, renal/heart failure
-Sulfa allergy

14

Drug-drug interactions of loop diuretics

NSAIDs can decrease effectiveness of loop diuretics

15

PO to IV conversion of furosemide

2:1
40 mg PO = 20 mg IV

16

PO to IV conversion of torsemide and bumetanide

1:1

17

Which drug classes work on distal convoluted tubule?

Thiazide diuretics

18

Thiazide MOA

-Inhibits NaCl transporter
-Enhances Ca reabsorption

19

Indications for thiazides

-HTN
-Heart failure
-Nephrogenic DI
-Nephrolithiasis

20

PK of thiazides

-Absorbed slowly
-Chlorthalidone slowest but longer duration of action

21

What agent is the slowest absorbed but longest lasting thiazide?

Chlorthalidone

22

ADRs of thiazides

-Low Na, K
-High uric acid, lipids
-Allergic rxn
-Photosensitivity

23

Thiazides should be used with caution in which conditions?

-Hepatic cirrhosis
-Renal failure
-Heart failure

24

Which thiazide is effective with GFR less than 20 ml/min?

Metolazone

25

Which thiazide comes in IV formulation?

Chlorothiazide

26

Which drug classes work on the cortical collecting tubule?

K sparing diuretics
Adenosine antagonists

27

Indications for K sparing diuretics

Hypokalemia (prevention/tx)

28

Indications for spironolactone

-Hyperaldosterism
-Polycystic ovary disease
-Hirsutism

29

ADRs of K sparing diuretics

-High K
-Kidney stones (triamterene)
-Gynecomastia, impotence (spironolactone)

30

When is spironolactone contraindicated?

Addison's disease

31

Drug-drug interactions of K sparing diuretics

-Eplerenone only
-Strong CYP3A4 agents

32

Which drug classes act on the medullary collecting duct?

Vassopressin (ADH) antagonists

33

Indications of ADH antagonists

-Congestive heart failure
-SIADH

34

ADH antagonist agents (indirect)

Lithium
Demeclocycline
(MOA unknown)

35

ADH antagonist agents (direct)

Conivaptan
Tolvaptan
(MOA: inhibits vasopressin receptors)

36

ADRs of direct ADH antagonists

-Nausea
-Dry mouth
-Thirst

37

CI of direct ADH antagonists

-Hypovolemia
-Hyponatremia

38

Drug-drug interactions of direct ADH antagonists

Strong CYP3A4 agents

39

Osmotic diuretics MOA

-Increase osmotic pressure in glomerulus
-Decreases reabsorption of H2O and electrolytes

40

Indications for osmotic diuretics

-Cerebral edema
-Acute glaucoma
-Bronchial hyper-responsiveness

41

Osmotic diuretic agents

-Glycerol
-Mannitol (PO, inhaled, IV)

42

PK of osmotic diuretics

-Poorly absorbed
-Quickly excreted

43

ADRs of glycerol

N/V, diarrhea

44

ADRs of mannitol

Excessive volume expansion (heart failure, edema, pulm congestion)

45

How are osmotic agents better tolerated?

-Oral
-Mixed w/small amount of juice
-Add ice
-Small sips

46

How is CrCl calculated?

Cockroft-Gault (MC)

47

Which meds can cause vasoconstriction of afferent arteriole?

NSAIDs
Cyclosporine
Tacrolimus
Amphotericin B

48

Which meds can cause vasodilation of efferent arteriole?

ACEI/ARBs
Dilt and verapamil

49

Which meds cause direct toxicity to renal tubules?

Aminoglycosides
Amphotericin B
Cisplatin and carboplatin
Radiocontrast agents

50

What drug has been proven to accelerate the recovery of renal failure?

None!