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
