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Pharm Renal Mod 4 Flashcards

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1
Q

Acetazolamide MOA

A

Inhibits Carbonic Anhydrase at PCT

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2
Q

Acetazolamide Uses (4)

A

Glaucoma (topical)
Alkalinize urine
Altitude sickness
Treat Metabolic Alkalosis

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3
Q

Acetazolamide Toxicity (5)

A
  1. Metabolic acidosis
  2. Elevated urinary pH and renal stones (Alkaline pH makes Ca salts insoluble)
  3. Drowsiness
  4. Paresthesias
  5. Sulfa allergy*
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4
Q

Loop diuretics include (4)

A
  1. Ethacrynic acid (non-sulfa)
  2. Furosemide
  3. Bumetanide
  4. Torsemide
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5
Q

Loop diuretics MOA

A

Inhibit Na/K/2Cl cotransport system
(20-30% of Na reabsorption may be blocked)

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6
Q

Loop diuretics act at the

A

Thick ascending loop of Henle

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7
Q

Acetazolamide acts at the

A

Proximal Convoluted Tubule

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8
Q

Loop diuretics uses (7)

A
  1. Acute pulmonary edema
  2. CHF
  3. HTN
  4. Refractory edemas
  5. Hypercalcemia
  6. Hyperkalemia
  7. Acute Renal Failure
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9
Q

Loop diuretics toxicity (9)

A
  1. Hypokalemia
  2. Metabolic alkalosis
  3. Hypovolemia
  4. Thirst
  5. Hyponatremia
  6. Hyperuricemia
  7. Hyperglycemia
  8. Ototoxicity (Ethacrynic acid may be irreversible)
  9. Sulfa sensitivity (Furosemide, Bumetanide, Torsemide)
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10
Q

Thiazides act on the

A

Distal convoluted tubule

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11
Q

Thiazides include (3)

A
  1. Hydrochlorothiazide
  2. Chlorothiazide
  3. Metolazone
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12
Q

Thiazides MOA

A

Inhibit Na/Cl cotransporter at DCT

Diuresis due to high sodium and chloride load with water. Calcium is retained

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13
Q

Thiazide Uses (4)

A
  1. HTN
  2. CHF
  3. Nephrogenic diabetes insipidus (direct stimulation of ADH site)
  4. Reduce formation of calcium stones- benefit osteoporosis
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14
Q

Thiazide toxicity (7)

A
  1. Hypokalemia
  2. Metabolic alkalosis
  3. Hypercalcemia
  4. Hyperuricemia
  5. Hyperglycemia
  6. Hyponatremia
  7. Sulfa hypersensitivity*
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15
Q

K+ sparing: Amidoride and Triamterene MOA

A

Block sodium transport at Cortical collecting tubule

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16
Q

K+ sparing: Amidoride and Triamterene Uses

A

Combine with thiazide or loops to neutralize K+ loss

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17
Q

K+ sparing: Amidoride and Triamterene toxicity (2)

A
  1. Hyperkalemia
  2. Metabolic acidosis
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18
Q

K+ Sparing: Spironolactone and
Eplerenone MOA

A

Aldosterone receptor antagonist at medullary collecting tubule

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19
Q

K+ Sparing: Spironolactone and
Eplerenone Uses (5)

A
  1. HTN
  2. CHF- antagonize aldosterone during renin-angiotensin
  3. Combine with loops or thiazides to offset hypokalemia
  4. Antiandrogen
  5. Hyperaldosteronism
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20
Q

K+ Sparing: Spironolactone and
Eplerenone toxicity (2)

A
  1. Hyperkalemia
  2. Spironolactone-endocrine effects (gynecomastia, antiandrogen)
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21
Q

Osmotic diuretic

A

Mannitol

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22
Q

Carbonic anhydrase inhibitor

A

Acetazolamide

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23
Q

Mannitol MOA

A

Filtered, not reabsorbed, carries water with it- increases urine flow and decreases intracranial or intraocular pressure

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24
Q

Mannitol Uses

A

Osmotic diuresis can increase the water load in the nephron to prevent damage by concentrated nephrotoxic drugs.
Can resolve edema and glaucoma.

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25
Mannitol toxicity (3/4)
1. Pulmonary edema 2. Dehydration 3/4. Hypo or hypernatremia
26
ACEi: Direct acting (2)
Captopril Lisinopril
27
ACEi: Prodrugs (3)
Enalapril Ramipril Fosinopril
28
ACEi: Active metabolites (2)
Enalaprilat Ramiprilat
29
ACEi: Sulfur containing (1)
Captopril
30
Lisinopril: Drug class, inactive/active, length of half life
ACEi, active, long half life
31
Captopril: Drug class, inactive/active, length of half life
ACEi, active, short-half life
32
ACEi MOA
Inhibit ACE > less angiotensin II Increases bradykinin
33
ACEi Uses (4)
1. Antihypertensive 2. CHF 3. MI recovery and prevention 4. Diabetic Nephropathy
34
ACEi toxicity (6)
1. Cough 2. Angioedema 3. 1st dose phenomenon hypotension 4. Hyperkalemia 5. Decrease GFR 6. Teratogen
35
Angiotensin II Receptor Blockers (ARBs) include (4)
Candesartan Irbesartan Losartan Valsartan
36
ARB MOA
Angiotensin II receptor antagonist
37
ARB Uses (4)
1. Alternative to ACEi 2. Antihypertensive 3. CHF 4. CKD
38
ARB Toxicity (4)
1. 1st dose phenomenon hypotension 2. Hyperkalemia 3. Decrease GFR 4. Teratogen
39
Aliskiren MOA
Binds renin (a peptidase). Renin is then unable to convert Angiotensinogen to Angiotensin I. So no Angiotenisin II is made
40
Aliskiren use
HTN- Diuretics, ACE Inhibitors and Angiotensin Receptor Blockers reduce blood pressure, but increase renin release. Therefore, adding a direct renin blocker (AKA Aliskerin) may suppress the renin increase which opposes antihypertensive drug action.
41
Aliskiren toxicity (3)
1. Hyperkalemia 2. Decrease GFR 3. Hypotension
42
Drugs that cause Hemodynamically-mediated kidney injury (4)
ACEi/ARBs NSAIDs Cyclosporine/tacrolimus Contrast media
43
Drugs that cause Acute Tubular Necrosis (ATN) (4)
Aminoglycoside Cisplatin/Carboplatin Amphotericin B Contrast media
44
Drugs that cause Osmotic nephrosis (2)
IV immunoglobulin (IVIG) Mannitol
45
Drugs that cause Acute Allergic Interstitial Nephritis (AIN) (6)
Allopurinol Penicillins Cephalosporins Quinolones (Ciprofloxacin) Rifampin Sulfonamides
46
Drugs that cause Chronic Interstitial Nephritis (CIN) (2)
Lithium Cyclosporine
47
Drugs that cause Crystal nephropathy (4)
Acyclovir/Ganciclovir Foscarnet Indinavir Ethylene glycol (oxalate stones)
48
Drugs that cause rhabdomylosis
Lovastatin, use with gemfibrozil, niacin or inhibitors of CYP3A4
49
Management rhambodmyolysis
Vigorous hydration and urine alkalinization
50
Management Crystal nephropathy
Vigorous hydration and urine alkalinization
51
AIN triad of symptoms
Fever, rash, eosinophiluria
52
AIN treatment
prednisone
53
Is CIN reversible
No- chronic damage to kidney
54
Muddy brown casts are seen in
ATN
55
ATN effect on K and Mg
Decreases both- Hypokalemia Hypomagnesemia
56
Hemodynamically-mediated kidney injury symptom
oliguria
57
Hemodynamically-mediated kidney injury seen in ACEIs/ARB susceptible patients
Renal artery stenosis
58
Drugs (4 classes) used to treat glomerulonephritis
Corticosteroids ACEi/ARBs Furosemide Warfarin
59
ACEi/ARBS MOA and use in treatment of glomerulonephritis
Inhibit Angiotensin II Treat HTN and decrease proteinuria
60
ACEi/ARBs used to treat glomerulonephritis (4)
Captopril Enalapril Losartan Valsartan
61
Furosemide use in treatment of glomerulonephritis
Loop diuretic, treats edema
62
Warfain use in treatment of glomerulonephritis
Intravascular thrombosis
63
Corticosteroids/Immunosuppressants used to treat glomerulonephritis (4)
Prednisone Azathioprine Mycophenolate mofetil Cyclosporine
64
Corticosteroid use in treatment of glomerulonephritis (2)
1. Anti-inflammatory 2. Immunosuppressant Note: 1. Patient’s response to the treatment depends on the specific type. 2. Minimal-change Nephropathy responds best to Corticosteroid treatment.
65
Urinary tract antiseptic (1)
Nitrofurantoin
66
Urinary tract analgesic (1)
Phenazopyridine
67
Antibiotics used to treat UTI's (5)
1. Sulfonamides: Sulfamethoxazole-Trimethoprim 2. Fosfomycin 3. Fluoroquinolones: Ciprofloxacin/Levofloxacin 4. Broad Spectrum Penicillins 5. Cephalosporins
68
Trimethoprim- Sulfamethoxazole Use/MOA (3)
1. Synergistic combination against folate synthesis. 2. Block purine production and nucleic acid synthesis. 3. Treatment UTI- cystitis
69
Trimethoprim- Sulfamethoxazole Toxicity (4)
1. Hypersensitivity; Stevens Johnson Syndrome. 2. Hemolytic anemia in patients with G6PD deficiency, kernicterus (infants) 3. Photosensitivity 4. AIN/ Crystalluria
70
Nitrofurantoin Use/MOA
Intermediates attack large macromolecules in the cell (effective for E coli, safe in pregnancy except near term) Treatment- cystitis
71
Nitrofurantoin Toxicity (2)
1. Avoid in G6PD deficiency-hemolytic anemia 2. Pulmonary fibrosis (chronic use)
72
Fosfomycin Use/MOA
Inhibits peptidoglycan biosynthesis via inhibition of MurA enzyme Treatment- cystitis
73
Ciprofloxacin/Levofloxacin Use/MOA
Inhibit bacterial DNA replication by inhibiting topoisomerase II (DNA-gyrase) and IV Alternative in treatment of cystitis DOC for pyelonephritis
74
Ciprofloxacin/Levofloxacin toxicity (6)
1. Tendonitis: tendon rupture 2. Contraindicated in pregnancy, children (causes cartilage damage) and patients with G6PD deficiency (Hemolysis) 3. Phototoxicity. 4. GI upset: nausea, and vomiting 5. CNS effects: insomnia, dizziness, seizure 6. Cardiotoxicity: Prolonged QT interval, Torsade.
75
Ampicillin +Sulbactam Amoxicillin+Clavulanic acid Piperacillin+tazobactam MOA
Penicillins interact with cytoplasmic membrane-binding proteins (PBPs) to inhibit transpeptidation reactions involved in cross-linking, the final steps in cell-wall synthesis
76
Ampicillin +Sulbactam Amoxicillin+Clavulanic acid Piperacillin+tazobactam Toxicity (3)
1.Hypersensitivity: skin rash, anaphylaxis 2. Drug interaction with Probenecid (compete for tubular secretion) 3. Acute allergic interstitial nephritis
77
Cephalosporins -2nd-3rd generation Examples: Cefpodoxime Cefdinir Cefepime Use/MOA
Same as penicillins, use for pyelonephritis
78
Cephalosporins -2nd-3rd generation Examples: Cefpodoxime Cefdinir Cefepime Toxicity (2)
1. Hypersensitivity: ~10% cross-reactivity in patients with an allergy to penicillin. 2. Acute allergic interstitial nephritis
79
Phenazopyridine Use/MOA
Urinary tract analgesic Used in conjunction with antibiotics to provide immediate symptomatic relief of pain, burning, urgency, frequency from UTI
80
Phenazopyridine Toxicity (2)
1. Avoid in G6PD deficiency-hemolytic anemia. 2. Produces orange to reddish color to urine
81
Creatinine clearance is an indicator of: (2)
GFR and renal function
82
Diuretics associated with sulfa hypersensitivity (4)
Acetazolamide Most loops (except ethacrynic acid) All thiazides Amiloride
83
Sulfa hypersensitivity symptoms (5)
1. photosensitivity 2. generalized dermatitis (rash) 3. hemolytic anemia 4. thrombocytopenia 5. acute necrotizing pancreatitis
84
ACEi and ARBs are used to treat: (2)
HTN CHF
85
Actions of Angiotensin II (5)
1. Vasconstriction 2. Aldosterone release (causes Na retention and increased blood volume) 3. ADH (vasopressin) release (causes water retention and vascular volume expansion) 4. Activate sympathetic nervous system 5. Induce Hypertension
86
Actions of Bradykinin (3)
1. Vasodilation (mediated by nitric oxide, PGE2, PGI2) and decreases blood pressure 2. Inflammation (can cause angioedema) 3. Smooth muscle contraction (can cause bronchoconstriction and cough)
87
Clinical usefulness of ACEi (3)
1. Lower BP in hypertensive pts who have elevated renin 2. Identify responsive hypertensives who do not have elevated renin 3. Improve CHF
88
The clinical benefits of ACEi are due to: (4)
1. Decreased Angiotensin II 2. Increased bradykinin 3. Decreased aldosterone 4. Decreased ADH/vasopressin
89
Contraindications of ACEi (2)
1. pregnancy (second and third trimester)- risk for fetal renal failure and hypotension 2. Renal insufficiency may be associated with neutropenia and proteinuria
90
Patients with bilateral renal artery stenosis are at risk for acute renal failure if taking what class of drugs?
ACEi
91
-pril is what drug class?
ACEi
92
-sartan is what drug class?
ARBs (Angiotensin II receptor blocker)
93
What side effects of ACEi are NOT seen in ARBs? (2)
Angioedema, cough
94
A patient with G6PD Deficiency cannot use: (4)
1. TMP-SMX 2. Nitrofurantoin 3. Ciprofloxacin/Levofloxacin 4. Phenazopyridine
95
Cephalosporins -2nd-3rd generation Include: (3)
Cefpodoxime Cefdinir Cefepime
96
Bartter syndrome presents similar to
Chronic loop diuretic use
97
Gitelman syndrome presents similar to:
lifelong thiazide diuretic use
98
Liddle syndrome presents similar to:
Hyperaldosteronism
99
Treatment for Liddle Syndrome
Amiloride
100
Tolvaptan MOA
ADH antagonist at collecting duct
101
Hypertension is treated by (3)
1. Loops 2. Thiazides 3. K+ sparing
102
CHF is treated by (2)
1. Loops 2. K+ sparing
103
DI is treated by: (3)
1. Desmopressin (if neurogenic) 2. K+ sparing: Amiloride or triamterene (if lithium nephrogenic) 3. Thiazides (if non-Lithium nephrogenic)
104
Idiopathic hypercalciuria is treated by
Thiazides
105
Acute hypercalcemia is treated by
Loops
106
Ototoxicity is associated with
Loops
107
Sulfa hypersensitivity is associated with (4)
1. Acetazolamide 2. Thiazides 3. Loops (except ET) 4. Amiloride
108
ADH analogue
Desmopressin
109
ADH antagonist
Conivaptan/Tolvaptan

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