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Renal > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Diuretics in the Proximal Tubule

A
  • mannitol

- acetazolamide

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2
Q

Mannitol

A
  • non metabolized, non reabsorbed osmotic diuretics
  • draws free water out of the tissue and into the circulation, where it is excreted by the kidneys
  • used in management of elevated ICP
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3
Q

Acetazolamide

A
  • Carbonic Anhydrase Inhibitor
  • induces metabolic acidosis
  • used for glaucoma and prevention/treatment of high altitude sickness
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4
Q

Loop Diuretic MOA

A

-inhibits Na/K/2Cl pump in ascending loop of henle

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5
Q

Loop Diuretic List

A
  • furosemide- most commonly used
  • bumetanide
  • torsemide- impoved bioavailability with data in HF
  • ethacrynic acid- only nonsulfa containing loop or thiazide
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6
Q

Loop Diuretic Uses

A
  • volume overload
  • heart failure
  • BP reduction
  • pulm edema
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7
Q

Loop Diuretic Adverse Effects

A
  • dec. K/Mg
  • hypocalcemia
  • precipitate gout attack
  • metabolic alkalosis
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8
Q

Thiazide Diuretic MOA

A

• Inhibit Na/Cl cotransporter in distal tubule
– Smaller portion of filtrate and less diuretic effect
• Antihypertensive effect secondary to dec plasma volume and dec CO
– Secondary mild vasodilation

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9
Q

Thiazide Side Effects

A
  • hyperuricemia
  • metabolic alkalosis
  • hypokalemia
  • hyperglycemia
  • lose efficacy in later stages of CKD as less drug reaches site of action as kidney fails
  • more efficacious loop diuretic need as GFR
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10
Q

Thiazide List

A
  • chlorthalidone
  • hydrochlorothiazide (HCTZ)
  • indapamide
  • metolazone
  • metalozone
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11
Q

K Sparing Diuretics MOA

A

• Bind to the aldosterone dependent Na/K exchange site
• Spironolactone and eplerenone competitively inhibit the mineralocorticoid receptor
– Eplerenone more specific

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12
Q

Aldosteronism causes:

A
  • Increase Na/H20 reabsorption (K loss)
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13
Q

RAS Inhibitors

A
  • ACE

- ARB

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14
Q

ACE Inhibitors

A 
Side effects:
- cough (secondary to increase bradykinin and substance P)
- hyperkalemia
- rise in serum creatinine (transient) 
- angioedema
-hypotension
-category D pregnancy
INDICATIONS: 1st line therapy HTN, CKD, HF, DM nephropathy
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15
Q

ARBs

A

Side effects:
- hyperkalemia
- rise in serum creatinine (transient) - angioedema
INDICATIONS: 1st line therapy HTN, CKD, HF, DM nephropathy

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16
Q

Ca Channel Blockers MOA

A

• Block L-type Calcium Channels
– Arterial vasodilation and decrease PVR
• Dihydropyridines (amlodipine, felodipine, -pine)
– Potent vasodilators with no effect on cardiac contractility
• Non-Dihydropyridines (verapamil, diltiazem)
– Less potent vasodilators with greater depressive effect on cardiac conduction

17
Q

Ca Channel Blockers: DHP

A

DHP (“-pines”)
• Reflex tachycardia
• Coronary and peripheral vasodilator
• SE: Peripheral edema, inc HR, gingival hyperplasia

DHP - well tolerated and provide effective BP control. Good 2nd line agents for BP reduction.

18
Q

Ca Channel Blockers: NDHP

A

NDHP (verapamil/diltiazem) • Negativeinotropicactivity
• Coronary and peripheral vasodilator
• SE: constipation, bradycardia, nausea

NDHP – Primarily reserved for neg inotropic activity

19
Q

Beta Blockers MOA

A
  • block peripheral adrenergic receptors therapy decreasing CO
  • dec. sympathetic output

Keys:
– Labetalol and carvedilol (alpha and beta blocker)
– Metoprolol – renal and hepatic elimination
– Atenolol – renal elimination

20
Q

Beta Blocker Side Effects

A

• Side effects: decrease libido, bradycardia,

bronchospasm, glucose/lipid changes

21
Q

Vasodilators (hydralazine, minoxidil)

  • MOA
  • side effects
  • keys
A

• MOA:
– Increase intacellular cGMP relaxation of arterial smooth muscle decrease systemic pressure and contractility
• Side effects: edema, tachycardia, lupus rash (hydralazine), neuropathy, hair growth (minoxidil)
• Keys:
– Minoxidil is a 3 drug drug
– Dosed BID
– Third/fourth line therapy. EFFECTIVE

22
Q

Alpha 1 Receptor Blockers

A

(terazosin, doxazosin, prazosin)
• MOA:
– peripheral postsynaptic blockade decrease in arterial
tone
– relaxes the smooth muscle of the bladder neck
• Side effect: postural hypotension, dizziness, somnolence, nasal congestion/rhinitis, and impotence
• Keys:
– Primarily used for BPH symptoms
– ALLHAT study arm discontinued early secondary to increase CV events vs. thiazide

23
Q

Alpha 2 Receptor Blockers

A

(Clonidine, methyldopa)
• MOA: stimulate presynaptic alpha 2 receptor decrease sympathetic tone
– Decrease PVR and CO
• Side effects: dry mouth, depression, lipid
abnormalities, sedation
• Keys:
– Clonidine patch available to increase compliance – Methyldopa is DOC in pregnancy
– Clonidine off label: smoking cessation, ADHD, – Used 3rd/4th line

24
Q

Effects of AngII in Kidney

A

-efferent vasoconstriction: inc GFR inititally, but dec. renal blood flow

25
Q

Effects of Norepinephrine on Kidney

A
  • efferent vasoconstriction: inc GFR inititally, but dec. renal blood flow
  • afferent vasoconstriction: dec GFR, dec. RBF
26
Q

Effect of Dopamine (or caffeine) on Kidneys

A
  • afferent vasodilation: inc. GFR, inc. RBF

- this is how caffeine causes diuretic effect

27
Q

Effect of ACEi or ARBs on Kidneys

A

-efferent vasodilation: dec. GFR, inc. RBF

28
Q

Effect of NSAIDS on Kidney

A

-afferent vasoconstriction: dec. GFR, dec. RBF

29
Q

Effect of Prostaglandins on Kidney

A

-efferent vasodilation

30
Q

Recombinant Erythropoeitin

A
  • tx for anemia
  • MOA: simple replacement
  • side effects: well tolerated, if HgB > 12 there is inc. risk of CV events and mortality
31
Q

Iron Products

A
  • tx for anemia
  • MOA: parenteral or supplement
  • side effects: GI, hypotension, allergic rxns
32
Q

Phosphate Binding Agents

A
  • calcium compounds that bind PO4 to prevent bone disease due to renal osteodystrophy
  • side effects: hypercalcemia
33
Q

Vitamin D Compounds

A
  • decreases PTH relsease indirectly and directly
  • side effects; hypercalcemia
  • note: paracalcitol acts selectively at D3 receptors on PT gland- not at intestint- so ho hypercalcemia
34
Q

Calcimimetics

A
  • alternative to vitamin D if pt develops hypercalcemia
  • reduce release of PTH
  • side effects: hypocalcemia
  • DDIs: potent inhibitor of CYP2D6
35
Q

Drugs That Can Cause Hyperkalemia

A
  • potassium sparing diuretics
  • ACE inhibitors
  • ARBs
  • digoxin (toxic, not therapeutic, doses)
36
Q

How to Treat Hyperkalemia

A 
C-calcium gluconate or chloride
B-B2 agonist
I- insulin
G- glucose
K- kayexalate

Renal (14 decks)

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