Pharmacology Renal Flashcards Preview

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Flashcards in Pharmacology Renal Deck (25):
1

Decreases intraocular and intracranial pressure

Mannitol: osmotic diuretic--increases tubular fluid osmolarity-->increased urine flow. Tx: pulmonary edema, dehydration, Contraindicated in anuria, CHF

2

Used in glaucoma

Acetazolamide: carbonic anhydrase inhibitor--self limited NaHCO3 diuresis, decrease total-body HCO3. Used in glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri

3

Tx of acetazolamide? Acid/Base disturbance?

Hyperchloremic metabolic acidosis, paresthesias, NH3 toxicity, sulfa allergy

4

Sulfonamide loop diuretic

Furosemide: inhibits NaK2Cl cotransporter in thick ascending limb-->abolishes hypertonicity of medulla and inhibits urine concentration. Stimulates PGE release, which dilates afferent arteriole. Increases Ca excretion.

5

Uses for furosemide:

Edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia

6

Furosemide toxcity:

Sulfa drug!! OH DANG: ototoxicity, hypokalemia, dehydration, allergy, nephritis (interstitial), gout

7

What is the difference between furosemide and ethacrynic acid?

Both have same MoA. Ethacrynic acid is phenoxyacetic acid derivative and safe to use in sulfa-allergic patients.

8

Tx of ethacrynic acid

Can cause hyperuricemia, induce gout. Never use to treat gout.

9

Thiazide diuretic

HCTZ--inhibits NaCl reabsorption in early distal tubule, decreases diluting capacity of nephron, decreased Ca excretion

10

Uses for HCTZ:

HTN, CHF, hypercalciuria, nephrogenic diabetes insipidus, osteoporosis (save calcium)

11

HCTZ toxicity:

Hypokalemic metabolic alkalosis. Hyponatremia, HyperGLUC: Hyerglycemia, hyperLipidemia, hyperUricemia, hyperCalcemia. Sulfa allergy.

12

K sparing diuretics

Spironolactone, epleronone, Triamterene, Amiloride. All can cause hyperkalemia. Use in hyperaldosteronism, K depletion, CHF

13

Competitive aldosterone receptor antagonists

Spironolactone, epleronone

14

Block Na channels in collecting tubule

Triamterene, amiloride

15

Toxicity of spironolactone

Mild anti-androgen effects: gynecomastia

16

Increase urine NaCl

all diuretics except acetazolamide

17

Increase urine K+

loop and thiazide diuretics

18

Causes acidemia

carbonic anhydrase inhibitors, K+ sparing diuretics

19

Causes alkalemia

loop diuretics, thiazides

20

What causes alkalosis and paradoxical aciduria

In low K state, H+ (instead of K) is used in Na/K exchange to re-absorb Na-->aciduria

21

Calcium wasting

loop diuretics cause hypocalcemia (decrease paracellular Ca re-absorption)

22

Hypercalcemia

thiazides can cause hypercalcemia

23

What happens to renin levels when ACEi are used?

Renin levels increase (loss of ACE negative feedback). Also bradykinin levels rise (ACE inactivates bradykinin)

24

ACEi toxicity?

CATCHH: cough, angioedema (contraindicated in C1 esterase deficiency), teratogen (fetal renal malformations), increased creatinine (low GFR), Hyperkalemia, Hypotension

25

ACEi contraindicated when?

C1 esterase deficiency, pregnancy, bilateral renal artery stenosis