RENAL Flashcards Preview

PHARM SHELF AND BOARDS > RENAL > Flashcards

Flashcards in RENAL Deck (44):
1

Name 2 diuretics that act in the PCT

mannitol and acetazolamide

1

What acid base status would result from a person going on acetazolamide?

acidosis (metabolic) because they are losing their NaHCO3

1

What is the most common sulfonamide loop diuretic?

furosemide

2

Where does acetazolamide act in the nephron?

PCT

2

In what 2 ways do loop diuretics cause diuresis?

1) By inhibiting the NKCC pump in the TALH they cause a loss of hypertonicity in the renal medulla, thus, you cannot concentrate urine. 2) The stimulate PGE production which dilates the afferent arteriole and increases GFR

2

What AE is shared by spironolactone and cimetidine?

development of gynecomastia

3

What is the MOA of acetazolamide?

It is a carbonic anhydrase inhibitor, therefore, NaHCO3 is lost in the urine, this causes acidosis

3

3 indications for thiazides

HTN, idiopathic hypercalciuria, nephrogenic diabetes insipidus

3

What 2 diuretics cause alkalosis and why?

Loops and thiazides. This is predominately secondary to K loss, this pulls H in from plasma in exchange for K? Also, the volume contraction turns on RAAS which further causes H loss

4

Which K sparing diuretics are competitive antagonists of ENaC?

Triamterene, Amiloride

6

What are the indications (3) for loop diuretics?

Edematous states, hypercalcemia, and hypertension

6

What are the two MOA's of potassium sparing diuretics?

1) competitive aldosterone inhibitor in cortical collecting tubules 2) Sodium Channel blocker (ENaC) in cortical collecting tubule

8

Which type of diuretic is actually contraindicated in congestive heart failure?

mannitol

9

Which diuretic is used to treat pseudotumor cerebri?

acetazolamide

10

What are the AE of thiazide diuretics (5)?

Sulfa allergy and hyperGLUC = Hyper -Glycemia, -Lipidemia, -Uricemia, -Calcemia

12

Which diuretic would be best for a hypercalcemic patient? Hypocalcemic?

Loop diuretics cause loss of Ca; Thiazides increase serum Ca

13

Which K sparing diuretics are competitive aldosterone antagonists?

Spironolactone and eplerenone

14

Which side effects are not present in ARBs that ACE-inhibitors cause?

Cough and Angioedema because ARBs do not increase bradykinin

15

Where does mannitol act in the nephron?

PCT

16

How is the chemical makeup of ethacrynic acid different from furosemide?

Ethacrynic acid is from phenoxyacetic acid whereas furosemide is from sulfonamides

17

Which diuretic has the most endocrine AE?

Spironolactone, can cause gynecomastia

18

What effect do ACE-I have on cardiac tissue in CHF?

Somehow prevent unfavorable remodeling of heart tissue

19

Which 2 diuretics may cause acidosis and why?

1) Carbonic anhdyrase inhibitors (Acetazolamide) because it increases secretion of HCO3 2) K sparing diuretics because it blocks aldosterones ability to secrete H, and the excess K is exchanged for H at the cellular level, further increasing the acidosis

21

What are the indications for K sparing diuretics?

Hyperaldosteronism, CHF, and K depletion

22

What are the indications for mannitol?

Decreasing an increase in intracranial pressure and for drug overdose

23

What is acetazolamide indicated for (5)?

Glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness (respiratory alkalosis), and pseudotumor cerebri

24

In whom is mannitol contraindicated?

Anuric patients and CHF

26

What is the MOA of thiazide diuretics?

Inhibit NaCl reabsorption by the distal tubule, this blocks the diluting capability of the nephron

27

Why do ACE inhibitors cause hyperkalemia?

Because there is no stimulation of aldosterone which would cause K secretion

29

Why do ACE inhibitors increase serum creatinine?

because they decrease the GFR

30

What are the adverse effects of mannitol?

pulmonary edema and dehydration

31

What is the MOA of mannitol?

An osmotic diuretic, it increases the osmolarity of the renal TUBULE, thereby increasing urine flow

32

Which renal drugs are highly teratogenic?

ACE inhibitors

33

Which diuretic is a phenoxyacetic acid derivative? Significance?

Ethacrynic acid? Other loop diuretics are from sulfa drugs, so ethacrynic acid can be given to a pt with sulf allergy

34

Which type of diuretic is most likely to lead to a cardiac arrhythmia and why?

K sparing diuretic because of the potential for hyperkalemia

35

What drug increases tubular fluid osmolarity thereby producing an increase in urine flow?

mannitol

36

Which diuretics can be used to treat nephrogenic diabetes insipidus?

thiazides

37

Which diuretics are best for osteoporotic patients?

Thiazides because increase calcium reabsorption

39

What are the plasma renin levels of a person on ACE-inhibitors?

increased due to loss of negative feedback

40

Where in the nephron is the increased calcium reaborption with thiazides taking place?

Paracellular route in LOH and PCT; HOWEVER, thiazides act on the DCT

41

Name 3 types of diuretics that can cause sulfa allergy

acetazolamide, hydrochlorothiazide, and loop diuretics (ethacrynic acid is safer)

42

What are the AE (6) of loop diuretics?

Ototoxicity, Hypokalemia, Dehydration, sulfa Allergy, interstitial Nephritis, Gout (OH DANG = mnemonic)

43

Which drugs can inhibit loop diuretics? Why?

NSAIDs; part of the effect of the loop diuretic involves the release of PGE to dilate afferent arteriole and increase GFR, NSAIDs would block that

44

In whom are ACE inhibitors contraindicated because they will precipitate renal failure?

Bilateral renal artery stenosis, as they will further decrease GFR