Renal Drugs

Question 1

Acetazolamide

Answer 1

M: CAI. Less Na/H antiport. Inc. Na/HCO3 excretion.
Use: Glaucoma, Mt. Sickness
SE: hypokalemia, acidosis (less HCO3 to buffer)
OSE: Hepatic encephalopathy (CI in cirrhotic pts), depression, skin tox, allergic reactions

Question 2

Methazolamide

Answer 2

M: CAI. Less Na/H antiport. Inc. Na/HCO3 excretion.
Use: Glaucoma, Mt. Sickness
SE: hypokalemia, acidosis (less HCO3 to buffer)
OSE: Hepatic encephalopathy (CI in cirrhotic pts), depression, skin tox, allergic reactions

Question 3

Dichlorphenamide

Answer 3

M: CAI. Less Na/H antiport. Inc. Na/HCO3 excretion.
Use: Glaucoma, Mt. Sickness
SE: hypokalemia, acidosis (less HCO3 to buffer)
OSE: Hepatic encephalopathy (CI in cirrhotic pts), depression, skin tox, allergic reactions

Question 4

Mannitol, Glucose, Urea, Isorbide

Answer 4

M: Osmotic diuretic. Inc tubular osmolarity
Use: Inc drug clearance, minimize renal failure, dec intraocular/cranial pressure, diagnose oliguria (little pee)
SE: pulmonary edema
O: think diabetics, lots of glucose, lots of pee

Question 5

Loop Diuretic Mechanism and uses

Answer 5

M: Loop. Inhibits Na/2Cl/K. Dec lumen positivity. Dec reabsoprtion of Na, Cl, K, Ca, Mg.
Use: DOC crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug OD, sever hypertension in setting of CHF/cirrhosis.

Question 6

Loop Diuretic SE

Answer 6

Hypokalemia/natremia/calcemia/magnesia (–> QT syndrome arrhythmia), alkalosis, Inc BUN/Cr, ototoxicity (esp ethacrynic acid).
Hyperuricemia (gout)/glycemia/lipidemia, nephrocalcinosis, photosensitivity, erectile dysfunction. Drug interactions (digoxin).

Question 7

Loops (4)

Answer 7

Furosemide, Bumetanide, Torsemide, Ethacrynic acid (sulfa-safe).

Question 8

Loops: eventual effect

Answer 8

FENa = 25%. Leads to eventual PT reabsorption They are vasoldilators via PGs (avoid NSAIDS!!). Low salt diet. Useful in renal insufficiency (GFR < 30-40).

Question 9

Thiazide Mechanism

Answer 9

M: Inhibit Cl portion of Na/Cl co transport. Dec Na reabsorption. Hypokalemia, alkalosis. Dec intracellular Na drives Na/Ca antiport on basolateral side –> Hypercalcemia!!

Question 10

Thiazide Use

Answer 10

HTN (intravascular contraction)
Chronic edema (cardiac insufficiency)
Stones (idiopathic hypercalcuria)
Nephrogenic diabetes insipidus

Question 11

Thiazide SE

Answer 11

Hypokalemia, -natremia, -magnesia
Hyperglycemia, -lipidemia (not indapimide), -uricemia (gout), -calcemia.
Alkalosis, Inc BUN, Cr, photosensitivity, impotence, drug inxns.

Question 12

Thiazide Extra

Answer 12

Lethal intxn with Quinidine.
Avoid NSAIDS
Inc risk of hypokalemia w/ anti-inflamm/Amph B
Dec positive free water clearance

Question 13

Thiazides (6)

Answer 13

Chlorothiazide, Hydrochlorothiazide, Chlorthalidone(also red stroke risk, CHF events), Quinethazone, Metolazone, Indapamide (no hyperlipidemia).