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Flashcards in Renal Drugs Deck (14):
1

mannitol mechanism, clinical use and toxicity

- mech: osmotic diuretic, inc urine flow and decreases intracranial/intraocular pressure
- used in drug overdose or inc ICP/ocular pressure
- tox: pulmonary edema, dehydration, hypernatremia. contraindicated in anuria, CHF.

2

acetazolamide mechanism, clinical use and toxicity

- mech: carbonic anhydrase inhibitor, causes self-limited NaHCO3 diuresis and decreased bicarb stores
- clinical use: glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri
- tox: hyperchloremic met acidosis, paresthesias, NH3 tox, sulfa allergy, hypokalemia

3

furosemide mechanism

- sulfonamide loop diuretic
- inhibits Na/K/Cl transport of thick ascending loop
- abolishes hypertonicity of the medulla, preventing concentration of urine.
- stimulates PGE release (vasodilate afferent), inhibited by NSAIDs.
- inc Ca excretion

4

furosemide clinical use and toxicity

- used in edematous states (CHF, cicrrhosis, nephrotic syndrome, pulmonary edema), HTN and hypercalcemia
- tox: OH DANG!
- ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis (interstitial), gout
- also metabolic alkalosis, hypocalcemia and hypomag

5

ethacrynic acid

- phenoxyacetic acid derivative (not a sulfonamide) with the same action as furosemide
- clinical use: diuresis in sulfa-allergic pts
- tox: similar to furosemide, can cause hyperuricemia so dont give to people with gout

6

HCTZ

- mech: thiazide diuretic, inhibits NaCl reabsorption in early distal tubule, dec diluting capacity of nephron and dec Ca excretion
- clinical use: HTN, CHF, idiopathic hypercalciuria, nephrogenic DI, osteoporosis
- tox: HyperGLUC (glycemia, lipidemia, uricemia, calcemia), hypokalemia, hypotension. sulfa allergy

7

K+ sparing diuretics (names)

- spironolactne and eplerenone, triamterene, amiloride

8

spironolactone and eplerenone mechanism

- inhibits apical ENaC channel and basolateral Na/K ATPase pump in cortical collecting tubules
- competitive aldosterone receptor antagonists

9

triamterene and amiloride mechanism

- inhibit apical ENaC channel in cortical collecting duct

10

K sparing diuretics clinical use and tox

- use: hyperaldo, K depletion, CHF
- tox: hyperkalemia
- spironolactone has endocrine effects because it is structurally similar to steroids (gynecomastia, antiandrogen effects)
** can be used for idiopathic hirsuitism

11

diuretics that cause acidemia

- carbonic anhydrase inhibitors and spironolactone/eplenorone

12

diuretics that cause alkalemia

loop diuretics and thiazides
- 2/2 contraction and K loss (K shifts out of cells in exchange of H, and prox tubule starts more Na/H exchange instead of Na/K - "paradoxical aciduria")

13

diuretic effects on urine Ca

- increases with loop diuretics
- decreases with thiazides

14

ACE inhibitors

- dec Ang II and prevents inactivation of bradykinin (vasodilator)
- used in HTN, CHF, proteinuria, diabetic nephropathy. prevent unfavorable heart remodeling as a result of chronic HTN
- tox: CATCHH - cough, angioedema, teratogen, inc creatinine, hyperkalemia and hypotension
- avoid in bilateral RAS, can further decrease GFR and lead to renal failure