Renal drugs

Question 1

mannitol mechanism

Answer 1

osmotic diuretic, increases tubular fluid osmolality producing increased urine flow

Question 2

mannitol site of action

Answer 2

mainly proximal convoluted tubule but also thin descending limb and medullary collecting duct

Question 3

mannitol use

Answer 3

increased intracranial pressure, shock, drug overdose

Question 4

mannitol toxicity

Answer 4

pulmonary edema, dehydration; contraindicated in anuria and CHF

Question 5

acetazolamide mechanism

Answer 5

carbonic anhydrase inhibitor; causes self-limited NaHCO3 diuresis and reduction in total body bicarb stores

Question 6

acetazolamide site of action

Answer 6

proximal convoluted tubule

Question 7

acetazolamide use

Answer 7

glaucoma, alkalinization of urine, metabolic alkalosis, altitude sickness

Question 8

acetazolamide toxicity

Answer 8

hypercholremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy

Question 9

furosemide mechanism

Answer 9

sulfonamide diuretic; inhibits Na/K/2Cl pump ; abolishes hypertonicity of medulla, preventing urine concentration

Question 10

furosemide site of action

Answer 10

loop of Henle, particularly thin ascending loop

Question 11

furosemide use

Answer 11

edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, hyperkalemia

Question 12

furosemide toxicity

Answer 12

ototoxicity, hypokalemia, dehydration, sulfa allergy, interstitial nephritis, gout, increase serum creatinine

Question 13

ethacrynic acid mechanism

Answer 13

phenoxyacetic acid derivative; inhibits Na/K/2Cl pump ; abolishes hypertonicity of medulla, preventing urine concentration

Question 14

ethacrynic acid site of action

Answer 14

loop of Henle

Question 15

ethacrynic acid use

Answer 15

diuresis in patients allergic to sulfa drugs or in patients with gout/hyperuricemia (since it is a furosemide toxicity)

Question 16

ethacrynic acid toxicity

Answer 16

ototoxicity, hypokalemia, dehydration, sulfa allergy, interstitial nephritis, increase serum creatinine

Question 17

hydrochlorothiazide mechanism

Answer 17

inhibits NaCl transporter, reducing diluting capacity of early distal tubule; decreases Ca excretion

Question 18

hydrocholorthiazide site of action

Answer 18

distal convoluted tubule

Question 19

hydrochlorothiazide use

Answer 19

Ca oxalate stones, hypertension, CHF, nephrogenic DI

Question 20

hydrochlorothiazide toxicity

Answer 20

hypokalemic metabolic acidosis, hyponatremia and hypotension/hypovolemia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia; sulfa allergy

Question 21

spironolactone mechanism

Answer 21

competitive aldosterone receptor antagonist

Question 22

eplerenone mechanism

Answer 22

competitive aldosterone receptor antagonist

Question 23

triamterene mechanism

Answer 23

block Na channels

Question 24

amiloride mechanism

Answer 24

block Na channels

Question 25

spironolactone site of action

Answer 25

distal convoluted tubule

Question 26

eplerenone site of action

Answer 26

distal convoluted tubule

Question 27

triamterene site of action

Answer 27

distal convoluted tubule

Question 28

amiloride site of action

Answer 28

distal convoluted tubule

Question 29

K-sparing diuretics

Answer 29

spironolactone, eplerenone, triamterene, amiloridie

Question 30

K-sparing diuretic use

Answer 30

spironolactone and elperenone: hyperaldosteronism; mild diuretic effects but decrease ventricular remodeling in CHF and reduce morbidity and mortality

Question 31

amiloride toxicity

Answer 31

hyperkalemia

Question 32

triamterene toxicity

Answer 32

hyperkalemia

Question 33

spironolactone toxicity

Answer 33

hyperkalemia, gynecomastia

Question 34

eplerenone toxicity

Answer 34

hyperkalemia, endocrine effects?

Question 35

ACE inhibitors

Answer 35

lisinopril, captopril, enalapril

Question 36

ACE inhibitior mechanism

Answer 36

inhibit angiotensin converting enzyme, reducing levels of angiotensin II and preventing inactivation of bradykinin, a potent vasodilator; renin release increased from loss of negative feedback

Question 37

ACE inhibitor use

Answer 37

hypertension, CHF, diabetic renal disease

Question 38

ACE inhibitor toxicity

Answer 38

cough, angioedema, proteinuria, taste changes, hypotension, teratogen (fetal renal damage), increased renin, rash, hyperkalemia, increased renin, lower angiotensin II; first dose hypotension