Renal Drugs

Question 1

MOA of mannitol

Answer 1

osmotic diuresis

Question 2

uses of mannitol

Answer 2

drug overdose
increased ICP
increased IOP

Question 3

toxicity of mannitol

Answer 3

pulmonary oedema
dehydration
contraindicated in HF and anuria

Question 4

MOA of acetazolamide

Answer 4

inhibits carbonic anhydrase in the PCT

results in self limited NaHCO3 diuresis and decreased total body HCO3- stores.

Question 5

clinical used of acetazolamide

Answer 5

glaucoma
urinary alkalinisation
metabolic alkalosis
altitude sickness
pseudotumor cerebri (chronic vitamin A use)

Question 6

toxicity of acetazolamide

Answer 6

hyperchloremic metabolic acidosis ACIDazolamide causes Acidosis
paresthesias
NH3 toxicity
sulfa allergy

Question 7

list the sulfa drugs

Answer 7

probenecid
furosemide
thiazides
acetazolamide
sulfa abs
sulfonylureas
sulfasalazine
celecoxib

Question 8

list the loops diuretics

Answer 8

furosemide
bumetanide
torsemide

Question 9

MOA of loops

Answer 9

inhibit the NaK2Cl in the thick ascending loop of henle – no hypertonicity in the medulla – no concentration of urine
stimulates PGE release - vasodilation of the afferent arterioles (can inhibit with NSAIDs)
Ca excretion
LOOPS LOSE CALCIUM

Question 10

clinical use of loops

Answer 10

edematous states - HG, irrhosis, nephrotic syndrome, pulmonary yoedema
hypertension
hypercalcemia

Question 11

toxicity of loops

Answer 11

OH DANG
ototoxicity
hyperkalemia
dehydration
allergy (sulfa)
nephritis (interstitial)
glout (hyperuricemia)

Question 12

why would you use ethacrynic acid

Answer 12

for diuress in patients allergic to sulfa drugs (furosemide, acetazolamide, thiazides)

Question 13

MOA of ethacrynic acid please

Answer 13

pheonoxyacetic acid derivative with same MOA of forusemide (NaK2Cl blocker)

Question 14

toxicitiy of ethacrynic acid please

Answer 14

similar to furosemide OH DANG: ototoxicity, hyperkalemia, dehydration, neprhritis, gout`

Question 15

list the thiazide diurectic please

Answer 15

chlorthalidone

hhydrochlorothiazide

Question 16

MOA of thiazides

Answer 16

inhibits NaCl reabsorption in early DCT – decreases diluting ability
decreased Ca excretion

Question 17

clinical use fo thiazides

Answer 17

hypertenision
HF
idiopathic hypercalciuria
nephrogenic diabtes insipidus
osteoporosis
calcium stones

Question 18

toxicity of thiazides

Answer 18

HyperGLUC
hypokalemic metabolic alkalosis
hyponatremia
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia

Question 19

list the K sparing diuretics

Answer 19

spironolactone, eplerenone

triamterene, amiloride

Question 20

MOA of spironolactone and eplerenone

Answer 20

competitive aldoster recetpro antagos in the cortical collecring tubule

Question 21

MOA of triamterene and amiloride

Answer 21

inhibt ENaC in the cortical collecting tubule

Question 22

cx use of k sparign diuretics

Answer 22

hyperaldosternosim
K depletion
HF

Question 23

toxo of K sparing diuretics

Answer 23

hyperkalaemia - arrhythmias

spironolactone - anti androgenic - gynecomastia

Question 24

which diuretics increased urine NaCl

Answer 24

all but acetazolamide

serum NaCl may decrease as a result

Question 25

which diuretics increased urine K

Answer 25

loops and thiazides | may descreased serum K as a result

Question 26

which diuretics cause acidemia

Answer 26

carbonic anhydrase inhibitos | K sparing

Question 27

which diuretics cause alkalemia

Answer 27

loops | thiazides

Question 28

describe how carbonic anhydrase inhibitors cause acidemia

Answer 28

decreased HCO3 reabsorption

Question 29

describe how K sparers caused acidemia

Answer 29

aldoseterone blockade prevents K secretion and H secrtion | increased K results in H out

Question 30

describe how loops and thiazides cause alkalemia

Answer 30

volume contraction -- increasd AngII -- increased Na/H exchange and icnreasd HCO3 reabsorption CONTRACTION ALKALOSIS K loss leads to exchange out K out for H in to cells low K states, H si exchangd for Na in the corical collecting tubules -- paradoxical aciduria

Question 31

what diuretics cause increased urine ca

Answer 31

loops - decreasd paracellular ca reabsorption -- hypocalcemia

Question 32

which diuretcics caus decreasd urine ca

Answer 32

thiazides - enhanced Ca reabsorption in DCT

Question 33

list the ACEi

Answer 33

captopril enalapril lisinopril ramipril

Question 34

MOA of ACEi

Answer 34

inhibit ACE -- decreased ANng II -- decreased GFR by prevention of constriction of efferent arterioles icnreasd renin due to loss fo negative inhibition prevents inacativation of bradykinin -- vasodilation

Question 35

cx of ACEi

Answer 35

hypertension HF proteinuria diabetic nephropathy

Question 36

why are ACEi good in chronic hypertension

Answer 36

prevent unfavourable remodelling of heart

Question 37

why are ACEi good in diabetes?

Answer 37

decreased intraglomerular pressure - slows GBM thickenign

Question 38

toxo of ACEi?

Answer 38

Captoprils CATCHH Cough Angioedema - don't use with C1 esterase deficiency Teratogen - fetal kidney abnormalities Creatinine serum increased - decrease GFR hyperkalemia hypotencion

Question 39

list the Ang II receptor blockers/ARBs

Answer 39

losartan candesartan valsartan

Question 40

MOA of ARBs

Answer 40

selectively block binding of ant II to AT1 receptor | similar to ACEi but don't prevent breakdown of bradykinine

Question 41

use of ARBs?

Answer 41

``` hypertension HF proteinuria diabetic nephropathy when ACEi aren't good (cough angioedema) ```

Question 42

a/se of ARBS

Answer 42

``` similar to ACEi (CATCHH) teratogen increasd creatinine hyperkalemia hypotension ```