Renal drugs

Question 1

Acetazolamide (Diamox)

Answer 1

Proximal Tubule: Carbonic Anhydrase Inhibitor

Question 2

Furosemide (Laxis)

Answer 2

Loop diuretic “high ceiling” (Loop of hence-thick ascending limb)

Question 3

Bumeanide (Bumex)

Answer 3

Loop diuretic “high ceiling” (Loop of hence-thick ascending limb)

Question 4

Ethacrynic Acid (Edacrin)

Answer 4

Loop diuretic “high ceiling” (Loop of hence-thick ascending limb)

Question 5

Acetazolamid (Diamox)

Actions:

Answer 5

• decrease NaHCO3 reabsorption
• decrease H2O reabsorption
• metabolic acidosis

Question 6

Acetazolamid (Diamox)

Clinical uses:

Answer 6

• acute mountain sickness
• metabolic alkalosis
• glaucoma
• urinary alkalizations

Question 7

Acetazolamid (Diamox)

Toxicities:

Answer 7

• hyperchloremic metabolic acidosis
• renal stones
• renal potassium wasting
• drowsiness/paresthesia

Question 8

Acetazolamid (Diamox)

Contraindications:

Answer 8

• hepatic cirrhosis

- sulfa allergies

Question 9

Loop Diuretics Actions:

Answer 9

• inhibit the Na+/K+/2Cl- cotransporter in the thick ascending limb
• reduce NaCl, K+ and divalent cations (Ca2+ and Mg2+) reabsorption
• increase renal blood flow
• rapid response after I.V. administration
• duration of action dependent upon renal function

Question 10

Loop Diuretics Clinical Uses:

Answer 10

• edematous conditions
• acute pulmonary edema
• acute hypercalcemia
• hyperkalemia
• acute renal failure
• anion overdose

Question 11

Loop Diuretics toxicities

Answer 11

• dehydration
• hypokalemic metabolic alkalosis
• ototoxicity
• hyperuricemia
• hypomagnesemia

Question 12

Loop diuretics contraindications:

Answer 12

sulfa allergy

Question 13

Thiazides act

Answer 13

distal convoluted tubule: Na+ Cl- symport inhibitors

Question 14

chlorthalidone (Hygroton)

Answer 14

thiazide like

Question 15

indapamide (Lozol)

Answer 15

thiazide like

Question 16

metolazone (Diulo, Zaroxolyn)

Answer 16

thiazide like

Question 17

thiazide actions:

Answer 17

• inhibit the NaCl
• reabsorption in the distal convoluted tubule
• enhance Ca2+ reabsorption

Question 18

thiazide clinical uses:

Answer 18

• hypertension
• congestive heart failure
• nephrolithiasis due to idiopathic hypercalciuria
• nephrogenic diabetes inspidus

Question 19

thiazide toxicities:

Answer 19

• hypokalemic metabolic alkalosis and hyperuricemia
• impaired carbohydrate
• hyperlipidemia
• hyponatremia

Question 20

thiazide contraindications:

Answer 20

sulfa allergies

Question 21

Amiloride (Midamor) act

Answer 21

diuretics that act in the collecting tubule: Na+ channel inhibitors

Question 22

Amiloride (Midamor) actions:

Answer 22

• inhibit the Na+ channels in the apical membrane of the collecting tubule
• reduce Na+ entry into these cells also reduces K+ excertion (K+ sparing)

Question 23

Amiloride (Midamor) clinical uses:

Answer 23

-adjunctive treatment with thiazide or loop diuretic in CHF or hypertension

Question 24

Amiloride (Midamor) toxicities:

Answer 24

• hyperkalemia

- hperchloremic metabolic acidosis

Question 25

Amiloride (Midamor) contraindications:

Answer 25

- K+ supplements | - ACE inhibitors (cause retention of K+)

Question 26

Triamterene (Dyrenium) actions:

Answer 26

- inhibit the Na+ channels in the apical membrane of the collecting tubule - reduce Na+ entry into these cells also reduces K+ excretion (K+sparing)

Question 27

Triamterene (Dyrenium) clinical uses:

Answer 27

-edema associated with CHF, nematic cirrhosis, nephrotic syndrome, or hyperaldosteronism

Question 28

Triamterene (Dyrenium) toxicities:

Answer 28

- hyperkalemia | - hyperchloremic metabolic acidosis

Question 29

Triamterene (Dyrenium) contraindications:

Answer 29

- kidney stones | - K+ supplements, ACE inhibitors

Question 30

Spironlactone (Aldactone) actions:

Answer 30

- block actions of aldosteron | - inhibition of 5alpha-reductace

Question 31

Spironlactone (Aldactone) clinical uses:

Answer 31

- hypertension or CHF w/other diuretics - mineralcorticoid excess - aldosteronism (primary or secondary resulting from CHF, hepatic cirrhosis or nephrotic syndrome)

Question 32

Spironlactone (Aldactone) toxicities:

Answer 32

- hyperkalemia - hyperchloremic metabolic acidosis - gynecomastia - impotence - BPH

Question 33

Spironlactone (Aldactone) contraindications:

Answer 33

- supplements, ACE inhibitors | - chronic renal insufficiency

Question 34

Eplerenone (Inspra) actions:

Answer 34

-selective antagonisms of mineralcorticoid receptor in kidnye, heart, blood vessels, and brain

Question 35

Eplerenone (Inspra) clinical uses:

Answer 35

- hypertension, alone or in combination | - full therapeutic effect should be observed within 4 weeks

Question 36

Eplerenone (Inspra) toxicities and adverse reactions:

Answer 36

- hyperkalemia | - hypertriglyceridemia

Question 37

Eplerenone (Inspra) contraindications:

Answer 37

- K+ supplements, K+ sparing diuretics, ACE inhibitors - chronic renal insufficiency - diabetes associated with microalbuminuria - CYP450 3A4 inhibitors (e.g. ketoconazole)

Question 38

Manitol actions:

Answer 38

- excreted, but not reabsorbed from the lumenal fluid (urine) - creates osmotic resistance that limits water reabsorption in the proximal tubule and descending limb of the loop of hence - natriuresis

Question 39

Manitol indications:

Answer 39

- to increase urine volume | - reduction of intracranial or intraocular pressure

Question 40

Manitol toxicity:

Answer 40

- extracellular volume expansion | - dehydration and hypernatremia

Question 41

Demeclocycline (Declomycin) actions:

Answer 41

- tetracycline derivative - inhibit the effects of ADH at the collecting tubule - reduce water reabsorption - lithium salts have a similar effect

Question 42

Demeclocycline (Declomycin) indications:

Answer 42

- syndrome of inappropriate ADH secretions (SIADH) | - elevated ADH

Question 43

Demeclocycline (Declomycin) toxicity:

Answer 43

- nephrogenic diabetes insipidus | - renal failure

Question 44

CA inhibitor structure: Cl-, Br-, CF3-, or NO2-

Answer 44

maximal diuretic activity (upper left or ring structure)

Question 45

substitution with amine (-NH2) structure activity

Answer 45

increases natriuretic activity, but decrease CA inhibitor activity (upper right of ring structure)

Question 46

H2NO2S structure activity (lower left)

Answer 46

unsubstituted sulfamoyl moiety required for activity

Question 47

SO2NH2 structure activity (lower right)

Answer 47

can be replaced with electrophilic group (carboxyl, carbamoyl, etc.) increases diuretic activity and decreases CA inhibitory activity