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Flashcards in Renal Drugs Deck (35):
1

What is mannitol?

Osmotic diuretic
Causes increased tubular osmolarity resulting increased sodium and water excretion

2

What is mannitol used for?

To decrease intracranial pressure
To decrease intraocular pressure
To counteract drug overdose

3

What is the toxicity of mannitol?

Pulmonary edema
Dehydration

4

What is mannitol contraindicated in?

Anuria
CHF

5

What is acetazolamide?

Carbonic anhydrase inhibitor
Causes NaHCO3 excretion and reduces total body stores of Hco3

6

What is acetazolamide used for?

Glaucoma
Urinary alkalinization
Metabolic alkalosis
Altitude sickness
Pseudotumor cerebri

7

What is side effect of acetazolamide?

Hypercholesterolemic metabolic acidosis
Paresthesias
NH3 toxicity
Sulfa allergy
('ACID'azolamide causes Acidosis)

8

What do loop diuretics (Furosemide) do?

Inhibits co transport in thick ascending limb loop (Na, K, 2 Cl)
Abolishes hypertonicity in the medulla preventing water from moving out into the interstitium and thereby concentrating the urine.
Stimulates PGE release dilating the afferent arteriole
Increases Ca excretion

9

What are the loops (furosemide) useful for?

Edematous states - CHF, cirrhosis, nephrotic syndrome, pulmonary edema
HTN
Hypercalcemia

10

What is the toxicity of loops (furosemide)?

OH DANG
Ototoxicity
Hypokalemia
Dehydration
Allergy (sulfa drug)
Nephritis (interstitial)
Gout

11

What is ethacrynic acid used for?

Patients who need a loop who are allergic to sulfonamides.
Same mech and side effects as a loop
(Phenoxyacetic acid derivative-- not sulfonamide derivative)

12

What is the MOA of thiazides?

Inhibits NaCl reabsorption in early distal tubule
Decreases calcium excretion

13

What are thiazides used for?

HTN
CHF
Idiopathic hypecalciuria
Nephrogenic diabetes insipidus (reduces diluting capacity of the nephron)

14

What are the side effects of thiazides?

Hypokalemic metabolic alkalosis
Hyponatremia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Hypercalcemia
Sulfa allergy
(HyperGLUC)

15

What do Spironolactone & Eplerenone (K sparing diuretics) do?

Competitively inhibit aldosterone at the cortical collecting tubule

16

How do amiloride and triamterene work?

Block Na channels at cortical collecting tubule
They are also K sparing

17

What are K sparing diuretics used for?

Hyperaldosteronism
K depletion
CHF

18

What is the toxicity of K sparing diuretics?

Hyperkalemia --> arrhythmia (prolongs phase 3)
Gynecomastia & Anti-antrogen endocrine effects (Spironolactone)
Acidemia (Spironolactone & Eplerenone)

19

What is the treatment for recurrent Calcium stones?

Thiazides
Citrate
Fluid intake

20

What is the treatment for Uric Acid Stones?

Alkalinization of the urine
fluid intake

21

How do you treat Cystine stones?

Alkalinization of the urine
fluid intake

22

What are the side effects of Ethacrynic Acid?

OHDNG (same as Loop except sulfa allergy)
Hyperuricemia-- CONTRA with gout

23

Which Diuretics cause Acidemia?

Carbonic Anhydrase Inhibitors
K+ Sparing inhibitors (Aldosterone R antags)

24

Which Diuretics cause Alkalemia?

Thiazides
Loops

25

Which Diuretics cause hypocalcemia?

Loops (dec paracellular Ca resorption)

26

Which diuretics ause hypercalcemia?

Thiazides (inc paracellular Ca resorption)

27

What are the common ACE-I's?

Captopril
Enalapril
Lisinopril

28

What is the MOA of ACE-I?

Inhibits ACE (angiotensin-converting enzyme) = decrease Ang II = dec GFR (prevents constriction of efferent arterioles)
Lose feedback inhibition = increase renin levels
Prevents bradykinin inactivation = keeps active = potent vasodilator

29

What are ACE-Is used for?

Hypertension (prevent unfavorable cardiac remodeling)
CHF
Diabetic renal dz
Proteinuria

30

What is the toxicity of ACE-I?

Cough
Angioedema
Teratogen (fetal renal malformations)
Creatinine increase (d/t dec GFR)
Hyperkalemia
Hypotension

(CATCHH)

31

What is ACE-I contraindicated in?

B/L renal artery stenosis
(further decrease GFR --> Renal failure)

32

What does ethylene glycol cause?

Hematocrit
Oliguria
Back pain due to calcium oxalate crystals

33

What are the drugs that can cause hyperkalemia?

Nonselective beta blockers
ACEi
ARBs
K sparing diuretics
Cardiac glycosides
NSAIDs

34

How do NSAIDs cause hyperkalemia?

Impaired local prostaglandin synthesis reduces renin and aldosterone secretion

35

What condition are ACEi contraindicated in?

Bilateral renal artery stenosis because can cause ARF due to decreased GFR from efferent arteriole dilation