Renal - FA Pharm p593 - 596

Question 1

all diuretic will inc urine NaCl except for what?

Answer 1

acetazolamide

Question 2

urine K+ inc with what 2 types of diuretics?

Answer 2

loop, thiazide

Question 3

explain 3 mech how loop and thiazide cause alkalemia?

Answer 3

1. volume contraction: inc ATII –> inc Na+/H+ exchange in PCT –> in bicarb absorption (contraction alkalosis)
2. K+ loss leads to K+ exiting all cells (via H+/K+ exchanger) in exchange for H+ entering cells
3. in low K+ state, H+ (rather than K+) is exchanged for Na+ in cortical collecting tubule –> alkalosis and paradoxical aciduria

Question 4

which diuretics is the only one that leads to hypokalemic metabolic acidosis (not hypokalemic metabolic alkalosis)?

Answer 4

acetazolamide

Question 5

which diuretic can treat idiopathic intracranial HTN ?

What else can lead to this condition

Answer 5

acetazolamide,

vit A toxicity & Danazol

Question 6

name 6 toxicities of acetazolamide

Answer 6

• Proximal renal tubular acidosis,
• paresthesias,
• NH3 toxicity,
• sulfa allergy,
• hypokalemia.
• Promotes calcium phosphate stone formation

Question 7

name 6 toxicity of loop

Answer 7

• Ototoxicity,
• Hypokalemia,
• Hypomagnesemia,
• Dehydration,
• Allergy (sulfa),
• metabolic Alkalosis,
• Nephritis (interstitial),
• Gout

Question 8

what is ethacrynic acid?

Answer 8

phenoxyacetic acid derivative (not a sulfonamide)

Question 9

how does loop prevent the concentration of urine?

Answer 9

abolish hypertonicity of medulla

Question 10

name all the side effects of thiazide

Answer 10

• Hypokalemic metabolic alkalosis
• Hyponatremia
• hyperGlycemia
• hyperLipidemia
• hyperUricemia
• hyperCalcemia
• Sulfa allergy

Question 11

name 2 competitive aldosterone receptor antagonist

Answer 11

spironolactone, eplerenone

Question 12

name 2 other K+ sparing that block Na+ channel at the cortical collecting tubule

Answer 12

triamterene, amiloride

TriANterene ANiloride = NA channels

Question 13

name 3 thiazide

Answer 13

Hydrochlorothiazide, chlorthalidone, metolazone.

Question 14

name 3 loops

Answer 14

furosemide bumetanide torsemide

Question 15

name 4 SE// with ace inhibitors

Answer 15

1. cough 2. angioedema (contraindicated with C1 esterase inhibitor def) 3. teratogenic (fetal renal malformation) 4. bilateral renal artery stenosis

INC Creatinine, Inc K (hyperkal) , DEC BP (hypotension)

Question 16

why should you be careful using ACE inhibitors with NSAIDs?

Answer 16

ACE inhibitors lead to dilation of efferent arterioles by blocking ATII and NSAIDs lead to constricting afferent arterioles and both contribute to dec GFR and possibly renal failure

Question 17

what is the mech of angiotensin II receptor blockers and how are they diff from ACE inhibitors?

Answer 17

block angiotensin II to AT1 receptor, thus, effects similar to ACE inhibitors, but do not increase bradykinin –> thus no cough side effects

Question 18

what is Aliskiren and what is its contraindication?

Answer 18

direct renin inhibitor, contraindicated in diabetics taking ACE inhibitors or ARBs

Question 19

Why do loops increase creatinine in serum?

Answer 19

bc they dec RBF (Dec GFR)

Question 20

MOA of Loops?

Answer 20

Sulfonamide loop diuretics. Inhibit cotransport system (Na+/K+/2Cl−) of thick ascending limb of loop of Henle. Abolish hypertonicity of medulla, preventing concentration of urine. Stimulate PGE release (vasodilatory effect on afferent arteriole); inhibited by NSAIDs. INC Ca2+ excretion. Loops Lose Ca2+.

Question 21

Carbonic anhydrase inhibitors cause dec in what blood parameter

Answer 21

can lower total body HCO3 stores = INC HCO3 in urine

Question 22

Major side effect of Acetazolamide TOX?

Answer 22

metabolic acidosis (loss of HCO3) hypOkalemia renal stones (inc pH = struvite, Ca oxalate)

Question 23

TOX of Loops?

Answer 23

Reversible OTOtox, HypOkalemia interstitial nephritis Gout

Question 24

Diff b/w Ototox of ethacrynic acid and Loops?

Answer 24

Worse w. ethacrynic acid - irrev!!

Question 25

Which 3 Rx does Loops have rxns with?

Answer 25

Aminoglycosides - ototox inc Digoxin - The hypokalemia caused by loops can lead to digoxin tox NSAIDS - both can VCaff Sulfa allergy

Question 26

What to watch out for w/ Thiazides w/ Niacin/Gemfibrozil? with Lithium?

Answer 26

INC LDL With Lithium can inc toxicity of Li

Question 27

MOA of Thiazides?

Answer 27

Inhibit NaCl reabsorption in early DCT diluting capacity of nephron. dec Ca2+ excretion.

Question 28

Tox of K sparing diuretics

Answer 28

HYPER kalemia

Question 29

Which kidney issue can follow Amiloride use?

Answer 29

Nephrogenic DBI

Question 30

Diff of MOA in Spironolactone vs Triamterene?

Answer 30

Spironolactone and eplerenone are competitive aldosterone receptor antagonists in cortical collecting tubule. Triamterene and amiloride act at the same part of the tubule by blocking Na+ channels in the cortical collecting tubule.

Question 31

Urine Ca2+ changes w/ diuretics?

Answer 31

INC with loop diuretics: paracellular Ca2+ reabsorption hypocalcemia. DEC with thiazides: enhanced Ca2+ reabsorption.

Question 32

Angioedema seen as TOX for which renal rx?

Answer 32

Aliskiren, and ACEIs W. ACEIs - Bradykinin norm metabolized by ACE, local venoconstriction and VD of arterioles

Question 33

Kidney Toxic Rx?

Answer 33

* Aminoglycosides * Amphotericin B * Radio contrast dye * Heavy metals * Adefovir (Hep B rx)

Question 34

Rx that cause Urinary retention bc of cholinergic (-)'n?

Answer 34

TCAs - Amitriptyline, Imipramine Anti-psychotics - Chlorpromazine. Thioridazine Anti-histamines - Diphenhydramine Atropine Opiates Sympathomimetics - bc inc tone of int urethral sphincter