Renal/ GU Pharm

Question 1

What do loop diuretics target?

Give examples

Answer 1

-They target the thick ascending limb to block Na reabsorption (more delivered distally downstream)
-Blocked channel = Na-K-2Cl tri-porter
-More Na reabsorption in the CD = more K lost

-Furosemide, Torsemide, Bumetanide
-Potent meds
-SEs = hypokalemia, Low Mg, hypercalciuria, low vol
-Furosemide = ototoxicity
-Should not be used with NSAIDs

Question 2

What do Thiazide diuretics target?

Give examples

Answer 2

-Working at the DCT, the Na-Cl channel
-Blocking Na resorption & more delivered to CD

-Chlorothiazide, Hydrochlorothiazide, Chlorthalidone
-SEs = hypokalemia, hypocalciuria (can be used for calcium oxalate stones), pancreatitis, Hyperuricemia (gout)

Question 3

What do Aldosterone antagonists target?

Give examples (steroid based)

Answer 3

-Potassium-sparing diuretics
-Targeting the CD and blocking the effects of aldosterone or the synthesis of ENaC channels = less Na resorption

-Spironolactone, Eplerenone

-SEs = Hyperkalemia, hyponatremia
-Decline in GFR
-Spironolactone = gynecomastia, breast tenderness & impotence in men, amenorrhea in women, etc.

-SJS, metabolic acidosis, SLE
-Upper GI effects

Question 4

What are the other non-steroid K-sparing diuretics?

Answer 4

-Still working at the CD
-Inhibition of Na reabsorption = increased Na excretion
-inhibiting K & H excretion (K sparing)
-Inhibiting the action of Aldo at the mineralcorticoid receptor = preventing synthesis of new Na channels in principal cells

-Triamterene, Amiloride

-SEs:
-Hyperkalemia if used alone
-Metabolic acidosis
-Nephrotoxicity (triamterene)
-Electrolyte imbalance
-HA

Question 5

What do carbonic anhydrase inhibitors target?

Answer 5

-The PCT & blocking H formation = Less Na resorption
-Alkalinization of the urine = promotes the reabsorption of ammonia

-Acetazolamide, Dorzolamide

• Prophylaxis for altitude sickness, Glaucoma, Pseudotumor cerebri, Cystinuria recurrent renal stones (alkalinizes the urine)

-SEs = Metabolic acidosis because H cannot escape

Question 6

What do Osmotic diuretics target?

Answer 6

-The PCT
-Draws water out of cells & into bloodstream = decreased blood viscosity & increased renal blood flow = increased water excretion with relatively less effect on Na
-Urine volume increases = pt becomes volume depleted

-Mannitol
-Increased intracranial pressure, glaucoma, etc.

-SEs = pulmonary edema, hyperkalemia, etc.

Question 7

What is Flutamide?

Answer 7

-Competitive testosterone receptor inhibitor
-Used for prostate cancer