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Flashcards in Renal Pharm from FA Deck (40):
1

Mannitol

Mechanism?

Osmotic diuretic

Incr tubular fluid osmolarity producing increased urine flow

decreases intracranial/ontraocular pressure

2

Mannitol

Clinical Use?

Drug OD

increased intracranial or intraocular pressure

3

Mannitol

Tox?

Pulmonary edema

Dehydration

Contraindicated in anuria, CHF

4

Acetazolamide

Mechanism?

Carbonic anhydrase inhibitor

Cuases self-limited NaHCO3 diuresis and decreased total-body HCO3- stores

5

Acetazolamide

Clinical Use?

-Glaucoma

-Urinary alkalization

-Metabolic alkalosis

-Altitude sickness

-Pseudotumor cerebri (hydrocephalus, occurs w young obese women, decreased CSF outflow at arachnoid villi)

6

Acetazolamide

Tox?

Hypercloremic metabolic acidosis

Paresthesias

NH3 toxicity

Sulfa allergies

7

Acetazolamide

site of action?

Prox convoluted tubule

8

Mannitol

site of action?

Descending tubule

9

Loop Diuretics: name 2

-Furosemide

-Ethacrynic acid

10

Furosemide

site of action?

Loop - thick ascending limb

11

Ethacrynic acid

site of action?

Loop - thick ascending limb

12

Furosemide

Mech?

effect on Ca excretion?

Sulfonamide loop diuretic

Inhibits cotransport system (Na/K/2Cl) of thick ascending limb of LOH

abolishes hypertonicity of medulla, preventing concentration of urine.

Stimulates PGE release (vasodilatory effect on afferent arteriole) 

Increases Ca excretion

"Loops Lose calcium"

13

Furosemide

what inhibits it?

NSAIDs

14

Furosemide

Use?

-Edematous states (CHF, cirrhosis, nephrotic syndrome, pulm edema)

-Hypertension

-Hypercalcemia

 

15

Furosemide

Tox?

Ototoxicity

Hypokalemia

Dehydration

Allergy (sulfa)

Nephritis (interstitial)

Gout

"OH DANG"

16

Ethacrynic Acid

Mech?

effect on Ca excretion?

Phenoxyacetic acid derivative (NOT a sulfanamide!)

Same action as Furosemide (inhibits cotransport (Na/K/2Cl).

-> Prevents urine concentration.

Increases Ca excretion

"Loops Lose Ca"

17

Ethacrynic Acid

Use?

Diuresis in patients allergic to sulfa drugs

18

Ethacrynic Acid

Tox?

similar to Furosemide (OH DANG)

Can cause hyperuricemia

Never use to treat gout

19

Thiazides

site of action?

Distal convoluted tubule

20

Hydrochlorothiazide

Mech?

Effect on Ca excretion?

Thiazide diuretic

Inhibts NaCl reabsorption in early distal tubule, decreasing the diluting capacity of the nephron.

Decreases Ca excretion (Ca-sparing)

21

Hydrochlorothiazide

Use?

HTN

CHF

Idiopathic hypercalciuria

nephrogenic diabetes insipidus

osteoporosis

22

Hydrochlorothiazide

Tox?

Hypokalemic metabolic alkalosis

Hyponatremia

HyperGlycemia

HyperLipidemia

HyperUricemia

HyperCalcemia

Sulfa drug -> allergies

"HyperGLUC"

23

K+ sparing diuretics

Name 4

Spironolactone (& Eplerenone)

Triamterene

Amiloride

"The K+ STAyEs"

24

K+ sparing diuretics/Spironolactone and Eplerenone

Mech?

Site of action?

Competitive aldosterone receptor antagonists

Cortical collecting tubule

25

K+ sparing diuretics/Trimterene, Amiloride

Mech?

Site of action?

Cortical collecting tubule

Block Na+ channels

26

K+ sparing diuretics

Use?

Hyperaldosteronism

K+ depletion

CHF

27

K+ sparing diuretics

Tox?

Hyperkalemia (can lead to arrhythmias)

Spironolactone: Endocrine effects (gynecomastia, andiandrogen)

28

Diuretics in general

Effect on Urine NaCl?

All increase Urine NaCl except Acetazolamide

Serum NaCl may decrease as a result.

29

Diuretics in general

Effect on Urine K?

Loop and Thiazide diuretics: Urine K increases

Serum K may decrease

30

Loop diuretics: effect on Urine Ca2+?

Urine Ca2+ increases with Loop Diuretics

Mech: decreased paracellular Ca2+ absorption -> hypocalcemia

31

Thiazide diuretics: effect on Urine Ca2+?

Urine Ca2+ decreases with Thiazides

Mech: enhanced paracellular Ca2+ reabsorbtion in the distal tubule

32

Which diuretics cause acidemia? mech?

Carbonic anhydrase inhibitors (acetazolamide)

Mech: decreases HCO3- absorption. 

-> K+ sparing aldosterone blockade prevents K+ secretion and H+ secretion. 

-> Hyperkalemia leads to K+ entering all cells (via H/K exchanger) in exchange for H+ exiting cells

33

What diuretics cause alkalemia?

mech?

Loop diuretics and thiazides.

Mech 1: Volume contraction -> incr AT II -> incr Na/H exchange in prox tubule -> incr HCO3- reabsorption (contraction alkalosis)

Mech 2: K+ loss leads to K+ exiting all cells in exchange for H+ entering cells

Mech 3: in low K+ state, H+ is exchanged for Na+ (rather than K+) in cortical collecting tubule -> alkalosis and "paradoxical aciduria"

 

34

ACE inhibitors

name 3

Captopril

Enalapril

Lisinopril

35

ACE inhibitors

mech?

inhibit ACE -> decr At II -> decr GFR by preventing constriction of efferent arterioles.

Renin increases due to loss of feedback inhibition.

ACE inhibition also prevents inactivation of bradykinin (vasodilator)

36

AT II blockers (-sartans)

effect?

similar to ACE inhibitors

do not increase bradykinin so there is decr risk of cough or angioedema

37

ACE inhibitors

use?

HTN

CHF

proteinuria

diabetic nephropathy

Prevent heart remodeling as a result of chronic HTN

38

ACE inhibitors

Tox?

Cough

Angioedema

Teratogen

incr Creatinine (decr GFR)

HyperKalemia

Hypotension

"Captoprils CATCHH"

39

ACE inhibitors

teratogenic effect?

fetal renal malformations

40

ACE inhibitors

contraindications?

-C1 esterase inhbitor deficiency

-Bilateral renal artery stenosis (because ACE inh will further decr GFR -> renal failure)