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Tubules- Pharmacology Flashcards

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1
Q

Carbonic andydrase inhbitors, loop diuretics, thiazide diruetics, and K+ sparing diuretics cause which effect: naturesis or diuresis?

A

natruresis

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2
Q

What is the 1 diuretic that causes diuresis?

A

Osmotic diuretics

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3
Q

What is the mechanism of action of CA inhibitors?

A

↓ CA activity –> can’t form CO2 and H2O –> ↓ Na and HCO3 resorption

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4
Q

How does thiazide blockade of the NCC at the DCT ↑ Ca reabsorption?

A

By ↑ Na/Ca exchanging

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5
Q

What are the 2 actions of aldosterone to ↑ Na and water reabsorption?

A

stimulates ENaC and Na/K ATPase

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6
Q

What will happen to K levels if you give CAi’s?

A

Hypokalemia

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7
Q

What will happen to K levels if you give loop diruetics?

A

Hypokalemia

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8
Q

What will happen to K levels if you give thiazide diuretics?

A

Hypokalemia

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9
Q

What will happen to K levels if you give K sparing diuretics?

A

Hyperkalemia

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10
Q

What will happen to K levels if you give osmotic diuretics?

A

Hypokalemia

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11
Q

What is the #1 CAi?

A

Acetazolamide

i took this in peru in preparation for high altitude and i tell you now this stuff totally sucks. makes you weird and sick. like trippin balls type stuff…

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12
Q

CAi’s cause what shift in pH in the blood?

A

Metabolic acidosis

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13
Q

CAi’s cause what shift in the pH in the urine?

A

↑ pH

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14
Q

An increase in pH in the urine from CAi’s can lead to the formation of what?

A

Kidney stones

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15
Q

CAi’s will cause what shift in the [Cl-] in the blood?

A

Hyperchloremia (cuz of loss of HCO3-)

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16
Q

So since CAi’s shift the acid levels, what can it be used to treat?

A

Since it causes metabolic acidosis, it can be used to treat metabolic alkalosis (vomiting).

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17
Q

Inhibition of CA in the cilliary process epithelium reduces the secretion of aqueous humor and is therefore used to treat what?

A

Glaucoma

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18
Q

What are the transporters on the ciliary epithelium of the eye that are subsequently inhibited by using a CAi?

A

Cl/HCO3

Na/H

Na/HCO3

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19
Q

What is the main liver contraindication to CAi’s due to ↑ NH3 in the blood?

A

Hepatic encephalopathy (cirrhosis)

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20
Q

If the pt has renal insufficiency, what will be the side effect of CAi’s?

A

Nervous system toxicity –> paresthesias

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21
Q

Furosemide, ethacrynic acid, bumetanide, and torsemide all inhibit what transporter?

A

NKCC transporter

loop diuretics

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22
Q

Because of the gnarly inhibition of loop diuretics, what are the main side effects?

A

hypo-mg, ca, cl & na and alkalosis

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23
Q

This is a life-threatening skin condition in which cell death causes the epidermis to separate from the dermis when using loop diuretics.

A

Steven Johnson syndrome

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24
Q

What moiety in the loop diuretic causes the steven johnson syndrome?

Study These Flashcards
A

Sulfonamide moeity

25
What is the side effect that loop diuretics share with aminogycoside antibiotics?
Ototoxicity
26
When using loop diuretics, there can be upregulation of PCT reabsorption of uric acid, leading to what condition?
Gout
27
Since loop diuretics are pretty aggressive, what conditions are they used to treat?
Pulmonary and peripheral edema
28
Case: pt presents with peripheral edema. labs show increased BUN and hypocalcemia. Is it safe to treat with loop diuretics?
NO. loop diuretics already cause hypocalcemia and ↑ BUN as a side effect
29
So other than acute pulmonary edema, HTN, and ARF, what ionic imbalances can u use loop diuretics for?
acute hypercalcemia hyperkalemia
30
Which drug is a contraindication to loop diuretics?
Aminoglycosides (ototoxicity)
31
Which allergy is a contraindication to loop diuretic use?
sulfonamide
32
What are the 4 side effects of thiazide use?
Natiuresis Diuresis Hypokalemia Metabolic alkalosis
33
Thiazides kinda have the same issue as loops in that they upregulate tubular reabsorption of uric acid, leading to what?
Gout
34
What are thiazides a first-line treatment for?
HTN
35
What other indications do u use thiazides for? jusy fyi. i hate them.
``` Heart failure Nephtolithiasis from hypercalciuria Nephrogenic diabetes insipidus Pt with osteoporosis Pt with diabetes ```
36
Which arrythmia agents are contraindications for thiazide use?
agents that prolong the QT
37
What are the 2 main side effects to all K-sparing diuretics?
Hyperkalemia and metabolic acidosis (↓ H secretion)
38
What is the main hormonal side effect of spironolactone?
It inhibits the androgen receptor and can cause impotence and gynecomastia in men.
39
What is the main indication of K sparing diuretics?
to treat hypokalemic alkalosis secondary to mineralcorticoid access due to heart failure and hepatic failure
40
Which drug is used in monotherapy for ascites and edema with impaired plasma protein biosynthesis, as well as obesity assocaited HTN (mineralcortioids or Na-channel blocker)?
Mineralcorticoids
41
Direct Na channel inhibitor monotherapy is used to treat which syndrome, which is characterized by low levels of aldosterone, HTN, and is AD?
Liddles syndrome
42
All K-sparing diuretics except eplerenon can be gives ina combined formulation with which drug?
hydrochlorothiazide
43
What is the most commonly used osmotic diuretic?
mannitol
44
What is the primary indcation for mannitol?
increased intracranial pressure due to head trauma, brain hemorrhage, or symptomatic cerebral mass.
45
This is the excessive secretion of ADH.
SIADH
46
This is the decreased responsiveness to ADH?
Diabetes insipidus
47
What are the 2 ADH R antagonists?
Conivaptan and tolvaptan "ya' ADH scallywag! aye aye -aptan!"
48
What is the 1 indication for ADH R antagonists?
SIADH
49
Which ADH R antagonist blocks V2 and is available orally?
Tolvaptan
50
How do demeclycycline and lithium block ADH?
they block adenylate cycle in the CD and antaonize the fxn of ADH
51
Why is Li no longer used to treat SIADH?
it causes tubulointerstitial nephritis
52
What are the indications to demeclocycline?
Persistent chronic SIADH
53
What is the DOC for neurogenic diabetes insipidus?
Desmopressin
54
What is the MOA for desmopressin
V2 agonist
55
Why can thiazides but not loop diuretics used for the treatment of nephrogenic DI?
because thiazides dont affect medullary tonicity
56
How does Li induces downregulation of AQP2 by inhibiting ADH, leading to what condition?
Nephrogenic DI
57
What is the DOC for Li-induced nephrogenic DI?
Amiloride
58
How do NSAIDs treat nephrogenic DI?
They inhibit the formation is PGE2 --> ↓ GFR --> ↑ resorption of water and electrolytes in the PCT

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