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Renal > Tubules- Pharmacology > Flashcards

Tubules- Pharmacology Flashcards

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?

A

Sulfonamide moeity

25
Q

What is the side effect that loop diuretics share with aminogycoside antibiotics?

A

Ototoxicity

26
Q

When using loop diuretics, there can be upregulation of PCT reabsorption of uric acid, leading to what condition?

A

Gout

27
Q

Since loop diuretics are pretty aggressive, what conditions are they used to treat?

A

Pulmonary and peripheral edema

28
Q

Case: pt presents with peripheral edema. labs show increased BUN and hypocalcemia. Is it safe to treat with loop diuretics?

A

NO. loop diuretics already cause hypocalcemia and ↑ BUN as a side effect

29
Q

So other than acute pulmonary edema, HTN, and ARF, what ionic imbalances can u use loop diuretics for?

A

acute hypercalcemia

hyperkalemia

30
Q

Which drug is a contraindication to loop diuretics?

A

Aminoglycosides (ototoxicity)

31
Q

Which allergy is a contraindication to loop diuretic use?

A

sulfonamide

32
Q

What are the 4 side effects of thiazide use?

A

Natiuresis
Diuresis
Hypokalemia
Metabolic alkalosis

33
Q

Thiazides kinda have the same issue as loops in that they upregulate tubular reabsorption of uric acid, leading to what?

A

Gout

34
Q

What are thiazides a first-line treatment for?

A

HTN

35
Q

What other indications do u use thiazides for?

jusy fyi. i hate them.

A 
Heart failure
Nephtolithiasis from hypercalciuria
Nephrogenic diabetes insipidus
Pt with osteoporosis 
Pt with diabetes
36
Q

Which arrythmia agents are contraindications for thiazide use?

A

agents that prolong the QT

37
Q

What are the 2 main side effects to all K-sparing diuretics?

A

Hyperkalemia and metabolic acidosis (↓ H secretion)

38
Q

What is the main hormonal side effect of spironolactone?

A

It inhibits the androgen receptor and can cause impotence and gynecomastia in men.

39
Q

What is the main indication of K sparing diuretics?

A

to treat hypokalemic alkalosis secondary to mineralcorticoid access due to heart failure and hepatic failure

40
Q

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)?

A

Mineralcorticoids

41
Q

Direct Na channel inhibitor monotherapy is used to treat which syndrome, which is characterized by low levels of aldosterone, HTN, and is AD?

A

Liddles syndrome

42
Q

All K-sparing diuretics except eplerenon can be gives ina combined formulation with which drug?

A

hydrochlorothiazide

43
Q

What is the most commonly used osmotic diuretic?

A

mannitol

44
Q

What is the primary indcation for mannitol?

A

increased intracranial pressure due to head trauma, brain hemorrhage, or symptomatic cerebral mass.

45
Q

This is the excessive secretion of ADH.

A

SIADH

46
Q

This is the decreased responsiveness to ADH?

A

Diabetes insipidus

47
Q

What are the 2 ADH R antagonists?

A

Conivaptan and tolvaptan

“ya’ ADH scallywag! aye aye -aptan!”

48
Q

What is the 1 indication for ADH R antagonists?

A

SIADH

49
Q

Which ADH R antagonist blocks V2 and is available orally?

A

Tolvaptan

50
Q

How do demeclycycline and lithium block ADH?

A

they block adenylate cycle in the CD and antaonize the fxn of ADH

51
Q

Why is Li no longer used to treat SIADH?

A

it causes tubulointerstitial nephritis

52
Q

What are the indications to demeclocycline?

A

Persistent chronic SIADH

53
Q

What is the DOC for neurogenic diabetes insipidus?

A

Desmopressin

54
Q

What is the MOA for desmopressin

A

V2 agonist

55
Q

Why can thiazides but not loop diuretics used for the treatment of nephrogenic DI?

A

because thiazides dont affect medullary tonicity

56
Q

How does Li induces downregulation of AQP2 by inhibiting ADH, leading to what condition?

A

Nephrogenic DI

57
Q

What is the DOC for Li-induced nephrogenic DI?

A

Amiloride

58
Q

How do NSAIDs treat nephrogenic DI?

A

They inhibit the formation is PGE2 –> ↓ GFR –> ↑ resorption of water and electrolytes in the PCT

Renal (7 decks)

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