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99 Cards in this Set
- Front
- Back
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What is the net effect of uric acid filtration in the kidney?
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8-12% of plasma Utica acid excreted - one of the goals of gout treatment is affect greater excretion
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What is the concentration of uric acid that defines hyperuricemia?
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6.8 mg/dl - treament is usually directed at reducing below 6.0
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What do NSAIDS do in treating gout?
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Block cycloxygenase (COX) - analgesic and antiinflammatory, does not block formation of uric acid crystals.
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Why is asprin never given to patients with gout due to renal effects?
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Asprin decreases urate excretion by competing for organic acid excretion sites: asprin -> salicylic acid -> excreted in same site as urate
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What is the MOA of corticosteriods in the treatment of gout?
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Inhibit cytokine formation -> supress lymphocytes, eosinophils, and mast cells
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Why are oral steriods not normally a long term treatment?
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Cushings-like side affects, thus only administered short term to avoid toxicity: 10 days - 2 weeks
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What does triamcinolone treatment?
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Steroid: gout -> intra-articular injection
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What is the mechanism of colchicine?
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Anti-inflammatory for gouty arthritis - binds to tubulin to inhibit granulocyte motility (less phagocytosis, release of granules, cytokine release)
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What of the use of adrenocorticostimulating hormone in treating gouty arthritis?
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Additional benefit - may interfere with WBC ability to engulf uric acid crystals, a partner with corticosteroids
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What is the gout drug combo of choice for patients with renal toxicity?
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ACTH + triamcinelone (intra-articular steroid injection) instead of colchicine and NSAIDS
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What is the goal of reducing hyperuricemia?
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Reduce uric acid pool to dissolve existing acids and prevent new acid formation
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What is the MOA of allopurinol?
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Blocks xanthine oxidase which is the final enzyme in pathway of purines -> uric acid not formed so no crystallization.
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What drugs may interact with allopurinol?
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6 mercaptopurine and azathioprine that need xanthine oxidase
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What does febuxostat do?
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Blocks xanthine oxidase like allopurinol but has less side effects
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What is the MOA of probenecid?
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Blocks secretion and reabsorption of uric acid at the proximal convoluted tubule
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What is a common side effect of probenecid?
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Renal stone - probenicid causes alkaline pH in urine, need to maintain high urinary output to lessen likelyhood of stone formation
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What is a use of probenecid to increase efficacy of other drugs?
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Retain certain antibiotics to increase duration and therefore efficacy at a lower dose in duration dependent renally excreted antibiotics.
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What does acetalzolamide do?
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Alkalanize urine
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What is the affect of probenecid on renally excreted drugs?
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Increases blood levels - for patients who need high sustained levels of antibiotics
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Why wouldn't salicylates and probencid be administered at the same time?
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Both compete for the same excretion sites
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What does sulfinpyrazone do?
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Same as probenicid - blocks acid secretion and reabsorbtion but more potent with more side affets. Need to give with food or milk and can aggrevate ulcers
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What is Rasburicase?
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Catalyzes the oxidation of uric acid into allantoin -> inactive soluble and out in urine
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What drugs cause hyperuricemia?
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All the diuretics - loop, thiazides
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Why does alchohol cause gout?
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Upsets NAD/NADH to favor production of lactate. Lactate competes with uric acid for excretion sites
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What is the function of the juxtaglomerular apparatus?
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Maintains regulation of renal blood flow and glomerular filtration rate in within a range of 80-200 mm Hg
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What does the juxtoglomerular apparatus monitor?
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Afferent/efferent arterioles and distal convoluted tubule of SAME nephron
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How does the juxtablomerular apparatus regulate GFR?
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Macula densa cells sense increase in GFR and increase ateriolar tone to decrease GFR
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What is the function of the proximal tubule?
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Recover NaHCO3, Na+
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What is the function of the ascending loop?
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Recover everything
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What is the function of the distal convoluted tubule?
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Recover Na+ and Ca++
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What hormones act on the collecting tubule?
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Aldosterone and ADH
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Where do c anhydrase inhibitors work in the nephron?
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At the proximal convoluted tubule as a diuretic
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Where do sulfonamides work in the nephron?
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Distal convoluted tubule as a diuretic
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Where do loop diuretics act on the nephron?
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Thick ascending limb
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Where do the sodium influx blocking potassium sparing diuretics act in the nephron?
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Coritcal collecting duct
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What is the basic action of any diuretic?
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Block sodium recovery in nephron ->>> water follows
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Where do the aldosterone antagonists work in the nephron?
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Medullary collecting tubule - potassium sparing
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What are the zolamides?
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Carbonic anhydrase inhibitors - acetazolamide, methazolamide, dorzolamide & brinzolamide for glaucoma (topical)
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Zola minded the carbs?
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Zolamides are carbonic anhydrase inhibitors! Yayyyy! Giggles.
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What are the loop diuretics?
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Ethacrynic acid, sulfonamides, furosemide, bumetanide, torsemide
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Thiazides make MICH disconvoluted?
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Metolazone, Indapamide, Chlorothiazide, Hydrochlorothiazide work on the distal convoluted tubule
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Try to ameliorate and collect my potassium?? NO WAY!
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Triemterine and amelioride spare potassium and work on the cortical collecting tubule!!!
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If the zolamides produce alkaline urine, what is a systemic side affect?
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Systemic acidosis due to decreased bicarbonate reabsorption
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Aside from diuretics, how are carbonic anhydrase inhibitors useful?
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Glaucoma, alkalinzation of urine for lipid soluble weak acids, and to correct metabolic alkalosis
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How is altitude sickness treated?
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Acetazolamide causes metabolic acidosis causing physiological reflex hyperventilation
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What are the side affects alkaline urine? What drug causes alkaline pH?
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Zolamides (Carbonic Anhydrase Inhibitors) - can cause kidney stones
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What are the sulfonamide based loop diuretics?
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Bum Toes smell like Furious Sulfur - Bumetanide, Torsemide, Furosemide
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What does a loop diuretic inhibit?
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NKCC2 Transporter
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What are the main uses of loop diuretics?
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Edemas, CHF, hypertension, hypercalcemia, hyperkalemia, and acute renal failure
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Besides Na, K, Cl, what other ions are lost using loop diuretics?
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Ca and MG
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What drug can cause ototoxicity with loop diuretics?
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Aminoglycosides, esp ethacrynic acid
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What are symptoms of sulfonamide hypersensitivity?
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Skin reactions: hives, photo sensitivity, Steven Johnson Syndrome, hepatitis, kidney failure, reduced blood cell counts
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How do thiazides affect calcium?
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The don't. Shame on you.
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What action do thiazides block and where in the nephron?
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Block the Na/CL symporter in the DCT
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Which thiazide is also a vasodilator?
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Indapamide
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Why are thiazides useful in patients with osteoperosis?
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Don't alkalanize urine to promote stone formation -> preserve calcium
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What classes of diuretics cause hypokalemia and alkalosis?
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Thiazides and Loops
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What drug is used to preserve potassium when renin/angiotensin/aldosterone axis is high?
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Spironalactone - "prevent a spiral from lack of potassium"
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Which diuretics can cause gout and why?
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Loops and Thiazides are weak organic acids and compete for excretion sites with uric acid
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Why does hypokalemia cause hyperglycemia?
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Creates a steeper K+ gradient in the pancreatic beta cells -> more K+ flowing out of cell -> faster current -> more stable cell -> less insulin release -> more glucose in plasma
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What is the physiological response to rapid sodium and water loss?
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ADH water recovery and thirst - have to prevent unrestricted water intake to prevent dilution hyponatremia -> can lead to death
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What drug combats high aldosterone by competing for receptor sites?
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Spironolactone - used against a high renin/angiotensin/aldosterone axis
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Why are amiliride and triamterene used with thiazides or loops?
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Neutralize K+ loss
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What is the usefulness of mannitol?
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It is filtered but not reabsorbed so it carries water with it. OSMOTIC DIURETIC - increase water load in nephron -> dilute drugs to prevent nephrotoxosis
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How can mannitol resolve glaucoma?
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By reducing the intra ocular pressure
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What are the two functions of ADH (Vasopressin)?
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"1: aterial vasoconstrictor, 2: collecting duct water recovery
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What is the difference between vasopressin and desmopressin?
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"Desmo - only v2 activity: collecting duct water recovery,
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How is lithium induced diabetes insipidus treated?
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Lithion ion blocks V2 (collecting duct water recover) so use desmopressin since it only has V2 activity whereas vasopressin has both V2 and V1 (arterial vasoconstrictor) activity
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If the hypothalamus senses high osmoticity in the blood what does it cause?
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Release of ADH from the posterior pituitary to retain water, increase blood volume, and dilute blood
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What is the function of Renin?
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Converts 14 aa antiogensinogen to 10 aa antiogensinogen I - released from cells of JXTG cells of macula densa
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What conditions cause release of renin from JGA?
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Decreased sodium concentration at distal tubule or decreased pressure against the stretch receptors
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How is the JGA area innervated?
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By the SANS - beta 1 receptor -> release of renin
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What drugs would increase renin release by acting as beta 1 agonists
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NE, EPI, ISOP
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How would metoprolol affect renin release?
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Beta 1 antagonist would block SANS receptors in the JGA and prevent renin release
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What converts Angiotensin I to Angiotensin II?
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ACE - angiotensin converting enzyme, secreted by pulmonary and renal endothelial cells
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How does Antiogensin II affect renin release?
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Negative feedback
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How can the negative feedback of angiotensin II on renin release be interrupted?
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By ACE inhibitors and ARBs (AT1 receptor antagonists)
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What drugs decrease perfusion pressure?
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Vasodilators (hydralazine, minoxidil, nitroprusside) and alpha blockers (prazosin, phenoxybenzamine) --> promote renin release, Angiotensin II and Aldosterone production
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What effect do phosphodiesterase inhibitors, caffeine, and methylxanthines have?
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Mild diuresis via blocked Na+ recovery in the tubule
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What is caffeine's affect on the posterior pituitary?
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Blocks release of ADH (vasopressin)
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What are the affects of antiogensin II?
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Type 1 receptor agonist -> potent vasoconstriction, VMC reset to higher normal BP, stimulate SANS and aldosterone biosynthesis, CNS to release ADH
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Why is control of angiotensin II important in long term control of hypertension?
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Ang II -> mitogenic on vascular and cardiac cells --> hypertrophy and cardiac remodeling
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How does aldosterone affect the nephron?
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Promotes Na+ reabsorption at distal convoluted tubule and cortical collecting tubule -> increased plasma volume --> hypokalemia and alkalosis
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What is ACE affect on bradykinin?
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"Converts bradykinin to inactive fragments inorder to strengthen the overall affect of increasing blood pressure
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Why wouldn't you make an old lady jump through a loop?
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Loops cause Calcium loss and contribute to osteoperosis and could make your whore grandmother break her hip.
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What is the most common manifestation of drug induced nephrotoxicity?
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Rise in serum creatinine and BUN with DECREASE in GFR
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What would proximal tubular injury cause?
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Metabolic acidosis, bicarbonaturia, glycosuria w/o hyperglycemia
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What would be seen in distal tubular injury?
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Polyuria from failure to concentrate urine, metabolic acidosis from impaired urinary acidifaction
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What is the pathogenisis of aminoglycoside toxicity?
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Reduction in GFR due to PCT epithelial damage leading to obstruction of tubular lumen and backleakage of glomerular filtrate
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ACIDezolemide causes ACIDosis?
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Yes, you freak! Acetezolamide is a carbonic anhydrase inhibitor so bicarb is not reabsorbed and is lost in the urine
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Hydrochlothiozide -> hyperGLUC??!?
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Causes: Hyperglycemia, Hyperlipidemia, hyperUricemia, hyperCalcemia
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What part of nephron does Amphotericin B damage and what does that cause?
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Direct distal tubular epithelial cell toxicity - K, Na, and Mg wasting, inability to concentrate urine, and decrease in RBF due to areteriolar constriction
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How can mannitol damage the nephron?
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Vacuolization, swelling and necrosis of PCT epithelial cells, direct renal vasoconstriction -> decrease in renal blood flow
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How do penicillins, cephalosporins, and amoxicillin damage the nephron and what is seen clinically?
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Damage PCT -> metabolic acidosis, non-hyperglycemic glucosuria, allergic nephritis
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How is vancomycin nephrotoxic?
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Increased creatinine and BUN, can cause renal failure, interstitial nephritis, BAD BAD BAD with aminoglycosides
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What adverse affects can sulfonimides cause?
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Hypersensitivity, renal colic, crystaluria (can crystlize in the kidney), acute renal failure
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How can TMP-SMX mess up yo' kidney?
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Toxic nephrosis w/ oliguria/anuria/crytaluria (SMX can crystalize in the kidney), renal failure, high BUN/creatinine, interstitial nephritis
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Who gets orange piss?
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Rifampin - proteinuria too
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What is the MOA of lovestatin?
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HMG CoA reductase inhibitor
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