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39 Cards in this Set
- Front
- Back
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Osmotic diuretic
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Mannitol (increases tubular fluid osmolarity, producing increased urine flow)
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4 uses of mannitol
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Shock
Drug overdose Increased ICP or IOP |
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2 toxicities of mannitol
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Pulmonary edema
Dehydration |
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2 contraindications of mannitol
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CHF
Anuria |
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Mannitol works in the?
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Proximal convoluted tubule
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Acetazolamide works in the?
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Proximal convoluted tubule
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Mechanism of acetazolamide
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Carbonic anhydrase inhibitor
Causes self-limited NaHCO3 diureses and reduction in total body HCO3 stores (Na and HCO3 lost in urine) |
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Why is acetazolamide a weak diuretic?
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Kidney still has time to make up for Na lost
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4 uses of acetazolamide
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Glaucoma
Urinary alkalinization Metabolic alkalosis Altitude sickness |
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4 toxicities of acetazolamide
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Hyperchloremic metabolic acidosis
Neuropathy NH3 toxicity Sulfa allergy |
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____ causes metabolic acidosis while ____ causes metabolic alkalosis (diuretics)
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Acetazolamide
HCTZ |
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Mechanism of loop diuretics
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Inhibit cotransport system (Na, K, 2 Cl), abolishing hypertonicity of medulla and preventing concentration of urine
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Where do loop diuretics work?
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Thick ascending limp of the loop of Henle
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Loops lose _____
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Calcium
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Clinical use of loop diuretics (3)
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Edematous state (CHF, cirrhosis, nephrotic syndrome, pulmonary edema)
HTN Hypercalcemia |
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Toxicity of furosemide
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OH DANG, i lost my loop earrings
Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephritis (interstitial) Gout |
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What drug is used for diuresis in pts allergic to sulfa drugs?
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Ethacrynic acid (phenoxyacetic acid derivative; NOT a sulfonamide; same action as furosemide)
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What diuretic can be used in hyperuricemia/ acute gout (although not to treat gout)
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Ethacrynic acid
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Mechanism of thiazide diuretics?
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Inhibit NaCl reabsorption in early distal tubule, reducing diluting capacity of the nephron
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Where do thiazide diuretics work
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Early distal tubule
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4 uses of thiazide diuretics
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HTN
CHF Idiopathic hypercalciuria Nephrogenic diabetes inspidus |
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Why do thiazide diuretics decrease the risk of kidney stones?
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Decrease calcium excretion (hypocalciurics, can cause hypercalcemia though)
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Toxicity of HCTZ
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Hyper GLUC
Hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia Hypokalemic metabolic alkalosis, hyponatremic, and sulfa allergy |
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4 K+ sparing diuretics
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Spironolactone, eplerenone
Triamterene, Amiloride |
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Where do the K+ sparing diuretics work?
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Cortical collecting tubule
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Mechanism of spironolactone and eplerenone?
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Competitive aldosterone receptor antagonists
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Eplerenone has fewer _____ side effects than spironolactone
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Androgenic (is selective for aldosterone receptor)
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All diuretics increase?
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Urine NaCl
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Which diuretic classes cause acidemia?
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Carbonic anhydrase inhibitors and K+ sparing (aldosterone blockade prevents both K+ secretion and H+ secretion)
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Which diuretic classes cause alkalemia?
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Loop diuretics and thiazides
3 mechanisms: volume contraction, K+ exciting cells in exchange for H+ entering cells, and H+ being exchanged for Na+ in cortical collecting duct due to low K+ state |
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Hypocalcemia with _____, hypercalcemia with _____
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Loop diuretics
Thiazides |
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3 ACE inhibitors
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Captopril, enalapril, lisinopril
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Mechanism of ACE inhibitors
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Inhibit angiotensin-converting enzyme, with 2 effects:
Decreases levels of angiotensin II Prevents inactivation of bradykinin (--> more bradykinin), a potent vasodilator |
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Is renin release increased or decreased with ACE inhibitors?
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Increased (loss of feedback inhibition, though the renin cannot produce its downstream effects)
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3 uses of ACEIs
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HTN
CHF Diabetic renal disease |
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Mechanism of cough in ACEIs
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Increased bradykinin
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Treat cough from ACEIs with
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Replacement of ACEI with an ARB (e.g. losartan)
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Toxicity of ACEIs
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CAPTOPRIL + hyperkalemia
Cough Angioedema Proteinuria Taste changes hypOtension Pregnancy problems (fetal renal damage) Rash Increased renin Lower angiotensin II |
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ACEIs should be avoided in pts with?
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Bilateral renal artery stenosis, b/c ACEIs significantly decrease GFR by preventing constriction of efferent arterioles
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