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60 Cards in this Set

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What percentage of CO do the kidneys receive at rest?
Acetazolamide: what is it?
A carbonic anhydrase inhibitor
Acetazolamide: what does it do?
Carbonic anhydrase inhibitor

- NaHCO3 reabsorption in PCT down.

- Greatly increases excretion of HCO3 (so that 1/3 of all HCO3 filtered is excreted)

- Decreases H and NH4 excretion in the collecting tubules

- Causes urinary pH to rise to about 8

- Causes metabolic acidosis

- Na and K excretion go up.
Acetazolamide: the ceiling effect
Carbonic anhydrase inhibitor

Acetazolamide: other effects
Carbonic anhydrase inhibitor

- Dec aqueous humor formation in the eye

- Dec IOP

- Dec seizures

- Dec in mountain sickness
Acetazolamide: AE
Carbonic anhydrase inhibitor

- Somnolence
- Paresthesias
- Metabolic acidosis
- Inc amine reabsorption --> worsen hepatic encephalopathy
- Inc urinary pH --> renal stones
- Hypersensitivity reactions -- this is a sulfonamide derived medication
Acetazolamide: uses
Carbonic anhydrase inhibitor

Poor diuretic due to refractoriness


Mountain sickness (prophylaxis > treatment)

Osmotic diuretics: general
Freely filtered
Not reabsorbed
Not metabolized
Pharmacologically inert
Osmotic diuretics: site of action
PCT and the loop of Henle
Osmotic diuretics: M of A?
Increase extracellular fluid volume by drawing out intracellular water.
Osmotic diuretics: effects of using?
RBF: up

Excretion of all ions: up

NaCl concentrating ability in medulla: down

Urine concentrating ability: down
Osmotic diuretics: AE
Increase in extracellular fluid volume can exacerbate pulmonary edema.

Can mess with plasma ion concentrations.

Contraindicated in anuria
Osmotic diuretics: uses
Prophylaxis of ARF, ATN prior to ischemia, nephrotoxin (??)

Decreases cerebral edema

Decreases intraocular pressure (IOP)

Mannitol is a free-radical scavenger
Loop diuretics: what do they do?
Inhibit Na/K/2Cl symporter in the ascending limb.
Loop diuretics: effects
- Greatly increase NaCl excretion

- Increase K and H excretion due to increased delivery of Na to the distal tubule.

- Decrease medullary tonicity

- Decrease urine concentrating ability

- Ethacrynic acid is the only non-sulfonamide loop diuretic.
Furosemide: class
Furosemide: also inhibits?
Carbonic anhydrase
Furosemide: other effect besides diuresis?
Venous dilation
Loop diuretics: protein binding, filtration rate.
High protein binding, not well filtered.
Loop diuretics: secreted where?
In the PCT
Loop diuretics: oral bioavailability
Furosemide: ~60%
Ethacrynic acid: 100%
Loop diuretics: metabolism
2/3 excreted unchanged
1/3 metabolized
Loop diuretics: AE
Increased delivery of Na to distal tubule --> increased K, H excretion -->

Metabolic alkalosis

Increased Ca excretion in osteoporotic women

Ototoxicity due to altered endolymph --> hearing loss, vertigo (usually reversible)
Loop diuretics: rare AE
- Hyperuricemia (occasionally causes gout)

- Hyperglycemia (occasionally worsens glycemic control)

- Hypersensitivity cross reaction with other sulfonamides (except ethacrynic acid)
Loop diuretics: uses
- Acute pulmonary edema
- Edema of the nephrotic syndrome
- Edema of cirrhosis
- To increase excretion of some drugs
Thiazide diuretics: what do they do?
Inhibit the Na Cl symporter in the distal tubule.
Thiazide diuretics: derived from what
Thiazide diuretics: prototype
Thiazide diuretics: affect on carbonic anhydrase?
Weakly inhibits
Thiazide diuretics: secreted where?
Thiazide diuretics: half-lives
HCTZ: ~2.5 hrs
Chlorthalidone (used in the ALLHAT study): ~47 hrs!
Thiazide diuretics: AE
Increased Na delivery to the DT --> K, H excretion up -->

Metabolic alkalosis

Hyperuricemia (occasionally gout)
Hyperglycemia (occasionally worsens glycemic control)
Hypersensitivity cross reaction with other sulfonamides

- Erectile dysfunction!
Thiazide diuretics: uses
Edema of the nephrotic syndrome
Edema of cirrhosis
Thiazide diuretics: can be used with what for maximum diuretic effect?
Metolazone + loop diuretic
Spironolactone: what is it?
Aldosterone antagonist
Spironolactone: what does it do?
Increases Na excretion
Increases K, H retention
Also binds to sex hormone receptors!
Spironolactone: AE
- Hyperkalemia
- Estrogen effects: gynecomastia, impotence
- Androgen effects: hirsutism, deepening of voice
- Increases malignancies?
Spironolactone: uses
- To increase aldosterone concentrations (??)

- Decrease mortality in CHF

- Used in combination with loop or thiazide diuretics to minimize hypokalemia

- Used for hyperaldosteronism
Name two aldosterone antagonists
Name two K sparing diuretics
K sparing diuretics: what do they do?
Block ENaC channel in distal tubule and collecting duct

Block Na reabsorption, so block K, H, Ca, Mg excretion

Increase Na excretion (a little)

Increase K reabsorption (a little more)
K sparing diuretics: AE
K sparing diuretics: common useage?
In combination with other diuretics
ADH: released from where in response to what?
Released from the posterior pituitary in response to increased osmolality.
ADH: what does it do?
Increases water permeability in the collecting duct.
ADH: effect on vessels
ADH is a potent vasoconstrictor
Diabetes insipidus: what is it?
An underproduction or lack of ADH
Diabetes insipidus: most significant clinical presentation
Huge volume of dilute urine (~20 L/day)
Diabetes insipidus: treated with what?
Treated with long-acting ADH analogue (desmopressin)
Desmopressin: what is it?
Long-acting ADH analogue
Desmopressin: route
Nasally, orally, or via long-acting injection.
What is a drug combination that can cause nephrogenic DI?
Lithium + demeclocyline
SIADH: what is it?
When there is too much ADH released
SIADH: what is the concentration of the urine?
Concentrated urine
SIADH: often follows what type of injury?
Head injury
SIADH: resolution
Usually resovles spontaneously
SIADH: treatment
Usually resolves spontaneously

May be treated with loop diuretics
Conivaptan: what is it?
A V1 and V2 antagonist approved for the treatment of euvolemic and hypervolemic hyponatremia
Probenecid: what does it do?
- Inhibits the organic acid transporter

- Inhibits tubular secretion of many acids (e.g. penicillin)

- Inihibits tubular reabsorption of uric acid
Probenecid: uses
Useful in gout because it increases the amount of uric acid excreted.