Passes from plasma to renal tubule - ANSWER-Filtration
Moves back up into plasma from the tubule - ANSWER-Reabsorption
Moves into the tubule from
... [Show More] the plasma - ANSWER-Secretion
Common used for diuretics - ANSWER-Edema
HTN
Hyperkalemia
Diabetes insipidus
Are there medication sites of action at the glomerulus? - ANSWER-No
Where does the majority of reabsorption occur? - ANSWER-proximal convoluted tubule
Which diuretic has MOA at the PCT? - ANSWER-Carbonic anhydrase inhibitors
Name the carbonic anhydrase inhibitors - ANSWER-Acetazolamide
Dorzolamide
Brinzolamide
Carbonic anhydrase inhibitors MOA - ANSWER-Inhibit enzyme responsible for dehydration of H2CO3
Reduces aqueous humor in the eye
Indications for carbonic anhydrase inhibitors - ANSWER-Glaucoma, urinary acidosis, metabolic alkalosis, acute mountain sickness
Contraindication to carbonic anhydrase inhibitors - ANSWER-Hepatic cirrhosis
ADRs for carbonic anhydrase inhibitors - ANSWER-Renal stones, potassium wasting, drowsiness, hypersensitivity reaction
Name the loop diuretics - ANSWER-furosemide, bumetanide, torsemide, ethacrynic acid
Which is the only loop diuretic with no sulfa base? - ANSWER-Ethacrynic acid
Loop diuretics MOA - ANSWER-Inhibits Na/K/Acl transporter
Indications for loop diuretics - ANSWER-Edema
Hypercalcemia
Anion overdose (fluoride, bromide, iodide)
ADRs for loop diuretics - ANSWER-Hypomagnesemia, hyperuricemia, ototoxicity, allergic reaction
Contraindications for loop diuretics - ANSWER-Overuse in hepatic cirrhosis, renal failure, or heart failure
Sulfa allergy***
Drug drug interactions for loop diuretics - ANSWER-NSAIDS - decrease effectiveness
What is the conversion of PO lasix dose to IV? - ANSWER-2:1 PO to IV
What diuretic has site of action at DCT? - ANSWER-Thiazide diuretics
Name the thiazide diuretics - ANSWER-hydrochlorothiazide
chlorthalidone
Thiazide diuretics MOA - ANSWER-Inhibits NaCl transporter
Enhances Ca reabsorption
Indications for thiazide diuretics - ANSWER-HTN
Heart failure
Nephrogenic diabetes insipidus
Nephrolithiasis
Name the thiazide LIKE diuretics - ANSWER-Chlorthalidone
Indapamide
Metolazone
Which thiazide has slowest onset of action? - ANSWER-Chlorthalidone
ADRs for thiazide diuretics - ANSWER-Hyponatremia
Hypokalemia
Hyperuricemia
HLD
Allergic reaction
Photosensitivity
Contraindications to thiazide diuretics - ANSWER-Overuse in hepatic or renal failure, or heart failure
Thiazide diuretics are ineffective in GFR < _______ except ________ - ANSWER-20 ml/min, metolazone
Which is only thiazide in IV formulation? - ANSWER-Chlorothiazide
Which diuretic has site of action at cortical collecting tubule? - ANSWER-Potassium sparing diuretics
Name the potassium sparing diuretics - ANSWER-Spironolactone
Eplerenone
Potassium sparing diuretics MOA - ANSWER-Prevents K secretion by antagonizing mineralocorticoid receptors
"additional" potassium sparing agents - ANSWER-Triamterene
Amloride
MOA of triamterene and amiloride - ANSWER-Inhibits Na ion channels
Indications for potassium sparing diuretics - ANSWER-HTN
HF
Hypokalemia
Spironolactone: hyperaldosternisin, POCS, hirsutism
ADRs for potassium sparing diuretics - ANSWER-Hyperkalemia
Triamterene
Spironolactone only - gynecomastia, impotence, tumorgenic (in animals)
Contraindications to potassium sparing diuretics - ANSWER-Hyperkalemia, renal impairment, hepatic impairment
Spironolactone - Addison's
Drug drug interactions for Eplerenone only - ANSWER-Strong CYP3A4 agents: fluconazole, diltiazem, grapefruit juice
Which diuretics have site of action at medullary collecting duct? - ANSWER-Vassopressin (aka ADH) antagonists
Name the osmotic diuretics - ANSWER-Glycerol
Mannitol
MOA of osmotic diuretics - ANSWER-Increase osmotic pressure in the glomerulus, decreasing reabsorption of water and electrolytes
Indications for osmotic diuretics - ANSWER-Cerebral edema, acute glaucoma, bronchial hyper-responsiveness
ADRs for osmotic diuretics - ANSWER-Glycerol - N/V/D
Mannitol - Excessive volume expansion, heart failure, edema, pulmonary congestion
Contraindications to osmotic diuretics - ANSWER-hypersensitivity
What form of osmotic diuretics is often better tolerated? - ANSWER-Oral
Where and how much is creatinine excreted? - ANSWER-100% in kidneys
S/s of AKI - ANSWER-Increased BUN/Cr
Decreased GFR
Uremia
Edema
Foamy urine
Changes in urinary habits
Agents that can cause ATN/direct tubular toxicity - ANSWER-radiocontrast dye, APAP, cisplatin, rhabdo
Agents that can cause interstitial nephritis - ANSWER-PCN, cephalosporins, NSAIDS, PPIsm lasix, sulfa, rifampin, phenytoin
Which agents can cause decrease in renal perfusion? - ANSWER-ACEI or NSAIDS
Agents that cause afferent arteriole vasoconstriction - ANSWER-NSAIDS
cyclosporine/tacrolimus
Amphotericin B
Radiocontrast agents
Vasopressors
Agents that cause efferent arteriole vasoconstriction - ANSWER-ACEIs, ARBs
Diltiazem, verapamil
Contrast agent recommendations for AKI - ANSWER-Administer oral or IV hydration 6-12 hours prior
N-acetylcysteine
What is the physiology behind the renoprotective effects of ACEI? - ANSWER-Decreased filtration pressure through nephrons = decrease proteinuria and hematuria
Can't use in AKI [Show Less]