Renal Pharm

hezikry's version from 2015-08-06 20:28

Concentrations in renal tubular

Question Answer
lowest osmolarityDCT
highest osmolaritymedulla collecting duct and loop of henle
concentration at highest points1200
only H20 reabsorbeddescending limb and collecting duct
only NaCL reabsorbedascending limb

Quick review where do drugs work

Question Answer
acetazolamide (carbonic anhydrase inhibitors)PCT
mannitoldescending limb and proximal tubule
loopsthick ascending limb
potassium sparing diureticscollecting ducts


Question Answer
NSAIDSconstrict afferent arteriole
Prostaglandinsdilate afferent
Angiotensin IIconstricts efferent
ACEIdilate efferent


Question Answer
Where does acetazolamide workPCT
Where does mannitol workthick descending
Where does loop diuretics workthick ascending
Where do thiazides workDCT
Where do potassium sparing diuretics workcollecting tubule
Where do ADH antagonists workcollecting duct
MOA of mannitolosmotic diuretic. Increases solute load forces water out of cells.
Clinical use of mannitolacute glaucoma, increased ICP
A/E of mannitolpulmonary edema, dehydration. Contraindicated in anuria and HF.
MOA of acetazolamidecarbonic anhydrase inhibitor in the PCT. Leads to decrease in HCO3 stores.
Clinical of use of acetazolamideacute angle closure glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri, uric acid and cysteine stones (by alkalinizing urine)
A/E of acetazolamidehypercholermic metabolic acidosis, NH3 toxicity (retention of ammonia), sulfa allergy.
MOA of loop diureticsinhibits co-transport system (Na/K/2Cl) of thick ascending limb of loop of henle. Abolishes hypertonicity of medulla preventing concentration of urine. Causes calcium lost.
Clinical use of loop diureticsedematous states
Toxicity of loop diureticsOH DANG (ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis, gout (hyperuricemia), metabolic alkalosis and hypomagnesimia.
Loop diuretics and prostaglandsstimulate prostaglandin release and increase GFR. do not use NSAIDS with loops
MOA of ethacrynic acidessential same as furosemide
Clinical use of ethacrynic aciddiuresis in patients with sulfa allergies
Toxicitysimilar to furosemide
MOA of thiazidesinhibit NACL reabsorption in early DCT
Clinical use of thiazidesHypertension!!! Nephrogenic diabetes insipidus, osteoporosis.
Toxicity of thiazideshyperGLUC (hyperglycemia, hyperlipidemia, hyperuricemia, hypercalemia.) Sulfa allergy. Also causes metabolic alkalosis and hypokalemia.
Aldosterone antagonistsspironolactone and eplerenone
ENAC inhibitorstriamtrene and amiloride
Lithium induced nephrogenic diabetes inspidusamiloride
Hyperaldosteronismspironolactone and eplernone
A/E spironolactonegynecomastia, antiandrogen effects.
ARBSlosartan, candesartan, valsartan.
Mechanism of ARBSselectively blocks binding of angiotensin II to receptor. Effects: increase renin, increase angiotensin I, increase angiotensin II decrease in aldosterone. No change bradykinin.
Clinical use of ARBShypertension, HF, proteinuria, diabetic nephropathy with intolerance to ACEi
A/E of ARBShyperkalemia. Teratogen.
MOA of ACEiinhibit ACE decreases ATII decreases GFR by dilating efferent arteriole.
Relationship between ACEi and bradykinininhibition ACE prevents inactivation of bradykinin, a potent vasodilator.
Clinical use of ACE ihypertension, proteinuria, diabetic nephropathy.
What is the relationship between ACEi, ARBS and bilateral renal artery stenosisACE inhibitors further decrease GFR by dilating afferent arteriole so contraindicated!
What are A/E of ACEi thinkCAPTOPRIL (Cough, Angioedema, Pregnancy, metallic Taste, hypOtension Potassium elevation, Rash, Increased Renin, Lowered Angiotensin II)
MOA of aliskirendirect re nin inhibitor, blocks conversion of angiotensiongen to angiotensin I.
Clinical use of aliskirenhypertension.
A/E of aliskirencontraindicated in diabetes taking ARBS or ACEi.
Which drug could you give to help with calcium nephroliathisisthiazides
why use azetazolamide in altitude sicknessat high altitudes will hyperventilate causing a respiratory alkalosis. To counteract the respiratory alkalosis, azetazolamide will induce a metabolic acidosis.


Question Answer
causes pulmonary edemamannitol
work in PCTmannitol, acetazolamide
used for glaucoma and pseudo tumor cerebraacetazolamide
causes HCO3 excretionacetazolamide
loop diuretic for someone with a sulfa allergyethacrynic acid
ototoxicityloop diuretics
decreased Ca+loops
increased Ca+thiazides
where do loops workTAL (block Na/K/2Cl)
where do thiazides workDCT
can be used to treat osteoporosisthiazides
hyperkalemiaK+ sparing diuretics (spironolactone and epleronone)
ACE inhibitor effect on GFRnormally decreases AII and decreases GFR by preventing constriction of EA (rise in renin and in bradykinin) BUT, cause dangerous decrease in GFR (increased creatinine) in bilateral renal artery stenosis
treats pulmonary edemaloops
carbonic anhydrase inhibitoracetazolamide
where do K+ sparing diuretics work?collecting duct
beta blocker effectsbock beta 1 receptors of JG apparatus --> decreased renin, decreased Angiotensin I, decreased Angiotensin II, decreased Aldosterone, no change in bradykinin
ARB effectsblock AT1 receptor and inhibit effects of Angiotenin II while also disturbing the negative feedback --> increased renin, increased Angiotensin I, increased Angiotensin II, decreased aldo, no change in bradykinin --> overall decrease in GFR
when do you avoid kayexalate?post op patients or those with GI issues--can cause intestinal necrosis


Question Answer
urine NaCl increasesall diuretics except acetazolamide
urine K increasesloop and thiazides
acidemiacarbonic anhydrase inhibitors
alkalemialoops and thiazides
urine ca increasesloops
urine ca decreasesthiazides

Depositions Nephritic/Nephrotic Syndromes

Question Answer
post strep glomerulonephritisgranular IgG, IgM and C3
IgA nephropathyIgA
lupus nephritisfull house
Goodpastureslinear IgG and C3
membranoproliferative glomerulonephritisIgG and C3
membranous nephropathyIgG
alport mutationin collagen type 4
pauci immune with no asthma or granulomasMPA
pauci immune granulomas and no asthmaWegner's
pauci immune eosinophilia, asthma and granulomasChurg Strauss