Kidney/bladder pharm

Question 1

Applications of mannitol

Answer 1

• Reduce ICP and/or IOP
• Flush out renal toxins (i.e. myoglobin) and protect kidneys

Question 2

Electrolyte imbalances associated w/ mannitol use

Answer 2

1. Inital hyponatremia
2. Followed by hypernatremia and hypkalemia

Question 3

What enzyme converts CO₂ and H₂O back into carbonic acid once inside the cells of the proximal tubule?

Answer 3

Carbonic anhydrase type II

Acetazolamide inhibits this preventing bicarb reabsorption

The bicarbonate is transported into the
blood along with sodium (Na⁺), while hydrogen is secreted back into the tubule in exchange for
more sodium.

Question 4

What are the general effects of acetazolamide

Answer 4

• Increase excretion of bicarb, sodium, and water - leading to mild increase in urine output
• Decrease in bicarb serum cause metabolic acidosis

Question 5

Clinical uses of acetazolamide

Answer 5

1. Edematous conditions w/ alkalosis
2. Kidney stone prevention
3. Acute elevation sickness
4. Sleep apnea
5. Glaucoma
6. CSF leakage

Question 6

Adverse effects of acetazolamide use

Answer 6

1. MA
2. Hyperchloremia
3. Kidney stones
4. Hypokalemia
5. Neurological effects (drowsiness and paresthesia)

Question 7

Mechanism of carbonic anhydrase in the eye

Answer 7

Carbonic anhydrase in the ciliary body helps produce aqueous humor.

Inhibiting this enzyme reduces fluid production and lowers eye pressure, which is useful in glaucoma

Question 8

Mechanism of carbonic anhydrase in the brain

Answer 8

Carbonic anhydrase in the choroid plexus helps produce CSF

Inhibition reduces CSF production, which is useful for conditions like CSF leakage

Question 9

MOA of loop diuretics

Answer 9

Block NKCC cotransporter in thick ascending limb of the loop of Henle

Results in increased excretion of Na/K/Cl/Ca/Mg and water

Question 10

Effect of loop diuretic on prostaglandin release

Answer 10

Loop diuretics stimulate prostaglandin production - dilates afferent arteriole, increasing GFR and RBF

Question 11

Loop diuretics are used to Tx what electrolyte imbalance(s)

Answer 11

Hypercalcemia
Hyperkalemia

Increasing excretion of these ions

Question 12

Loop diuretics can be used to treat what toxic exposures?

Answer 12

Halide poisining

Question 13

Adverse effects of loop diuretics

Answer 13

1. Hypokalemic metabolic acidosis
2. Hypomagnesemia and hypocalcemia
3. Hyperuricemia
4. Ototoxicity
5. Hyperglycemia
6. May trigger allergic response in sulfa-sensitive patients (ethacrynic acid can be used in these cases)

Question 14

Thiazides share the same secretion system used by what?

Answer 14

Uric acid - competes with its secretion and can raise uric acid levels

Question 15

Thiazide MOA

Answer 15

Acts mainly on the NCC of the DCT

Like sulfonamide medications, thiazides can cause allergic reactions, so patients with sulfa allergies should use caution

Question 16

List examples of K-sparing diuretics

Answer 16

1. Spironolactone
2. Amiloride
3. Eplerenone
4. Triamterene

Question 17

MOA of K-sparing diuretics

Answer 17

Act on the cortical collecting tubules in the kidney

Question 18

What are the role of principal cells in the collecting ducts?

Answer 18

1. Epithelial sodium channels (ENaC) allow sodium to enter the cell from the tubule.
2. ATP-dependent potassium channels move potassium into the tubule.
3. Express V2 receptors to bind ADH

Question 19

Role of α-Intercalated Cells in the collecting ducts?

Answer 19

These cells are responsible for secreting hydrogen ions (H⁺) into the tubule to regulate blood pH.
They use two transporters:

1. H⁺ ATPase pumps hydrogen ions into the tubule.
2. H⁺/K⁺ ATPase pumps hydrogen ions into the tubule in exchange for potassium

Question 20

What types of Rx’s are tolvaptan and conivaptan?

Answer 20

ADH antagonists

Tolvaptan - po

Conivaptan - IV

Question 21

When ADH binds V₂ receptors, increased ______ leads to aquaporin transportation to the cell membrane

Answer 21

When ADH binds V₂ receptors, increased cAMP leads to aquaporin transportation to the cell membrane

Question 22

Which of the following is most likely to be used to treat calcium oxalate bladder stones that are recurrent?

A. Acetazolamide
B. Furosemide
C. HCTZ
D. Mannitol

Answer 22

C. HCTZ

Question 23

When used chronically, hydrochlorothiazide is LEAST likely to cause which of the following:

A. Decreased urinary excretion of calcium

B. Elevated blood cholesterol

C. Elevated blood glucose

D. Elevated uric acid

E. Irreversible ototoxicity

Answer 23

E. Irreversible ototoxicity

Question 24

Hypocalciuria is associated with what class of diuretics?

Answer 24

Thiazides

Why they’re used to prevent kidney stones (calcium stones)

Question 25

A patient complains of paresthesias associated with one of her drugs. She is found to have hyperchloremic metabolic acidosis. She is probably taking:

Answer 25

Acetazolamide

Question 26

A drug that increases the formation of dilute urine in water-loaded subjects and is used to treat SIADH is:

Answer 26

Conivaptan

Question 27

A drug that is useful when there is concern about high altitude sickness is:

Answer 27

Acetazolamide

Question 28

Where in the cell do potassium sparing diuretics bind its receptor?

Answer 28

In the cytoplasm (aldosterone receptor is in the cytoplasm)

Question 29

What diuretic is associated w/ hyperchloremic metabolic acidosis?

Answer 29

Carbonic anhydrase inhibitors

Question 30

Answer 30

1. Hyperkalemia 3. Blockade 6. Reduced expression of Na/K pumps ## Footnote Spironolactone has androgen effects by antagonizing progesterone receptors too

Question 31

Amilioride and triamterene antagonize what?

Answer 31

The ENaC channels of principal cells ## Footnote Unlike other k-sparing diuretics (i.e. aldosterone antagonists)

Question 32

What class of diuretics results in an increased excretion of Mg/Ca?

Answer 32

Loop diuretics

Question 33

What class of diuretics lead to enhanced potassium excretion due to increased sodium delivery to the collecting duct?

Answer 33

Thiazides ## Footnote Inhibition of the NCC symporter in the DCT increases sodium delivery to the collecting duct

Question 34

Do loop diuretics cause hyponatremia?

Answer 34

No - they cause loss of water in presence of excess sodium ## Footnote w/ , thiazides ADH stimulated water reabsorption in the collecting ducts remains intact, but not loop diuretics

Question 35

What is the physiologic response to stimulation of muscarinic receptors in the detrusor?

Answer 35

Contraction of the detrusor

Question 36

Which of the following is the best option for treating stress incontinence? A. Phenylephrine B. Methanamine C. Bethanechol D. Oxybutynin

Answer 36

A. Phenylephrine

Question 37

What is the best parmacologic class for treating neurogenic bladder?

Answer 37

A muscarinic antagonist

Question 38

Which medication can potentially worsen stress incontinence?

Answer 38

Lisinopril

Question 39

Which antiinfective is a possibility for treating serious infections caused by gram positive bacteria (e.g. Staph) in the urinary tract, but is not a treatment for the same type of bacteria in the lungs due to inactivation?

Answer 39

Daptomycin

Question 40

Which of the following is the best choice to treat a urinary tract infection in a pregnant woman, near term?

Answer 40

Nitrofurantoin

Question 41

If medication adherence is likely to be an issue for a patient, what would be the best empiric treatment for uncomplicated cystitis?

Answer 41

Fosfomycin

Question 42

Answer 42

B. Pseudoephedrine | Diloxetine also used - inhibits reuptake of NE (and serotonin)

Question 43

What cephalosporins cover *Enterococcus*

Answer 43

Cephalosporins don't cover *Enterococcus* ## Footnote ampicillin remains an effective therapy for susceptible enterococcal infections, but cephalosporins are completely ineffective against enterococci

Question 44

MOA of aminoglycosides and coverage

Answer 44

Aminoglycosides are bactericidal antibiotics that primarily work by inhibiting bacterial protein synthesis. They achieve this by binding to the 30S subunit of the bacterial ribosome ## Footnote Their primary coverage includes aerobic gram-negative bacteria, though they can also be effective against mycobacteria and some gram-positive bacteria

Question 45

MOA of fosfomycin

Question 46

MOA of nitrofuantoin

Question 47

MOA of methanamine

Answer 47

Antimicrobial agent that is converted to formaldehyde in acidic conditions; given with vit Cl

Question 48

Sulfa Abx compete with _______

Answer 48

PABA to bind with dihydroptoate synthetase ## Footnote Trimethroprim inhibits dihydrofolate reductase

Question 49

# T Why are sulfas contraindicated in newborns

Answer 49

Highly protein bound ## Footnote Leads to elevated bilirubin in neonates (also competes with warfarin in those taking)

Question 50

Ace/ARB w/ sulfa Abx can lead to

Answer 50

Hyperkalemia

Question 51

Cipro inhibits (MOA)

Answer 51

DNA gyrase (topoisomerase III)