Nephrology

Question 1

Which drug classes work on the glomerulus as their site of action?

Answer 1

None!

Question 2

Which drug classes work on the proximal tubules?

Answer 2

• Carbonic anhydrase inhibitors (CAIs)

- Adenosine antagonist (current investigation)

Question 3

Carbonic anhydrase inhibitors (CAIs) MOA

Answer 3

• Inhibits enzyme responsible for dehydration of H2CO3

- Reduces aqueous humor production

Question 4

CAI examples

Answer 4

Acetazolamide
Dorzolamide (ophthalmic)
Brinzolamide (ophthalmic)

Question 5

Indications for CAIs

Answer 5

• Glaucoma
• Urinary acidosis
• Metabolic alkalosis
• Acute mountain sickness

Question 6

ADRs of CAIs

Answer 6

• Renal stones
• K wasting
• Drowsiness
• Hypersensitivity reaction

Question 7

Contraindication of CAIs

Answer 7

Hepatic cirrhosis

Question 8

PK of CAIs

Answer 8

• Absorbs well
• Increases urine pH
• Onset w/in 30 mins
• Duration 12 hrs

Question 9

Which drug classes work on Loop of Henle?

Answer 9

Loop diuretics

Question 10

Loop diuretic MOA

Answer 10

Inhibits Na/K/Cl transporter

Question 11

Indications for loop diuretics

Answer 11

• Edema
• Hypercalcemia
• Hyperkalemia
• Anion overdose

Question 12

ADRs of loop diuretics

Answer 12

• Low Mg
• High uric acid
• Ototoxicity
• Allergic reaction

Question 13

Contraindications of loop diuretics

Answer 13

• Careful in hepatic cirrhosis, renal/heart failure

- Sulfa allergy

Question 14

Drug-drug interactions of loop diuretics

Answer 14

NSAIDs can decrease effectiveness of loop diuretics

Question 15

PO to IV conversion of furosemide

Answer 15

2:1

40 mg PO = 20 mg IV

Question 16

PO to IV conversion of torsemide and bumetanide

Answer 16

1:1

Question 17

Which drug classes work on distal convoluted tubule?

Answer 17

Thiazide diuretics

Question 18

Thiazide MOA

Answer 18

• Inhibits NaCl transporter

- Enhances Ca reabsorption

Question 19

Indications for thiazides

Answer 19

• HTN
• Heart failure
• Nephrogenic DI
• Nephrolithiasis

Question 20

PK of thiazides

Answer 20

• Absorbed slowly

- Chlorthalidone slowest but longer duration of action

Question 21

What agent is the slowest absorbed but longest lasting thiazide?

Answer 21

Chlorthalidone

Question 22

ADRs of thiazides

Answer 22

• Low Na, K
• High uric acid, lipids
• Allergic rxn
• Photosensitivity

Question 23

Thiazides should be used with caution in which conditions?

Answer 23

• Hepatic cirrhosis
• Renal failure
• Heart failure

Question 24

Which thiazide is effective with GFR less than 20 ml/min?

Answer 24

Metolazone

Question 25

Which thiazide comes in IV formulation?

Answer 25

Chlorothiazide

Question 26

Which drug classes work on the cortical collecting tubule?

Answer 26

K sparing diuretics | Adenosine antagonists

Question 27

Indications for K sparing diuretics

Answer 27

Hypokalemia (prevention/tx)

Question 28

Indications for spironolactone

Answer 28

- Hyperaldosterism - Polycystic ovary disease - Hirsutism

Question 29

ADRs of K sparing diuretics

Answer 29

- High K - Kidney stones (triamterene) - Gynecomastia, impotence (spironolactone)

Question 30

When is spironolactone contraindicated?

Answer 30

Addison's disease

Question 31

Drug-drug interactions of K sparing diuretics

Answer 31

- Eplerenone only | - Strong CYP3A4 agents

Question 32

Which drug classes act on the medullary collecting duct?

Answer 32

Vassopressin (ADH) antagonists

Question 33

Indications of ADH antagonists

Answer 33

- Congestive heart failure | - SIADH

Question 34

ADH antagonist agents (indirect)

Answer 34

Lithium Demeclocycline (MOA unknown)

Question 35

ADH antagonist agents (direct)

Answer 35

Conivaptan Tolvaptan (MOA: inhibits vasopressin receptors)

Question 36

ADRs of direct ADH antagonists

Answer 36

- Nausea - Dry mouth - Thirst

Question 37

CI of direct ADH antagonists

Answer 37

- Hypovolemia | - Hyponatremia

Question 38

Drug-drug interactions of direct ADH antagonists

Answer 38

Strong CYP3A4 agents

Question 39

Osmotic diuretics MOA

Answer 39

- Increase osmotic pressure in glomerulus | - Decreases reabsorption of H2O and electrolytes

Question 40

Indications for osmotic diuretics

Answer 40

- Cerebral edema - Acute glaucoma - Bronchial hyper-responsiveness

Question 41

Osmotic diuretic agents

Answer 41

- Glycerol | - Mannitol (PO, inhaled, IV)

Question 42

PK of osmotic diuretics

Answer 42

- Poorly absorbed | - Quickly excreted

Question 43

ADRs of glycerol

Answer 43

N/V, diarrhea

Question 44

ADRs of mannitol

Answer 44

Excessive volume expansion (heart failure, edema, pulm congestion)

Question 45

How are osmotic agents better tolerated?

Answer 45

- Oral - Mixed w/small amount of juice - Add ice - Small sips

Question 46

How is CrCl calculated?

Answer 46

Cockroft-Gault (MC)

Question 47

Which meds can cause vasoconstriction of afferent arteriole?

Answer 47

NSAIDs Cyclosporine Tacrolimus Amphotericin B

Question 48

Which meds can cause vasodilation of efferent arteriole?

Answer 48

ACEI/ARBs | Dilt and verapamil

Question 49

Which meds cause direct toxicity to renal tubules?

Answer 49

Aminoglycosides Amphotericin B Cisplatin and carboplatin Radiocontrast agents

Question 50

What drug has been proven to accelerate the recovery of renal failure?

Answer 50

None!