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Renal Pharmacology

Renal Pharmacology. Renal Exam II. Diuretics. Osmotic Diuretics. Overview Caution: Heart or pulmonary congestion ↑ ECF volume => PULMONARY EDEMA Contraindicated: AN URIA due to renal disease DO NOT USE IF THERE IS INTRACRANIAL BLEEDING! M annitol (IV) Clinical Use:

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Renal Pharmacology

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  1. Renal Pharmacology Renal Exam II

  2. Diuretics

  3. Osmotic Diuretics • Overview • Caution: • Heart or pulmonary congestion • ↑ ECF volume =>PULMONARY EDEMA • Contraindicated: ANURIAdue to renal disease • DO NOT USE IF THERE IS INTRACRANIAL BLEEDING! • Mannitol (IV) • Clinical Use: • Prevent or tx Oliguric phase of Acute Renal Failure • ↓ Intracranial pressure inCerebral Edema • ↓ IOP • Promote urinary excretion of toxic substances

  4. Osmotic Diuretics • Urea (IV) • Clinical Use: • ↓ Intracranial pressure inCerebral Edema • ↓ IOP • Glycerin (Oral) • Clinical Use: Glaucoma • SN: • Metabolized to glucose => HYPERglycemia • Isosorbide (Oral) • Clinical Use: • ↓ IOP and acute glaucoma attack after intraocular surgery

  5. Carbonic Anhydrase InhibitorsCAUTION if allergic to Sulfa • Overview • MOA (PCT) • Inhibits reabsorption of: • Na+, bicarb, water, and indirectly K+. • Refer to notes for exact mechanism • Clinical Uses: • Glaucoma • Catamenial epilepsy • Tx for MetabolicAlkalosis • High altitude sickness <= Chris Eicher’s HY

  6. Carbonic Anhydrase InhibitorsCAUTION if allergic to Sulfa • Acetazolamide • Methazolamide • Dorzolamide (only used for Glaucoma) • Brinzolamide (only used for Glaucoma)

  7. Loop Diuretics • Overview • MOA (ALH) • Inhibit the Na/K/Cl cotransport of the luminal membrane • Ascending limb of the LOOP of Henle. • Clinical Use: • Pulmonary edema • EdemaCirrhosis • Nephrotic Syndrome • CHF • Hypertension

  8. Loop Diuretics • SE: • ↑ RISK of ARRHYTHMIAS • ↓ [electrolyte] : Na, K, Cl, Ca, and Mg • Ototoxicity • Inhibition of electrolyte transport in ENDOLYMPH • HYPERglycemia • Insulin α Ca CAUTION DIABETICS

  9. Loop Diuretics • Rx Interactions • Aminoglycosides • Digoxin - ↑ risk of arrhythmias • NSAIDS • InhibitsPG-mediated ↑ in RBF=> ↓ diuretic effects • Li+ - subs for Na+ • Quinidine – Potentially fatal Torsades de pointes • Hypokalemia => ↑ risk of arrhythmias

  10. Loop Diuretics (Oral or IV) • Furosemide (Lasix) • MOA: • Dilate Veins => ↑ Venous Capacitance • Clinical Use:PULMONARY EDEMA • Torsemide • Bumetanide (diuretic action 4-6 hrs) • Ethacrynic Acid • MOST Ototoxic! But NOT aSulfa

  11. ThiazidesCAUTION if allergic to Sulfa • Overview • MOA(DCT) • Blocks Cl site of the Na/Clcotransporter (LM) • The kidney’s ability to [urine] during hydropenia is NOT altered. • Clinical Use • Hypertension • CHF • Hepatic cirrhosis • Nephrotic Syndrome assoc. edema

  12. Thiazides • Chlorothiazide • Hydrochlorothiazide • Bendroflumethiazide • Indapamide • Longest t1/2 = last up to 72 hours • Hydroflumethiazide • Trichlormethiazide • Methyclothiazide

  13. Thiazides-Like Drugs • Overview • SE: Like effects on electrolytes as loop diuretics • NotOtotoxic • Caution: • Quinidine – Potentially fatal Torsades de pointes • Diabetics - HYPERglycemia • Gout = ↑ plasma [uric acid] • Metolazone • Chlorthalidone • Long t1/2 = 24-72 hrs

  14. Potassium Sparing Diuretics • Na+ Channel Blockers (DCT & CD) • Triamterene • Amiloride • Aldosterone Receptor Agonist • Spironolactone • SE: • Hyperkalemia (ACEI & ARB ↑ side effect) • Gynecomastia, impotence, hirsutism, menstratrual, irregularities, ↓ libido • Eplerenone

  15. Potassium Supplements • Oral Liquids • Powders • Effervescent Tabs

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