Renal Pharmacology

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Renal Pharmacology

• Renal Exam II

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Diuretics
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Osmotic Diuretics

• Overview
• Caution
• Heart or pulmonary congestion
• ? ECF volume gt PULMONARY EDEMA
• Contraindicated ANURIA due 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 in Cerebral Edema
• ? IOP
• Promote urinary excretion of toxic substances

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Osmotic Diuretics

• Urea (IV)
• Clinical Use
• ? Intracranial pressure in Cerebral Edema
• ? IOP
• Glycerin (Oral)
• Clinical Use Glaucoma
• SN
• Metabolized to glucose gt HYPERglycemia
• Isosorbide (Oral)
• Clinical Use
• ? IOP and acute glaucoma attack after intraocular
  surgery

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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 Metabolic Alkalosis
• High altitude sickness lt

Chris Eichers HY
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Carbonic Anhydrase InhibitorsCAUTION if allergic
to Sulfa

• Acetazolamide
• Methazolamide
• Dorzolamide (only used for Glaucoma)
• Brinzolamide (only used for Glaucoma)

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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
• Edema Cirrhosis
• Nephrotic Syndrome
• CHF
• Hypertension

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Loop Diuretics

• SE
• ? RISK of ARRHYTHMIAS
• ? electrolyte Na, K, Cl, Ca, and Mg
• Ototoxicity
• Inhibition of electrolyte transport in ENDOLYMPH
• HYPERglycemia
• Insulin a Ca

CAUTION DIABETICS
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Loop Diuretics

• Rx Interactions
• Aminoglycosides
• Digoxin - ? risk of arrhythmias
• NSAIDS
• Inhibits PG-mediated ? in RBF gt ? diuretic
  effects
• Li - subs for Na
• Quinidine Potentially fatal Torsades de pointes
• Hypokalemia gt ? risk of arrhythmias

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Loop Diuretics (Oral or IV)

• Furosemide (Lasix)
• MOA
• Dilate Veins gt ? Venous Capacitance
• Clinical Use PULMONARY EDEMA
• Torsemide
• Bumetanide (diuretic action 4-6 hrs)
• Ethacrynic Acid
• MOST Ototoxic!

But NOT a Sulfa
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ThiazidesCAUTION if allergic to Sulfa

• Overview
• MOA (DCT)
• Blocks Cl site of the Na/Cl cotransporter (LM)
• The kidneys ability to urine during hydropenia
  is NOT altered.
• Clinical Use
• Hypertension
• CHF
• Hepatic cirrhosis
• Nephrotic Syndrome assoc. edema

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Thiazides

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

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Thiazides-Like Drugs

• Overview
• SE Like effects on electrolytes as loop
  diuretics
• Not Ototoxic
• Caution
• Quinidine Potentially fatal Torsades de pointes
• Diabetics - HYPERglycemia
• Gout ? plasma uric acid
• Metolazone
• Chlorthalidone
• Long t1/2 24-72 hrs

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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

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Potassium Supplements

• Oral Liquids
• Powders
• Effervescent Tabs