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🏠6. Renal pharmacology

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Question Bank

1
What does RAAS stand for?
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Renin-Angiotensin-Aldosterone System

2
What are RAAS pathway modulators?
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Agents that affect the RAAS to regulate blood pressure and fluid balance

3
What are the consequences of high blood pressure?
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Stroke, dementia, heart failure, vision loss, heart attack, kidney disease/ failure, and sexual dysfunction.

4
What are the four main categories of antihypertensive agents?
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1. Sympatholytic agents 2. vasodilators 3. antagonizing the renin-angiotensin-aldosterone pathway 4. diuretics

5
What are the RAAS med classifications
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Antagonizing the renin-angiotensin-aldosterone pathway.

6
What are the steps in the RAAS pathway?
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Angiotensinogen --renin→ Angiotensin I --ACE→ Angiotensin II → aldosterone production → BP mods

7
What are the examples of ACE-inhibitors mentioned in the slide?
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Captopril Enalapril

8
What is the mechanism of action (MOA) of ACE-inhibitors?
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Block ACE --> can't convert Ang I to II lower blood pressure

9
ACE inhibitor effects
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1. ↓ blood volume + ↓ vascular resistance 2. ↑ bradykinin → ↑ vasodilation 3. ↓ the secretion of aldosterone → ↓ sodium/water retention → ↓ blood volume

10
Renin Inhibitor Drug
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Aliskiren

11
renin inhibitor MOA
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Selective renin inhibitor

12
Angiotensin II receptor blockers (ARB) Drugs
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Losartan Valsartan

13
Angiotensin II receptor blockers (ARB) MOA
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Competitive antagonist for angiotensin-II receptor → blocks Ag-II → vasodilation + block aldosterone action (does not increase bradykinin)

14
What is the likely cause of angioedema and perioral swelling in individuals with African American ancestry?
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Increased bradykinin levels.

15
What is the low dose of Colchicine used for in adult patients with established atherosclerotic disease or multiple risk factors for cardiovascular disease?
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Antigout: cholchine NSAIDS: aspirin

16
Anti-gout MOA
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reduce the risk of MI, stroke, and cardiovascular death

17
What is the definition of a diuretic?
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med that increases urine production leading to increased excretion of water and electrolytes

18
What is the renal compensation mechanism?
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Increased blood volume = circulatory compensation mechanism helps return cardiac output and blood pressure toward normal

19
Indications for diuretics
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edematous states and hypertension

20
What is the site of action for loop diuretics?
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• Carbonic anhydrase inhibitors - weak • osmotic - rare

21
What diuretics are used in descending loop of henle?
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osmotics - rare

22
What diuretics are used in ascending loop of henle?
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loop diuretics - strongest

23
What diuretics are used in DCT?
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thiazides - weak

24
What diuretics are used in Collecting tubule and duct?
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• aldosterone antagonists - weak/moderate • sodium channel agonists - weakest • vasopressin agonists - moderate

25
Which diuretics are rarely used for diuresis?
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Osmotic diuretics

26
What is the example of an osmotic diuretic?
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Mannitol (Osmotrol®)

27
What is the indication for using osmotic diuretics?
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↑ osmolarity of tubular fluid → facilitates water excretion and prevents reabsorption

28
Carbonic anhydrase inhibitors Drug
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Acetazolamide

29
What is the mechanism of action (MOA) of carbonic anhydrase inhibitors?
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inhibits carbonic anhydrase → prevent sodium, hydrogen ion exchange → mild diuresis

30
Loop diuretic drugs
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Furosemide Bumetanide Torsemide

31
What are loop diuretics and what is their mechanism of action (MOA)?
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Block Na+-K+-2Cl− symporter → Reduce reabsorption of those electrolytes → increase ion concentration → more water secretion → increase the excretion of Na+, K+, Ca2+, Cl−, H+, and Mg2+

32
What is the sigmoidal dose-response curve of loop diuretics?
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It has three parts: threshold effect, rapid increase in diuresis with small changes in drug concentration, and ceiling effect.

33
Thiazide Diuretic drugs
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Chlorothiazide Hydrochlorothiazide

34
MOA of Thiazide Diuretics?
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inhibit sodium and chloride reabsorption → ↑ calcium reabsorption → ↑ excretion of sodium and chloride and ↓ excretion of calcium

35
What is the mechanism of action of Spironolactone (Aldactone®)?
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Spironolactone Amiloride

36
What are the indications for using potassium-sparing diuretics like Spironolactone?
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prevents Na+ reabsorption, prevent K+ and H+ secretion

37
What is the mechanism of action (MOA) of Amiloride?
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block epithelial sodium channels → decrease Na+/K+ exchange → increase sodium excretion, preserves K

38
What conditions are antidiuretics used to treat?
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Antidiuretics are used for central diabetes insipidus and nocturnal enuresis.

39
What are the uses of antagonists for ADH?
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to manage hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion

40
What is the renal function decline with advanced age?
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Renal function slightly declines with advanced age >70 years old.