Renal Pharmacology: Diuretics, RAAS Inhibitors, CCBs, and Lipid Lowering Drugs

Vocabulary flashcards covering the classification, mechanisms of action, clinical uses, and adverse effects of diuretics, ADH-related drugs, RAAS inhibitors, CCBs, vasodilators, anti-anginals, and hypolipidemic agents based on the lecture transcript.

Diuretics

Drugs that increase urine volume and flow rate.

Natriuretics

Drugs that primarily increase sodium ($Na^+$) excretion.

Aquaretics

Drugs that primarily increase water ($H_2O$) excretion by inhibiting the reabsorption of water.

Acetazolamide

A non-competitive and reversible carbonic anhydrase inhibitor that acts on the proximal convoluted tubule (PCT) of the nephron.

High ceiling diuretic

A class of diuretics, specifically Loop diuretics, that are the most effective and produce maximum $Na^+$ loss.

Bumetanide

The most potent drug among the loop diuretics.

Torasemide

The longest-acting loop diuretic.

Ethacrynic acid

A phenoxy-acetic acid loop diuretic that is highly ototoxic and can cause permanent deafness.

Chlorthalidone

The longest-acting thiazide diuretic.

Metolazone

A thiazide-like diuretic that is safe to use in patients with renal failure and acts as an add-on drug to loop diuretics.

Spironolactone

A potassium-sparing diuretic that acts as an aldosterone receptor antagonist from the basolateral side and also blocks testosterone receptors.

Canrenone

The active form of the drug Spironolactone.

Eplerenone

An aldosterone antagonist that, unlike spironolactone, does not produce side effects like gynecomastia or impotency.

Amiloride

An ENaC inhibitor used as the drug of choice for Liddle syndrome and lithium toxicity.

SGLT-2 Inhibitors

Drugs ending in '-gliflozin' that inhibit the sodium-glucose transporter in the PCT, causing sodium loss and glycosuria.

Hyperchloremic hypokalemic metabolic acidosis

An electrolyte and acid-base imbalance caused by carbonic anhydrase inhibitors where the kidney retains chloride while losing sodium, potassium, and bicarbonate.

Mannitol

An osmotic diuretic given IV that increases plasma osmolarity, used to treat cerebral edema and acute glaucoma.

Dialysis disequilibrium syndrome

A condition occurring after dialysis where the movement of water into the brain causes cerebral edema; treated with Mannitol.

V2 Receptor

A Gs-type GPCR present in endothelial cells (releasing vWF and Factor 8) and the collecting duct of the nephron (producing aquaporin II for water reabsorption).

Desmopressin (DDAVP)

A long-acting, potent $V_2$ agonist given orally or nasally; it is the drug of choice for Hemophilia A, nocturnal enuresis, and neurogenic diabetes insipidus.

Tolvaptan

A $V_2$ antagonist used in the treatment of Autosomal Dominant Polycystic Kidney Disease (ADPKD) and chronic hyponatremia in SIADH.

SiADH (Syndrome of Inappropriate ADH Secretion)

A condition characterized by excess water reabsorption leading to dilutional hyponatremia and negative free water clearance.

Aliskiren

The only approved direct renin inhibitor (DRI) used as a second-line antihypertensive drug.

ACE Inhibitors

Drugs ending in '-pril' that inhibit the conversion of Angiotensin 1 to Angiotensin 2 and decrease the degradation of bradykinin.

Angioedema

A severe allergic reaction involving swelling of the face, lips, and eyes; a known side effect of ACE inhibitors due to increased bradykinin.

Telmisartan

An Angiotensin-1 receptor blocker (ARB) that is the safest for patients with renal disease and possesses PPAR-gamma agonist properties.

Sprue with Sartans

A condition characterized by diarrhea due to $AT_2$ receptor activation in the GI tract; most commonly associated with Olmesartan.

Verapamil

A Non-DHP calcium channel blocker that is the most specific for cardiac tissue and the preferred CCB for supraventricular tachycardia (SVT).

Nimodipine

A cerebro-selective calcium channel blocker used as the drug of choice for cerebral vasospasm in subarachnoid hemorrhage (SAH).

Clevidipine

The shortest-acting IV calcium channel blocker, degraded by plasma esterase.

Calcium gluconate

The antidote for calcium channel blocker (CCB) toxicity.

Minoxidil

A potassium ($K^+$) channel opener used as a cutaneous vasodilator to treat alopecia.

Diazoxide

A potassium channel opener that inhibits insulin secretion by opening receptors on pancreatic beta cells; used to treat insulinoma.

Sodium nitroprusside

The fastest-acting antihypertensive drug; a combined vasodilator that directly releases nitric oxide but carries a risk of cyanide and thiocyanate toxicity.

Hydroxocobalamin

A form of Vitamin $B_{12}$ that acts as the drug of choice for cyanide poisoning by chelating cyanide to form cyanocobalamin.

Prinzmetal Angina

Also known as vasospastic or variant angina; it is caused by sudden coronary vasospasm and results in chest pain at rest.

Robinhood phenomenon

The redistribution of coronary blood flow from non-ischemic areas to ischemic areas, typically induced by nitrates.

Coronary steal syndrome

A phenomenon where drugs like dipyridamole dilate subendocardial arteries in non-ischemic areas, diverting blood away from ischemic zones and worsening angina.

Bezold Zarisch reflex

Bradycardia caused by the stimulation of the Vagus nerve following the sudden dilation of coronary arteries by nitrates.

Monday’s disease

A form of nitrate tolerance observed in factory workers where therapeutic effects and side effects are maximal on Monday and decrease throughout the week.

Ivabradine

A drug that inhibits 'funny' channels (HCN) in the SA node to reduce heart rate without affecting contractility; a side effect is visual abnormalities (luminous phenomenon).

Trimetazidine

A partial fatty acid oxidation ($pFOX$) inhibitor that shifts the heart's metabolism from fatty acids to glucose to save oxygen; it can induce Parkinson-like symptoms.

Statins

Competitive inhibitors of HMG-CoA reductase that block the rate-limiting step of de novo cholesterol synthesis in the liver.

Rosuvastatin

The most efficacious and longest-acting statin; it is not metabolized by the CYP enzyme system.

Rhabdomyolysis

A severe form of myopathy involving the degeneration of skeletal muscles, release of myoglobin into urine, and potentially asute renal failure; a side effect of statins.

Fibrates

PPAR-alpha agonists that stimulate the synthesis of lipoprotein lipase ($LPL$) to remove triglycerides from the blood; the drug of choice for hypertriglyceridemia.

Niacin

Vitamin $B_3$; at high doses, it inhibits lipolysis and is the most effective drug for increasing $HDL$ levels.

Ezetimibe

A drug that inhibits the $NPC_1L_1$ transporter in the intestine to block the absorption of dietary cholesterol.

PCSK9 Inhibitors

Monoclonal antibodies like Alirocumab and Evolocumab that block the $PCSK9$ enzyme, leading to an increase in LDL receptors and a drastic reduction in blood $LDL$ levels.

Lomitapide

A Microsomal Triglyceride Transfer Protein ($MTP$) inhibitor that decreases $VLDL$ synthesis in the liver.