03 - Renal System and Diuretics

Question 0

Edema is the passage of fluid from vasculature to

Answer 0

Interstitial space

Question 1

Fluid overload can occur

Answer 1

Throughout the body or in just one compartment

Question 2

You can treat or prevent fluid overload with fluid restriction but you may need

Answer 2

Diuresis

Question 3

Blood flows into the glomerulus via the afferent arteriole where it is

Answer 3

Filtrated into the renal tubule

Question 4

Na is mostly reabsorbed

Answer 4

ISOTONICALLY

Throughout the renal tubule

Question 5

What is the normal fractional excretion of Na (FENa)?

Answer 5

<1%

Question 6

Where in the kidneys do diuretics work? What happens if diuretic cannot get to this area?

Answer 6

Renal tubule

If diuretic cannot get into the tubule, (renal failure) it can’t work.

Question 7

Normally in the kidneys, H+ is ____ and bicarbonate is

Answer 7

Pumped into urine (Na/H pump)

Filtered into urine

Question 8

Hydrogen ions and bicarbonate form carbonic acid which is broken down by ______ into water and carbon dioxide and reabsorbed by the body.

Answer 8

Carbonic anhydrase

Question 9

Acetazolamide works in the proximal tubule by inhibiting ______. How does this act as a diuretic?

Answer 9

Carbonic anhydrase

Inhibition reverses the Na/H pump so that Na reabsorption is inhibited. Water will follow the Na that is in urine. There will also be excess bicarbonate

Question 10

In summary, the effects of acetazolamide are

Answer 10

Alkaline urine

Hyperchloremic metabolic acidosis

Question 12

If somebody has a sulfa allergy, what will they have cross sensitivity to?

Answer 12

Acetazolamide

Maybe mannitol

Question 13

Mannitol is an osmotic diuretic that is _____ filtered and ____ reabsorbed

Answer 13

Freely

Poorly

Question 14

How does mannitol limit passive water reabsorption?

Answer 14

It increases renal tubular osmolarity

Question 15

How can mannitol cause fluid overload, pulmonary edema, or hypernatremia from hyponatremia?

Answer 15

It draws water from cells into plasma, which increases renal blood flow

Question 16

Does mannitol show evidence for renal protection?

Answer 16

Maybe in acute injury in renal transplant but otherwise, no

Question 17

Extravasation of mannitol can cause

Answer 17

Tissue injury

Compartment syndrome

Question 18

Which diuretic would you use to decreases ICP or IOP?

Answer 18

Mannitol

Question 19

Dosage of mannitol?

Answer 19

.25-1 g/kg

Question 20

First line treatment for acute CHF?

Answer 20

Loop diuretics - furosemide (Lasix), torsemide (demadex), bumetanide (bumex)

Relieve congestion, pulm edema, swelling and peripheral edema

Question 21

How much NaCl is normally reabsorbed at the Loop of Henle?

Answer 21

25%

Question 22

Loop diuretics bind to the ____ site of the Na K ATPase pump to prevent

Answer 22

Cl

Salt reabsorption in the thick ascending limb of the Henle’s Loop

Question 23

What are the side effects of mannitol?

Answer 23

HYPOnatremia
HYPOkalemia
HYPOvolemia

Question 24

Diuretic that can possibly cause oto-toxicity?

Answer 24

Mannitol

Question 25

Hypovolemia along with diuresis can cause

Answer 25

Renal injury (decreased global perfusion)

Question 26

Dosage of furosemide?

Answer 26

.1-1 mg/kg

Question 27

Thiazides (HCTZ) block NaCl reabsorption at the

Answer 27

Distal convoluted tubule - causing large Na gradient Similar overall result to loop diuretics

Question 28

Which ions are excreted in the urine?

Answer 28

Na K Cl HCO3

Question 29

A large Na gradient in the distal tubules leads to

Answer 29

k excretion

Question 30

HCTZ is used for the treatment of

Answer 30

HTN Volume overload Pregnancy-associated edema

Question 31

The initial effect of HCTZ is due to

Answer 31

Decreased extra cellular volume

Question 32

The sustained effect of HCTZ is due to

Answer 32

Peripheral vasodilation Caused by diminished peripheral sympathetic activity

Question 33

The amount of peripheral vasodilation from HCTZ correlates with the decreases total body stores of

Answer 33

Sodium

Question 34

Side effects of HCTZ are

Answer 34

HYPOKALEMIC HYPOCHLOREMIC METABOLIC ALKALOSIS HYPOnatremia, HYPOvolemia, orthostatic hypotension Others: pancreatitis, hyperglycemia, diarrhea, aplastic anemia

Question 35

K sparing diuretics (amiloride, triamterene) block _____ in the distal collecting duct to prevent Na reabsorption

Answer 35

Epithelial Na channels

Question 36

Amiloride and triamterene inhibit ____ into distal renal tubules

Answer 36

K secretion

Question 37

K sparing diuretics are often used in combination with

Answer 37

Loop/thiazide diuretics

Question 38

Side effects of K sparing diuretics?

Answer 38

HYPOnatremia | HYPERkalemia

Question 39

Aldosterone: save sodium, pee potassium

Answer 39

Ok

Question 40

Aldosterone antagonists spare

Answer 40

Potassium

Question 41

Spironolactone is an

Answer 41

Aldosterone antagonist

Question 42

Spironolactone inhibits ____ and causes

Answer 42

Na reabsorption | K retention

Question 43

What is an effective treatment in volume overload with heart failures and cirrhosis, commonly combined with other anti hypertensive agents?

Answer 43

Spironolactone

Question 44

Side effects of spironolactone?

Answer 44

HYPOnatremia HYPERkalemia Gynecomastia

Question 55

Clinical indications for acetazolamide?

Answer 55

Moderate-severe alkalosis, altitude sickness, diuresis for heart failure Also, glaucoma, epilepsy, pseudo tumor cerebri, central sleep apnea - decreases formation of CSF and aqueous humor