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Pharm > Cardio V > Flashcards

Cardio V Flashcards

1
Q

What is the most metabolically active part of the nephron? Second?

A

Proximal convoluted tubule

Thick ascending

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2
Q

What is the order of the nephron? (7)

A 
Proximal
Thick descending
Thin Descending
Think Ascending
Think ascending
Distal convoluted
Collecting duct
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3
Q

Where is most of the Na/potassium in the renal tubule reabsorbed? Is this regulated?

A

Proximal convoluted tubule

Not regulated

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4
Q

What is the primary process that is occurring in the thin descending loop of henle?

A

Water reabsorption passively

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5
Q

What is the primary process that is occurring in the thick ascending loop of henle?

A

Reabsorption of electrolytes, no water

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6
Q

What is the primary process that is occurring in the distal convoluted tubule?

A

Na Cl reabsorption–No K

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7
Q

What is the primary process that is occurring in the collecting duct?

A

NaCl reabsorption

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8
Q

Where does ADH work?

A

Collecting duct

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9
Q

What part of the tubule is regulated for K uptake?

A

Distal convoluted tubule

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10
Q

What are the processes that are occurring at the glomerulus?

A

Non

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11
Q

Where is glucose reabsorbed in the nephron?

A

Proximal convoluted tubule

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12
Q

What is the relative water permeability of the distal convoluted tubule?

A

Very low

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13
Q

What is the primary transporter at the: glomerulus?

A

None

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14
Q

What is the primary transporter at the: PCT?

A

Na/H exchanger

Carbonic anhydrase

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15
Q

What is the primary transporter at the: Straight segments of the proximal tubule

A

Acid and base transporters

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16
Q

What is the primary transporter at the: thin descending loop

A

aquaporins

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17
Q

What is the primary transporter at the: thick ascending

A

Na/K/Cl

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18
Q

What is the primary transporter at the: DCT

A

Na/Cl

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19
Q

What is the primary transporter at the: cortical collecting tubule

A

Na channels
K channels
Aquaporins

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20
Q

What is the primary transporter at the: medullary collecting duct

A

Aquaporins

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21
Q

What happens when there is an increase in [Na] of the filtrate when it gets to the distal convoluted tubule?

A

Increased K excretion

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22
Q

What is the prototypical carbonic anhydrase inhibitor?

A

Acetazolamide

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23
Q

What is carbonic anhydrase needed for in the kidney? Where is it found?

A

HCO3 reabsorption in the proximal convoluted tubule

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24
Q

What is the exchanger protein in the proximal convoluted tubule, that is responsible for the reuptake of Na? Which side of the tubular cell is this found on?

A

Na/H exchanger

Both lumenal and basolateral–pumps H+ from circulation all the way out to the tubule in exchange for Na

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25
Q

What happens to the H+ that is secreted into the lumen of the renal tubule?

A

Combines with HCO3- to form bicarb

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26
Q

What happens to the bicarbonate in the nephron lumen?

A

carbonic anhydrase converts it to CO2 and H2O. CO2 then goes back into the tubule cell, where it forms H2CO3 again in the cell

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27
Q

Inhibition of carbonic anhydrase causes a major loss of what chemical in the urine? What chemical is maintained in the tubule? What is the effect of this on the circulation?

A

HCO3- lost
NH4 maintained
metabolic acidosis

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28
Q

What happens when there is decreased HCO3 absorption by the PCT? What does this cause?

A

Increased solute delivery to the macula densa, increasing afferent arteriolar resistance, and decreasing renal blood flow

29
Q

What is tubular glomerular feedback?

A

Increased solute delivery to the macula densa leads to increased afferent arteriolar resistance, and low GFR

30
Q

What happens to Na/Cl when HCO3 flows out of the tubule?

A

Na and Cl follow

31
Q

Why is it that when carbonic anhydrase is inhibited, there is an increase in K excretion?

A

Loss of HCO3 increases Na/Cl excretion. Higher Na in the filtrate will increase K excretion

32
Q

Why are carbonic anhydrase inhibitors used in the treatment of glaucoma?

A

CA is present in the ciliary body, and plays a role in aqueous humor production

33
Q

What is the most common indication for carbonic anhydrase inhibitors?

A

glaucoma

34
Q

Why is carbonic anhydrase used in the treatment of acute mountain sickness?

A

CA is present in the choroid plexus. By decreasing CSF formation, and decreasing the pH of the CSF and brain, CA can increase ventilation and diminish symptoms of mountain sickness

35
Q

Why is carbonic anhydrase used in the treatment of gout or drug clearance?

A

Increased excretion of uric acid in alkaline urine caused by CA inhibitors

36
Q

Why is carbonic anhydrase used in the treatment of edema states?

A

Diuretic aspect

37
Q

Chronic reduction of HCO3 stores by CA inhibitors leads to what?

A

Hyperchloremic metabolic acidosis

38
Q

How does CA inhibitors lead to renal stones?

A

Increased excretion of Na leads to the build up of Ca salts

39
Q

How does renal K wasting occur with CA inhibitors? How can this effect be counteracted?

A

Increasing the lumen negative electrical potential in the collecting tubule enhances K excretion

Administer KCl

40
Q

What diseases contraindicate CA inhibitors? Why?

A

Cirrhosis, hyperammonemia, and hepatic encephalopathy, because NH4 levels are increased with CA inhibitor

41
Q

What is the MOA of osmotic diuretics?

A

Osmotic agents that stay in the filtrate and cause water to be pulled into it

42
Q

What are the four osmotic diuretics?

A

Mannitol
Glycerin
Isosorbide
Urea

43
Q

What is the main site of action of osmotic diuretics?

A

Thin loop of henle

44
Q

Why is there an increased loss of K with osmotic diuretics?

A

Increased distal flow in the distal tubule stimulates K secretion

45
Q

How do osmotic diuretics reduce acute tubular necrosis?

A

maintain flow through the tubule

  1. Remove obstructing tubular casts
  2. Dilution of nephrotoxic substances
  3. Reduction of swelling of tubular elements
46
Q

Why are osmotic diuretics used in the treatment of cerebral edema?

A

Alter starling’s forces to pull water out of cells

47
Q

What is dialysis disequilibrium syndrome?

A

Too rapid of a removal of solutes from ECF by hemodialysis results in a reduction of osmolality of the ECF, causing a fluid shift into the intracellular compartment

48
Q

How do osmotic diuretics help in dialysis disequilibrium syndrome?

A

Osmotic diuretics increase the osmolality of the extracellular fluid compartment and thereby shift water back into the extracellular compartment

49
Q

How do osmotic diuretics help with acute attacks of glaucoma?

A

Increasing osmotic pressure of the plasma, extract water from the eye

50
Q

What are the three adverse effects of osmotic diuretics?

A

Expand extracellular fluid volume
Hyponatremia
Hypernatremia

51
Q

What pts are particularly at risk for expansion of ECF volume d/t osmotic diuretics?

A

heart failure

52
Q

How do osmotic diuretics cause hyponatremia?

A

Increased extraction of water

53
Q

How do osmotic diuretics cause hypernatremia?

A

Loss of water in excess of electrolytes

54
Q

Why should pts with impaired liver function not be given urea as an osmotic diuretic?

A

Increases ammonia level

55
Q

Why should pts with an active cranial bleed not be given mannitol or urea?

A

Diuretic will leak out of the intravascular compartment

56
Q

Why should hyperglycemic pts not be given glycerin?

A

Glycerin can be metabolized and cause hyperglycemia

57
Q

What is the MOA of loop diuretics?

A

Selectively inhibit NaCl reabsorption in the thick ascending loop of henle (NKCC inhibition)

58
Q

Why are loop diuretics so efficacious?

A

huge absorptive capacity of NaCl in the tubules

59
Q

What are the three loop diuretics?

A
  1. Furosemide
  2. Bumetanide
  3. Ethacrynic acid
60
Q

What is the effect of loop diuretics on the veins?

A

Decreased venous pressure

61
Q

Why is it that you lose Ca and Mg with loop diuretics?

A

Decreasing the lumen positive potential that promotes Ca/Mg reabsorption

62
Q

Why are loop diuretics used for acute pulmonary edema?

A

Rapid increase in venous capacity and fast natriuresis relieved pressure on the heart

63
Q

Why are loop diuretics used to treat chronic congestive heart failure?

A

Minimizes pulmonary and venous congestion

64
Q

Why are loop diuretics used for nephrotic syndrome?

A

Loop diuretics are the only drugs that are able to draw off fluid from the kidneys

65
Q

What are loop diuretics used in liver cirrhosis?

A

Draw of edema/ascites caused by liver failure

66
Q

Why are loop diuretics used in drug overdoses?

A

Induce a forced diuresis for rapid renal elimination of the offending drug

67
Q

What are loop diuretics used in hypercalcemia?

A

Will maintain Ca in the lumen of the nephron, causing loss in the urine

68
Q

Why are loop diuretics used to treat hyponatremia?

A

they interfere with the kidney’s capacity to produce concentrated urine.

Using hypertonic saline + loop diuretics

69
Q

What is THE major adverse effect of loop diuretics?

A

Hypokalemia

Pharm (73 decks)

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