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Pharm > Diuretics > Flashcards

Diuretics Flashcards

Test 3

1
Q

What do diuretics treat?

A

HTN
Edema

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2
Q

Diuretics and ______ are used interchangeably

A

Natriuretic

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3
Q

Diuretics increase _____ volume while Natriuretics increase __________ secretrion

A

Urine

Sodium ion (which increases water secretion)

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4
Q

Increasing urine output, decreases ______ and decreases blood pressure

A

blood volume

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5
Q

What is the functional unit of the kidney?

A

Nephron

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6
Q

Where does a nephron start?

A

The Glomerulus which is located in the cortex

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7
Q

What happens in the nephrons?

A
  • blood is filtered
  • water, ions, and glucose are reabsorbed
  • urine is produced & substances are from blood into urine
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8
Q

How many nephrons does each kidney contain?

A

800,000 to 1,000,000

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9
Q

What is one of the main substances that is secreted by the kidneys and not reabsorbed back into the blood? why?

A

NH3 – Ammonia

This is a waste product that is filtered by the kidneys. build up can cause coma/death. Therefore its converted to urea (made in the liver) and excreted by the kidneys.

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10
Q

T/F: The medulla is the outer part of the kidney and the cortex is the inner part

A

F

Switched

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11
Q

Describe the hilus

A

“hilum”

Center/medial side of the kidney where the renal artery, renal vein, and ureter are located

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12
Q

What structures exit the ureter?

A

hilum -> ureter -> urinary bladder -> urethra -> exits body

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13
Q

What type of structure is the glomerulus?

A

capillary

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14
Q

What is “the loop”

A

The very bottom of the loop of Henle

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15
Q

T/F: The glomerulus is located in the medulla

A

F

cortex

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16
Q

F/T: The cortex and medulla have different osmolality

A

T

It effects how much water is reabsorbed back into the urine vs blood

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17
Q

Where is the Loop of Henle?

A

The medulla

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18
Q

What parts make up the Loop of Henle?

A

Thick descending -> thin descending -> the loop -> ascending thin -> ascending thick

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19
Q

The proximal and distal _______ tubules are in the _______

A

convoluted

cortex

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19
Q

Describe the renal corpuscle

A

Bowman’s capsule
Glomerulus

Where the blood is filtered

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20
Q

Where does the distal tubules dump?

A

Collecting ducts

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20
Q

T/F: the collecting tubule and ducts are part of the nephron

A

F

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21
Q

What is the bowman’s capsule?

A

Epithelial and connective tissues that surrounds the glomerulus capillary structure .

Catches secretions and is the beginning of the nephron

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22
Q

What type of cell provides the filtration in the renal corpuscle?

A

podocytes

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23
Q

What does protein in the urine mean?

A

Proteinuria

Podocytes are not permeable to large protein molecules. This indicated problem with the kidneys.

(small proteins can cross)

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24
Q

Where are the Macula Densa Cells located?

A

Juxtaglomeruler apparatus in the distal tubule; which end up being very close to the glomerulus and the afferent glomerulus artery

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25
Q

What do the Macula Densa Cells do?

A

Sense Na+ and fluid pressure in the distal tubule

Active the RAA system and regulate blood flow directly into the glomerulus by increasing or decreasing release of NO to juxtaglomerular cells to increase or decrease the size of the afferent artery .

Negative feedback system

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26
Q

_____ artery takes blood into the glomerulus and the ________ takes blood out

A

afferent

efferent

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27
Q

T/F: Glomerulus is located in the medulla

A

F

cortex

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28
Q

What capillaries are only found in the cortex in the kidneys? what are they responsible for?

A

Peritubular capillaries

Filtation & water reabsorption

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29
Q

What capillaries are only found in the medulla in the kidneys?

A

vasa recta

omsolality changes -> ion reabsorption

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30
Q

What 2 items do we specifically want to be filtered and reabsorbed?

A

bicarb and glucose

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31
Q

Where does a majority of your reabsorption happen?

A

Proximal convoluted tubule

32
Q

How much urine is produced from the filtrate?

A

1%

33
Q

What does the juxtaglomerular appartaus consist of?

A

macula densa
Juxtaglomerular cells
extraglomerular mesanginal cells

34
Q

What is osmolality?

A

dissolved substances in a solution

35
Q

What is the juxtaglomerular cells? where is it located?

A

-modified epithelial cells that act like smooth muscle
-Communicate with macula dense cells
-contract and dilate to effect blood flow to the glomerulus

Afferent artery

36
Q

What 3 systems regulate how blood gets into the glomerulus?

A

Direct renal autoregulation (Juxtaglomerular apparatus)

neural regulation (Activation of SNS and release of Epi and NE)

hormonal regulation (Activation of RAA)

37
Q

What happens at the proximal tubule?

A

80% of water and ions are reabsorbed back into blood

-NaHCO3, NaCl, glucose, amino acids, organic solutes, K+, water are reabsorbed

38
Q

Where do Carbonic anhydrase inhibitors work?
What do they do?

A

Proximal tubule

Inhibit CA enzyme that allows carbonic acid to be converted to water an CO2 in the lumen-urine

block bicarb reabsorption

39
Q

Drugs: Caffeine

A

Diuretic

MOA: blocks adenosine-R in PCT

40
Q

Describe the function of NHE3 and carbonic anhydrase in sodium and bicarb reabsorption.

A

Located in the PCT

NHE3: Na+ in the nephron in exchange for H+ in the lumen-urine (water follows Na+)

Carbonic anhydrase: Converts Carbonic acid to water and CO2 to be reabsorbed into the nephron and Carbonic anhydrase converts it to bicarb

41
Q

Drugs: Acetazolamide

A

Class: Carbonic Anhydrase inhibitor

MOA: inhibits Carbonic Anhydrase -> blocks sodium bicarb reabsorption -> slows down NHE3 counter-transporter

Uses: Acute mountain sickness, glaucoma, alkalinization of urine

SE: decreased K+, Na+, pH (below 7.35), kidney stones

42
Q

Where does Acetazolamide work?

A

Carbonic Anhydrase inhibitor

PCT

43
Q

What is the osmolality in the cortex?

A

300

44
Q

What is the osmolality in the medulla? Why?

A

400-1200

increased solutes helps with water reabsorption

45
Q

What type of diuertic is mannitol?

A

osmotic diuretic

46
Q

List 5 major types of diuretics and relate them to their sites of action, urinary electrolytes, and main side effects.

A

Carbonic Anhydrase inhibitors: CA in PCT; bicarb/K+ loss; decreased pH

Loop diuretics: NKCC2 in TAL; Na+/K+/Cl-/Mg++/Ca++ loss; slight alkalosis

Thiazide: NCC (NaCl) in DCT; Na+/Cl- loss; slight alkalosis

omsotic: Mostly PCT but anywhere where water is permeable

Potassium-sparing: inhibit aldolsterone-R in CT;

47
Q

T/F: Mannitol is reabsorbed into bloodstream

A

F

impermeable solute
stays in nephron

48
Q

Mannitol increase _________

A

osmolality

49
Q

What area of nephron doesnt have an effect on diuretics?

A

S2 - straight segment

50
Q

What is the S2 - straight segment?

A

Area where some diuretics dont work

area where larger substances can be secreted:
- uric acid
- NSAIDs
- Abx
-Diuretics

51
Q

Where does water reabsorption happen in the loop of Henle?

A

Descending

52
Q

Where is water impermeable in the loop of Henle?

A

Ascending

53
Q

What are NKCC2? Where are they?

A

cotransporter that takes 1Na+, 1K+, 2Cl- into nephron

Ascending Loop of Henle

54
Q

Describe positive potential

A

potential in the lumen-urine thats affected by increasing positive charges (increased K+ in the nephron which increases K+ in the lumen-urine) in the lumen urine which drive Mg++ and Ca++ into the blood.

55
Q

What happens in the ascening loop of Henle?

A

Na+ moves only.
Impermeable to water

56
Q

What are the strongest diuretics?

A

Loop diuretics

57
Q

What are sulfamide diuretics?

A

Loop diuretics
Thiazide

58
Q

How do loop diuretics work?

A

inhibit NKCC2 cotransporter
prevents reabsorption of Na+/K+/Cl-

59
Q

What loop diuretic is NOT a sulfamide?

A

Ethacrynic acid

60
Q

What are my K-wasting diuretics?

A

Carbonic anhydrase inhibitors
loop diuretics
thiazide

61
Q

Drug: Furosemide

A

Loop Diuretic
Inhibits NKCC2 in TAL

Sulfa allergies

Secrete: Na, K, Cl, Mg, Ca

Causes slight alkalosis

62
Q

Drug: Ethacrynic acid

A

Loop Diuretic
Inhibits NKCC2 in TAL

Not a Sulfa Drug!!!

Secrete: Na, K, Cl, Mg, Ca

Causes slight alkalosis

63
Q

What do Thiazide drugs work?

A

inhibit the NCC (NaCl- cotransporter) in the Distal Convoluted tubule

Also inhibit Ca++ activity

64
Q

Is the thiazide prototype?

A

Hydrochlorothiazide

65
Q

What is the final site for sodium reabsorption in water reabsorption?

A

Collecting tubule

66
Q

What happens at the collecting tubule?

A

-Final site for sodium reabsorption
-Important site for potassium secretion
-Site for influence of aldosterone

67
Q

Where are the principal and intercalated cells?

A

Collecting tubules

68
Q

What is aldosterone’s role in the nephron at the collecting tubule?

A

diffuses into nephron at CT
binds with its receptor
increases ENaC (Na+ ion channel) activity
increases Na+ reabsorption
increases blood volume

this contributes to (-) lumen charge

69
Q

Drugs: Spironolactone

A

Potassium-sparing diuretic
inhibit aldosterone-R in CT

70
Q

Drugs: Amiloride

A

Potassium-sparing diuretic
inhibit ENaC (Na+ ion) channels

71
Q

Define “potassium wasting”.

A

increased excretion of potassium in the urine, which can occur with certain diuretics

72
Q

Explain the mechanism of potassium and bicarb wasting in the collecting tubule following specific diuretic administration

A

Carbonic anhydrase inhibitors block the enzyme responsible for converting carbonic acid to water and CO2.

This can cause potassium and bicarbonate wasting in the collecting tubule by blocking sodium-bicarbonate reabsorption in the proximal tubule, leading to increased delivery of sodium and bicarbonate to the collecting tubule, which then promotes potassium and bicarbonate excretion.

73
Q

What are the 2 drugs that reduce potassium loss during sodium diuresis

A

Spirolactone
Amiloride

74
Q

What do potassium sparing diuretics help with?

A

Spirolactone only.

Adrenal cortex overproducing alderosterone
-Conn’s syndrome
-Ectopic ACTH production

CHF
Nephrotic syndrome
use of K-wasting diuretics

75
Q

T/F: You want to use Potassium-sparing diuretics in combo with a K-wasting diuretic

A

T

76
Q

Drug: ADH/Vasopressin

A

Works in the Collecting Duct

Adds more Aquaporin channels to increase water reabsorption

increases blood volume (Increases BP) and concentrates urine

77
Q

Drug: Conivaptan

A

Potassium-sparing diuretic

Works in the collecting duct

ADH Antagonist

78
Q

Drug: Mannitol

A

Osmotic diuretic

Increases osmolality in nephron
Works in PCT and descending loop

Uses: , increase UO, decrease ICP; removal of renal toxin (rhabdo), after contrast, induce diarrhea (PO)

slight edema and increased Na+ when 1st administered

USE FILTER WHEN CONCENTRATION ABOVE 20%

79
Q

Discuss the use of diuretics in patients with diabetes insipidus.

A

DI is the dumping of dilute urine.

ADH/Vasopressin and thiazides diuretics treat this

Pharm (30 decks)

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