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Neonatal Pharmacology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Diuretics promote the excretion of ______ and __________.

A

Water & Electrolytes

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2
Q

Diuretics are used in situations of inappropriate or excessive Salt and/or water retention including what diseases/conditions:

A
  • Renal diseases
  • Congestive heart failure
  • Liver disease
  • Also when increased Na excretion is not the primary goal of tx: ARF, electrolyte disturbances, nephrogenic diabetes insipidus
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3
Q

Urine formation starts by the ultrafiltration of _______ through the glomerular capillary wall.

A

plasma

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4
Q

GFR is affected by changes in (3 things):

A
  1. Systemic Arterial pressure
  2. Intra-renal Arteriole Resistance
  3. Plasma Oncotic Pressure
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5
Q

Solutes are reabsorbed by ______ or ______ transport

A

active or passive

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6
Q

Active transport uses _____ for energy

A

ATP

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7
Q

What is the most important active process in active transport?

A

Na/K-ATPase

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8
Q

Cell membranes contain _________ or channels allowing rapid passage of specific ions ___, ____, ___ across cellular membranes.

A

uniporters

Na+, K+, Cl-

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9
Q

Active transport via channels/uniporters is a single substance down a concentration gradient. This process is also referred to as:

A

Facilitated diffusion

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10
Q

In this process water flows passively down the osmotic concentration gradient created by the active transport of solutes.

A

Passive transport

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11
Q

With passive transport, the process where water reabsorbed along the nephron is called ______ ________

A

solvent drag

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12
Q

The renal tubule can reabsorb up to ____% of the filtered load of Na+

A

99%

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13
Q

__/__ or ____% of Na+ is reabsorbed in the proximal tubule.

A

2/3, ~65%

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14
Q

__/__ or ___% of Na+ is reabsorbed in the ascending limb of the loop of henle

A

1/4, ~25%

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15
Q

___% of Na+ is reabsorbed in the distal tubule and collecting duct

A

10%

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16
Q

In the _______ proximal tubule, reabsorption of Na+ is coupled to that of ________ and a number of other organic molecules.

A

Early proximal tubule

Bicarb

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17
Q

Many solutes are almost completely removed from the _________ ______ in the 1st part of the proximal tubule.

A

tubular fluid

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18
Q

In the ____ half of the proximal tubule, Na_ is reabsorbed with _____.

A

2nd half

Cl-

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19
Q

The thick ______ limb of the loop of henle reabsorbs ~25 % of the filtered load of Na+.

A

Ascending

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20
Q

True/false: The thick, ascending limb of the loop of henle is impermeable to water.

A

True

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21
Q

The early _______ tubule forms part of the juxtaglomerular aparatus (that provides feedback control of single nephron GFR).

A

distal

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22
Q

True/False: the early distal tubule is impermeable to water.

A

True

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23
Q

True/false: There is avid, continuous reabsorption of Na+ in the distal tubule area resulting in the dilution of urine.

A

True

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24
Q

What segment of the nephron is also called the “diluting segment”?

A

the Distal tubule

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25
Q

What are the 2 types of cells in the distal tubule?
What do they reabsorb?
What do they secrete?
What are they controlled by?

A
  1. Principle cells
    reabsorb Na+ & H20
    secrete K+
    controlled by Aldosterone
  2. Intrakalated cells
    reabsorb K+
    secrete H+ in the tubular lumen–important for acid/base balance
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26
Q

The permeability of collecting duct cells to water is under the influence of ____/____.

A

AVP/ADH

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27
Q

Areas of the nephron highly permeable to water include:

A

proximal tubule

descending limb of the loop of henle

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28
Q

The areas of the nephron impermeable to water:

A

thick and thin ascending segments of the loop.

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29
Q

AVP/ADH controls the permeability of the ________ _____ to water.

A

collecting duct

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30
Q

With AVP/ADH presence, permeability of the collecting duct to water increases/decreases?

A

Increases.

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31
Q

Majority of K+ is reabsorbed in the ________tubule adn the __________limb of the loop of henle.

A

proximal tubule

ascending

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32
Q

Excretion of K+ in the nephron is regulated by what? (4 things)

A

plasma K+ concentration
acid/base balance
Aldosterone
AVP (ADH)

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33
Q 
Ca+ is reabsorbed what % in:
Proximal tubule?
Thick ascending limb of the loop of henle?
Distal tubule?
Collecting Duct?
A

70% (proximal tubule)
20% (thick ascending limb)
9% (distal tubule)
1% (collecting duct)

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34
Q

Renal excretion of Ca is regulated by what 3 levels?

A

Parathyroid hormone
Calcitriol (vit D)
Calcitonin

35
Q

Phosphate is reabsorbed what % in:
Proximal tubule?
Distal tubule?
Remainder lost in urine?

A

80% (proximal tubule)
10% (distal tubule)
10% (lost in urine)

36
Q

What 3 factors decrease the reabsorption of phosphate?

A
  1. Extracellular fluid volume expansion
  2. Metabolic Acidosis
  3. Glucocorticoids
37
Q

Renal excretion of phosphorus is mainly regulated by what hormone?

A

Parathyroid hormone

38
Q

Angiotensin II stimulates proximal reabsorption of what?

A

Na+ and H2O

39
Q

Release of Angiotentsin II is activated by?

A

Decrease extracellular fluid volume and renal perfusion

40
Q

What hormone is stimulated by distal reabsorption of Na+ by increasing the permeability of the collecting tubule luminal membranes to Na+?

A

Aldosterone

41
Q

Aldosterone favors secretion of ___ & ___ & increases reabsorption of ___.

A

Secretion of K+, H+

Reabsorption of Cl-

42
Q

The secretion of Aldosterone by the Adrenal Cortex is stimulated by? (3 things)

A

Angiotensin II
Hyperkalemia
Severe hyponatremia

43
Q

____ stimulates the secretin of Na+

A

APN

44
Q

Prostaglandin increases ____ excretion by increasing GFR and inhibiting ____ reabsorption in the collecting duct.

A

Na+

Na+

45
Q

Norepinephrine/Epinephrine stimulates ___ reabsorption in the proximal tubule, thick ascending limb of loop of henle, distal tubule, and collecting duct?

A

Na+

46
Q

Dopamine increases _____ excretion.

A

Na+

47
Q

ADH regulates?

A

water balance

48
Q

What are 8 clinical indications for use of Diuretics?

A
  1. Edema
  2. Congestive Heart Failure
  3. Nephrotic Syndrome
  4. Liver Dz
  5. Arterial Hypertension
  6. Electrolyte Imbalance
  7. Nephrogenic Diabetes Insipidus
  8. Acute Renal Failure
49
Q

Congestive heart failure is…?

Is sensed as a decrease in effective
circulating volume by _____ which is stimulated to retain NaCl and H2O

A

Failure provide normal tissue perfusion.

Kidney

50
Q

How can diuretics improve signs of CHF?

A

by moving the extra fluid

51
Q

With Left-sided heart failure edema backs up where? Leading to what?

A

to the lungs–>life-threatening pulmonary congestion

52
Q

Nephrotic syndrome is characterized by formation of?

A

Edema

53
Q

Diuretics assist w/Liver Dz by doing what?

Does it decrease mortality?

A

Assisting w/ascites.

No, but it improves quality of life.

54
Q

Defective liver fxn also results in impaired inactivation of Na+ and H2O retaining hormones like?

A

Vasopressin (ADH) & Aldosterone

55
Q

Diuretic use with Arterial Hypertension helps by?

A

Decreasing blood pressure by extracellular fluid volume contraction

56
Q

Diuretics:

  • Increase K+ ________ in hyperkalemic states.
  • Loop diuretics increase ___ excretion in ____________
  • Thiazides decrease the rate of ____ excretion in ____________ states.
A

excretion

Ca+, hypercalcemia

Ca+, hypercalciuric

57
Q

With Nephrogenic Diabetes Insipidus, the pt excretes large amounts of what?

A

Dilute Urine

58
Q

Loop diuretics are often given to pts with ______ renal insufficiency by ______ blood flow to the kidneys.

A

Oliguric renal insufficiency

Increasing blood flow

59
Q

Diuretics are classified according to their ____ & _____ of _______.

A

Site

Mode of Action

60
Q

All Diuretics increase _____ & _____ excretion

A

Na+ & H2O

61
Q

True/False: Diuretics variably modify electrolyte excretion

A

True

62
Q

Name the 6 types of Diuretics

A
  1. Filtration Diuretics
  2. Osmotic Diuretics
  3. Loop Diuretics
  4. Thiazide and Thiazide-like diuretics
  5. Inhibitors of Carbonic Anhydrase
  6. K+ sparing diuretics
63
Q

Filtration Diuretics increase _______ by increasing GFR.

A

Diuresis

64
Q

Name some Filtration Diuretics.

A 
Glucocorticoids
Theophylline
Isoproterenol
Dopamine
Dobutamine
65
Q

Filtration Diuretics moderately increase ___ excretion

A

Na+

66
Q

Osmotic Diuretics act in the _________ _____ and in the _____ of ______

A

Proximal tubule

Loop of Henle

67
Q

Osmotic Diuretics attract _______ from the intracellular compartment. They increase ____ volume & _____ blood flow

A

Water
ECF
Renal

68
Q

Osmotic diuretics increase the excretion of ___ ________

A

all electrolytes

69
Q

True/false: Osmotic Diuretics improve renal perfusion

A

True

70
Q

Name an example of an osmotic diuretic

A

Manitol

71
Q

Osmotic Diuretics have elevated/depressed salt and electrolyte reabsorption in the proximal tubule & loop of henle

A

Depressed salt and electrolyte reabsorption

72
Q

What are the most commonly used, highly effective type of diuretics?

A

Loop Diuretics

73
Q

Loop diuretics work by?

A

Inhibiting Na+ reabsorption in the ascending limb of the loop of henle

74
Q

Loop diuretics have a marked increase in excretion of what 5 electrolytes?

A 
Na+
K+
Cl-
Ca++
Mg+
75
Q

Name 2 loop diuretics

A

Furosemide (lasix)

Bumex

76
Q

What are the Adverse Effects of Loop Diuretics? (5)

A
  1. Hypochloremic metabolic alkalosis
  2. Hypercalciuria
  3. PDA
  4. Ototoxicity
  5. Chronic Use
77
Q

Thiazide and thiazide-like diuretics inhibit Na+ reabsorption in the distal convoluted tubule. Name the main indications of use: (6 reasons)

A 
Edema
Hypertension
Hypercalciuria
Chronic lung dz
Nephrogenic diabetes insipidus
Proximal renal tubular necrosis
78
Q

Inhibitors of Carbonic Anhydrase diuretics work by increasing urinary excretion of (3 things)?

They promote?

Where do they primarily act?

A

HCO3, Na+, K+

Alkaline Diuresis

Proximal tubule

79
Q

K+ sparing diuretics are often used in a/w what types of diuretics in babies w/CLD?

Why?

Name one.

A

Thiazide diuretics

Decreased risk of hypokalemia

Spirinolactone

80
Q

With osmotic diuretics…
Marked excretion of: (2 things)

Moderate excretion of: (4 things)

A

Marked excretion: Na+ & Mg+

Moderate: K+, Ca++, Cl-, & HCO3-

81
Q

With carbonic anhydrase diuretics…
Marked excretion of: (2)
Moderate excretion of: (1)
Decreased excretion of: (1)

A

Marked excretion : K+ & HCO3
Moderate excretion : Na+
Decreased excretion: H+

82
Q

With Loop diuretics…
Marked excretion of: (5)
Moderate excretion of: (2)

A

Marked excretion: Na+, K+, Ca++, Mg+ & Cl-

Moderate excretion: H+ & HCO3

83
Q

With Thiazide diuretics…
Marked excretion of: (1)
Moderate excretion of: (5)

A

Marked increase: K+

Moderate excretion: Na+, Mg+, H+, Cl-, & HCO3

84
Q

With K+ sparing diuretics…
Moderate excretion of: (3)
Decreased excretion of: (4)

A

Moderate excretion: Na+, Cl-, & HCO3

Decreased excretion: K+, Ca++, Mg+, & H+

Neonatal Pharmacology (17 decks)

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