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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
What are the 2 types of cells in the distal tubule? What do they reabsorb? What do they secrete? What are they controlled by?
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
26
The permeability of collecting duct cells to water is under the influence of ____/____.
AVP/ADH
27
Areas of the nephron highly permeable to water include:
proximal tubule | descending limb of the loop of henle
28
The areas of the nephron impermeable to water:
thick and thin ascending segments of the loop.
29
AVP/ADH controls the permeability of the ________ _____ to water.
collecting duct
30
With AVP/ADH presence, permeability of the collecting duct to water increases/decreases?
Increases.
31
Majority of K+ is reabsorbed in the ________tubule adn the __________limb of the loop of henle.
proximal tubule | ascending
32
Excretion of K+ in the nephron is regulated by what? (4 things)
plasma K+ concentration acid/base balance Aldosterone AVP (ADH)
33
``` Ca+ is reabsorbed what % in: Proximal tubule? Thick ascending limb of the loop of henle? Distal tubule? Collecting Duct? ```
70% (proximal tubule) 20% (thick ascending limb) 9% (distal tubule) 1% (collecting duct)
34
Renal excretion of Ca is regulated by what 3 levels?
Parathyroid hormone Calcitriol (vit D) Calcitonin
35
Phosphate is reabsorbed what % in: Proximal tubule? Distal tubule? Remainder lost in urine?
80% (proximal tubule) 10% (distal tubule) 10% (lost in urine)
36
What 3 factors decrease the reabsorption of phosphate?
1. Extracellular fluid volume expansion 2. Metabolic Acidosis 3. Glucocorticoids
37
Renal excretion of phosphorus is mainly regulated by what hormone?
Parathyroid hormone
38
Angiotensin II stimulates proximal reabsorption of what?
Na+ and H2O
39
Release of Angiotentsin II is activated by?
Decrease extracellular fluid volume and renal perfusion
40
What hormone is stimulated by distal reabsorption of Na+ by increasing the permeability of the collecting tubule luminal membranes to Na+?
Aldosterone
41
Aldosterone favors secretion of ___ & ___ & increases reabsorption of ___.
Secretion of K+, H+ | Reabsorption of Cl-
42
The secretion of Aldosterone by the Adrenal Cortex is stimulated by? (3 things)
Angiotensin II Hyperkalemia Severe hyponatremia
43
____ stimulates the secretin of Na+
APN
44
Prostaglandin increases ____ excretion by increasing GFR and inhibiting ____ reabsorption in the collecting duct.
Na+ | Na+
45
Norepinephrine/Epinephrine stimulates ___ reabsorption in the proximal tubule, thick ascending limb of loop of henle, distal tubule, and collecting duct?
Na+
46
Dopamine increases _____ excretion.
Na+
47
ADH regulates?
water balance
48
What are 8 clinical indications for use of Diuretics?
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
Congestive heart failure is...? Is sensed as a decrease in effective circulating volume by _____ which is stimulated to retain NaCl and H2O
Failure provide normal tissue perfusion. Kidney
50
How can diuretics improve signs of CHF?
by moving the extra fluid
51
With Left-sided heart failure edema backs up where? Leading to what?
to the lungs-->life-threatening pulmonary congestion
52
Nephrotic syndrome is characterized by formation of?
Edema
53
Diuretics assist w/Liver Dz by doing what? | Does it decrease mortality?
Assisting w/ascites. | No, but it improves quality of life.
54
Defective liver fxn also results in impaired inactivation of Na+ and H2O retaining hormones like?
Vasopressin (ADH) & Aldosterone
55
Diuretic use with Arterial Hypertension helps by?
Decreasing blood pressure by extracellular fluid volume contraction
56
Diuretics: - Increase K+ ________ in hyperkalemic states. - Loop diuretics increase ___ excretion in ____________ - Thiazides decrease the rate of ____ excretion in ____________ states.
excretion Ca+, hypercalcemia Ca+, hypercalciuric
57
With Nephrogenic Diabetes Insipidus, the pt excretes large amounts of what?
Dilute Urine
58
Loop diuretics are often given to pts with ______ renal insufficiency by ______ blood flow to the kidneys.
Oliguric renal insufficiency | Increasing blood flow
59
Diuretics are classified according to their ____ & _____ of _______.
Site | Mode of Action
60
All Diuretics increase _____ & _____ excretion
Na+ & H2O
61
True/False: Diuretics variably modify electrolyte excretion
True
62
Name the 6 types of Diuretics
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
Filtration Diuretics increase _______ by increasing GFR.
Diuresis
64
Name some Filtration Diuretics.
``` Glucocorticoids Theophylline Isoproterenol Dopamine Dobutamine ```
65
Filtration Diuretics moderately increase ___ excretion
Na+
66
Osmotic Diuretics act in the _________ _____ and in the _____ of ______
Proximal tubule | Loop of Henle
67
Osmotic Diuretics attract _______ from the intracellular compartment. They increase ____ volume & _____ blood flow
Water ECF Renal
68
Osmotic diuretics increase the excretion of ___ ________
all electrolytes
69
True/false: Osmotic Diuretics improve renal perfusion
True
70
Name an example of an osmotic diuretic
Manitol
71
Osmotic Diuretics have elevated/depressed salt and electrolyte reabsorption in the proximal tubule & loop of henle
Depressed salt and electrolyte reabsorption
72
What are the most commonly used, highly effective type of diuretics?
Loop Diuretics
73
Loop diuretics work by?
Inhibiting Na+ reabsorption in the ascending limb of the loop of henle
74
Loop diuretics have a marked increase in excretion of what 5 electrolytes?
``` Na+ K+ Cl- Ca++ Mg+ ```
75
Name 2 loop diuretics
Furosemide (lasix) | Bumex
76
What are the Adverse Effects of Loop Diuretics? (5)
1. Hypochloremic metabolic alkalosis 2. Hypercalciuria 3. PDA 4. Ototoxicity 5. Chronic Use
77
Thiazide and thiazide-like diuretics inhibit Na+ reabsorption in the distal convoluted tubule. Name the main indications of use: (6 reasons)
``` Edema Hypertension Hypercalciuria Chronic lung dz Nephrogenic diabetes insipidus Proximal renal tubular necrosis ```
78
Inhibitors of Carbonic Anhydrase diuretics work by increasing urinary excretion of (3 things)? They promote? Where do they primarily act?
HCO3, Na+, K+ Alkaline Diuresis Proximal tubule
79
K+ sparing diuretics are often used in a/w what types of diuretics in babies w/CLD? Why? Name one.
Thiazide diuretics Decreased risk of hypokalemia Spirinolactone
80
With osmotic diuretics... Marked excretion of: (2 things) Moderate excretion of: (4 things)
Marked excretion: Na+ & Mg+ Moderate: K+, Ca++, Cl-, & HCO3-
81
With carbonic anhydrase diuretics... Marked excretion of: (2) Moderate excretion of: (1) Decreased excretion of: (1)
Marked excretion : K+ & HCO3 Moderate excretion : Na+ Decreased excretion: H+
82
With Loop diuretics... Marked excretion of: (5) Moderate excretion of: (2)
Marked excretion: Na+, K+, Ca++, Mg+ & Cl- | Moderate excretion: H+ & HCO3
83
With Thiazide diuretics... Marked excretion of: (1) Moderate excretion of: (5)
Marked increase: K+ | Moderate excretion: Na+, Mg+, H+, Cl-, & HCO3
84
With K+ sparing diuretics... Moderate excretion of: (3) Decreased excretion of: (4)
Moderate excretion: Na+, Cl-, & HCO3 | Decreased excretion: K+, Ca++, Mg+, & H+

Neonatal Pharmacology (17 decks)

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