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PHARM 2 > Diuretics And Electrolyes > Flashcards

Diuretics And Electrolyes Flashcards

1
Q

What is the function of the glomerulus with Bowman’s capsule?

A

Filtration

25% of plasma that arrives here passes through the filtration barrier to become filtrate

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2
Q

What is the function of the proximal tubule?

A

Reabsorption: NaCl (primarily), glucose, K, amino acids, bicarb, phosphate, protein, urea, water (follows NaCl)

Secretion: Hydrogen, foreign substance, organic anions and cations

Blood is isotonic

Carbonic anydrase inhibitors, osmotic

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3
Q

What is the function of the Loop of Henle

A

Concentrates urine

Descending loop: water reabsorption, NaCl diffuses in

Ascending loop: sodium actively reabsorbed, water stays in

Isotonic hypertonic, hypotonic: depending on needs of the body

Loop diuretics

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4
Q

What is the function of the distal tubule?

A

Reabsorption: NaCl, water (ADH required) bicarb

Secretion: K, urea, hydrogen, NH3, some meds

Isotonic or hypotonic

Thiazides

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5
Q

What is the function of the collecting duct?

A

Reabsorption: Water (ADH required) NaCl

Reabsorption or secretion: Na, K, H, NH3

Final concentration

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6
Q

What is the definition of CKD?

A

Kidney damage for > 3 months defined by structural or functional abnormalities with or without decreased GFR

GFR < 60ml/min for > 3 months with our without kidney damage

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7
Q

What is the GFR for the 6 stages of CKD?

A
  1. > 90
  2. 60-89
  3. 30-59
  4. 15-29
  5. <15
  6. Dialysis
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8
Q

With acute kidney disease, what does the RIFLE criteria stand for?

A 
Risk
Injury
Failure
Loss
ESRD

Uses GFR and Urine output

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9
Q

What does pre-renal failure, intrinsic renal failure, and post renal failure mean?

A

Pre-renal: usually means they’re dehydrated

Intrinsic: means they’re taking something that has damaged the nephron

Post-renal: usually an obstruction

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10
Q

Carbonic anhydride inhibitors work on what part of the nephron

A

Proximal tubule

Inhibit CA with inhibits H secretion

Acetazolamide (Diamox)
Methazolamide (Neptazene)
Dichlorophenamien (Daranide)

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11
Q

Name 2 Osmotic Diuretics

What area of the nephron do they work?

A

Mannitol
Urea

Increase the osmotic gradient in proximal tubule

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12
Q

Osmotic effect in the renal tubules results in an osmotic diuretic effect with urinary excretion of what 4 things?

A

Water
Sodium
Chloride
Bicarbonate ion

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13
Q

Is urinary pH altered by mannitol-induced osmotic dieresis?

A

No

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14
Q

What 3 ways does mannitol redistribute fluid

A

Decreases brain bulk

May preferentially increase renal blood flow to the medulla

Detrimental effects of redistribution include: CHF in patients with poor myocardial function

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15
Q

What are 4 clinical uses of mannitol?

A

Prophylaxis avians acute renal failure (not used for this much anymore)

Differential diagnosis of acute oliguria

Treatment of increase in ICP

Decreasing IOP

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16
Q

T/F: there is evidence mannitol is nephroprotective

A

FALSE

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17
Q

Is an intact BBB required for mannitol to be effective in treating an increased ICP?

A

YES

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18
Q

Vasodilation affect intracranial and extracranial vessels and can simultaneously do what 2 things?

A

Increase cerebral blood volume and ICP

Decrease systemic blood pressure

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19
Q

What are some SE of mannitol?

A

Precipitate pulmonary edema

Hypovolemia, electrolyzing disturbances, plasma hyperosmolarity d/t water and NaCl secretion

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20
Q

Increased BUN after Urea administration should NOT be confused with __________. _________. _________

A

Acute renal failure

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21
Q

MOA of loop diuretics

A

Inhibits Na and CL reabsorption in the ascending loop and to a lesser extent in the proximal tubule

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22
Q

What allergy do you need to be concerned with when giving loop diuretics?

A

Sulfa - loop diuretics have a sulfa group in them. Some pts with a sulfa allergy can’t tolerate

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23
Q

Which loop diuretic does not have a sulfa group?

A

Ethacrynic acid (Edecrin)

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24
Q

Loop diuretics can cause hypokalemia metabolic _________

A

Alkalosis

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25
What is the renovascular effect?
Furosemide induced production fo prostaglandins result in renal vasodilation and increased RBF
26
Name 4 clinical uses for loop diuretics
Mobilization of edema fluid due to renal, hepatic or cardiac dysfunction Treatment of increased ICP Treatment of hypercalcemia Differential diagnosis of acute oliguria
27
With furosemide, ______ _______ precedes the onset of diuresis
Peripheral vasodilation
28
Furosemide increases lymph flow through the _______ _____
Thoracic duct
29
T/F: Compared to mannitol, furosemide is not as effective in decreasing ICP
TRUE
30
Is it more efficient to combine furosemide with mannitol to decrease ICP?
Yes Combining them is more effective in decreasing ICP than either drug alone *But risk of severe dehydration and electrolyte imbalance is increased
31
What fluid and electrolyte abnormalities are seen with loop diuretics?
``` Hypokalemia Hypochloremia Hyponatremia Hypomagnesemia Metabolic alkalosis (a response to reduction in K) ```
32
What drugs can interact with loop diuretics?
Antibiotics: - aminoglycosides: increased chance of nephrotoxicity - cephalosporins: nephrotoxicity may be increased - PCN: associated with allergic interstitial nephritis
33
Thiazides diuretics MOA
Computer for the Na-CL cotransporter in the DISTAL TUBULE to inhibit reabsorption Inhibit only urinary diluting capacity, not concentrating capacity
34
Name some thiazides diuretics
``` Chlorothiazide (Diuril) Hydrochlorothiazide (Hydrodiuril) Indapamide (Lozol) Metolazone (Zaroxolyn) Chlorthalidone (Hygroton) ```
35
Thiazides diuretics can cause what?
Hypokalemic metabolic alkalosis
36
What are 2 clinical uses of thiazides?
HTN | Mobilization of edema
37
T/F: Loss of potassium with Thiazide diuretics is not as significant as will loop diuretics.
TRUE
38
What are some side effects of hypokalemia?
``` Dysrhythmias skeletal muscle weakness GI ileus Increased likelihood of developing dig toxicity Potentiation of nondepolarizing NMBs ```
39
What are 4 SE of thiazides?
Decreased intravascular volume hyperglycemia (can still give to someone with DM) hyperuricemia (increased gout pain) decreased renal or hepatic function (through dehydration)
40
The potassium sparing diuretics - Amiloride (mmidamor) and Triamterne (Dyrenium) have what MOA?
inhibit Na reabsorption induced by aldosterone. Inhibit active counter transport of Na and K in the collecting ducts
41
The potassium sparing diuretics - Spironoactone (Aldactone) and Eplerenone (Inspra) have what MOA?
Competes for aldosterone receptor sites in the distal tubule to block Na reabsorption and K secretion *These are aldosterone antagonists
42
Potassium sparing diuretics are usually used with __________ because they are less effective
a Loop diuretic
43
Potassium sparing diuretics work in cirrhosis of the liver because decreased hepatic function and metabolism lead to increased plasma concentration of ______________
Aldosterone
44
What is the principle SE of potassium sparing diuretics?
Hyperkalermia
45
What other drugs when taken with k sparing diuretics increases risk of hyperkalemia?
NSAIDs ACE Inhibitors Beta Blockers
46
What are some causes of hyperkalemia?
``` Renal failure hypoaldosteronism K supplements ACEi/ARB heparin NSAIDs K sparing diuretics Digoxin ```
47
What are some causes of hypokalemia?
``` Loop diuretics thiazide diuretics osmotic diuretics hyperaldosteronism mineralcorticoids fluid loss (vomit/diarrhea) ```
48
What are 4 factors necessitating emergent treatment of hyperkalemia
EKG changes: tall peaked T wave, loss of p wave, widened QRS with tall T wave Rapid rise of serum K (K > 6.0) Decreased renal function Presence of significant acidosis
49
___________ BG can cause hyperkalemia
high
50
Why is IV calcium given with hyperkalemia?
Lowers threshold potential of myocardium *Caution in pts with Dig, Ca has been shown to worsen myocardial effects of dig toxicity - can use mag as substitute to stabilize myocardium
51
Calcium ___________ is preferred to stabilize the myocardium during hyperkalemia
Gluconate Chloride is an option if central line in place
52
What are 3 other ways to lower potassium
1. 10 units regular insulin and 50ml 50% dextrose 2. Inhaled Beta2 agonist (albuterol) *effects are additive to that of insulin administration 3. Sodium bicarb: no longer recommended, can take several hours
53
This med binds to potassium in the colon in exchange for sodium
Sodium polystyrene sulfonate (Kayexalate) also lactulose for GI elimination
54
Patiromer (Veltassa) and Sodium zirconium cylosilicate (Lokelm) are 2 newer oral GI agents to treat what electrolyte abnormality?
Hyperkalemia
55
What are some causes of hypernatremia?
increased intake pure water loss (DI) antidiuretic hormone abnormalities osmotic diuretics
56
What are some causes of hyponatremia?
``` loss of body fluid thiazides/loops CHF carbamazepine/lithium liver disease *can also have dilutional hyponatremia ```
57
What are some presenting symptoms of sodium disorders?
neurologic depression seizures respiratory depression coma
58
With severe symptomatic hyponatremia, how rapidly can you correct it?
6-12 mEq/L in the first 24hrs, and 18 mEq/L or less in 8hr.
59
With chronic hypernatremia, how rapidly can you correct it?
0.5 mEq/L/hr with the max change of 8-10 mEq/L in a 24 hr period
60
What happens if you correct sodium levels too rapidly?
Central pontine demyelination --> leads to chronic neurologic complications
61
What should never be used with hypovolemic hyponatremia?
VAPTANS -vasopressin receptor blockers *for euvolemic and hypercolemic hyponatremia
62
What electrolyte is dependent upon albumin?
Calcium *Can have falsely low calcium if you have a low albumin level
63
What can cause hypercalcemia?
hyperparathyroid cancer thiazides
64
What can cause hypocalcemia?
hypoparathyroidism renal disease loop diuretics

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