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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
Q

What is the renovascular effect?

A

Furosemide induced production fo prostaglandins result in renal vasodilation and increased RBF

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26
Q

Name 4 clinical uses for loop diuretics

A

Mobilization of edema fluid due to renal, hepatic or cardiac dysfunction

Treatment of increased ICP

Treatment of hypercalcemia

Differential diagnosis of acute oliguria

27
Q

With furosemide, ______ _______ precedes the onset of diuresis

A

Peripheral vasodilation

28
Q

Furosemide increases lymph flow through the _______ _____

A

Thoracic duct

29
Q

T/F: Compared to mannitol, furosemide is not as effective in decreasing ICP

A

TRUE

30
Q

Is it more efficient to combine furosemide with mannitol to decrease ICP?

A

Yes

Combining them is more effective in decreasing ICP than either drug alone

*But risk of severe dehydration and electrolyte imbalance is increased

31
Q

What fluid and electrolyte abnormalities are seen with loop diuretics?

A 
Hypokalemia
Hypochloremia
Hyponatremia
Hypomagnesemia
Metabolic alkalosis (a response to reduction in K)
32
Q

What drugs can interact with loop diuretics?

A

Antibiotics:

  • aminoglycosides: increased chance of nephrotoxicity
  • cephalosporins: nephrotoxicity may be increased
  • PCN: associated with allergic interstitial nephritis
33
Q

Thiazides diuretics MOA

A

Computer for the Na-CL cotransporter in the DISTAL TUBULE to inhibit reabsorption

Inhibit only urinary diluting capacity, not concentrating capacity

34
Q

Name some thiazides diuretics

A 
Chlorothiazide (Diuril)
Hydrochlorothiazide (Hydrodiuril)
Indapamide (Lozol)
Metolazone (Zaroxolyn)
Chlorthalidone (Hygroton)
35
Q

Thiazides diuretics can cause what?

A

Hypokalemic metabolic alkalosis

36
Q

What are 2 clinical uses of thiazides?

A

HTN

Mobilization of edema

37
Q

T/F: Loss of potassium with Thiazide diuretics is not as significant as will loop diuretics.

A

TRUE

38
Q

What are some side effects of hypokalemia?

A 
Dysrhythmias
skeletal muscle weakness
GI ileus
Increased likelihood of developing dig toxicity
Potentiation of nondepolarizing NMBs
39
Q

What are 4 SE of thiazides?

A

Decreased intravascular volume
hyperglycemia (can still give to someone with DM)
hyperuricemia (increased gout pain)
decreased renal or hepatic function (through dehydration)

40
Q

The potassium sparing diuretics - Amiloride (mmidamor) and Triamterne (Dyrenium) have what MOA?

A

inhibit Na reabsorption induced by aldosterone. Inhibit active counter transport of Na and K in the collecting ducts

41
Q

The potassium sparing diuretics - Spironoactone (Aldactone) and Eplerenone (Inspra) have what MOA?

A

Competes for aldosterone receptor sites in the distal tubule to block Na reabsorption and K secretion

*These are aldosterone antagonists

42
Q

Potassium sparing diuretics are usually used with __________ because they are less effective

A

a Loop diuretic

43
Q

Potassium sparing diuretics work in cirrhosis of the liver because decreased hepatic function and metabolism lead to increased plasma concentration of ______________

A

Aldosterone

44
Q

What is the principle SE of potassium sparing diuretics?

A

Hyperkalermia

45
Q

What other drugs when taken with k sparing diuretics increases risk of hyperkalemia?

A

NSAIDs
ACE Inhibitors
Beta Blockers

46
Q

What are some causes of hyperkalemia?

A 
Renal failure
hypoaldosteronism
K supplements
ACEi/ARB
heparin
NSAIDs
K sparing diuretics
Digoxin
47
Q

What are some causes of hypokalemia?

A 
Loop diuretics
thiazide diuretics
osmotic diuretics
hyperaldosteronism
mineralcorticoids
fluid loss (vomit/diarrhea)
48
Q

What are 4 factors necessitating emergent treatment of hyperkalemia

A

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
Q

___________ BG can cause hyperkalemia

A

high

50
Q

Why is IV calcium given with hyperkalemia?

A

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
Q

Calcium ___________ is preferred to stabilize the myocardium during hyperkalemia

A

Gluconate

Chloride is an option if central line in place

52
Q

What are 3 other ways to lower potassium

A
  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
Q

This med binds to potassium in the colon in exchange for sodium

A

Sodium polystyrene sulfonate (Kayexalate)

also lactulose for GI elimination

54
Q

Patiromer (Veltassa) and Sodium zirconium cylosilicate (Lokelm) are 2 newer oral GI agents to treat what electrolyte abnormality?

A

Hyperkalemia

55
Q

What are some causes of hypernatremia?

A

increased intake
pure water loss (DI)
antidiuretic hormone abnormalities
osmotic diuretics

56
Q

What are some causes of hyponatremia?

A 
loss of body fluid
thiazides/loops
CHF
carbamazepine/lithium
liver disease
*can also have dilutional hyponatremia
57
Q

What are some presenting symptoms of sodium disorders?

A

neurologic depression
seizures
respiratory depression
coma

58
Q

With severe symptomatic hyponatremia, how rapidly can you correct it?

A

6-12 mEq/L in the first 24hrs, and 18 mEq/L or less in 8hr.

59
Q

With chronic hypernatremia, how rapidly can you correct it?

A

0.5 mEq/L/hr with the max change of 8-10 mEq/L in a 24 hr period

60
Q

What happens if you correct sodium levels too rapidly?

A

Central pontine demyelination –> leads to chronic neurologic complications

61
Q

What should never be used with hypovolemic hyponatremia?

A

VAPTANS
-vasopressin receptor blockers

*for euvolemic and hypercolemic hyponatremia

62
Q

What electrolyte is dependent upon albumin?

A

Calcium

*Can have falsely low calcium if you have a low albumin level

63
Q

What can cause hypercalcemia?

A

hyperparathyroid
cancer
thiazides

64
Q

What can cause hypocalcemia?

A

hypoparathyroidism
renal disease
loop diuretics

PHARM 2 (7 decks)

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