Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urinary System > Diuretics and Renal Replacement Therapy > Flashcards

Diuretics and Renal Replacement Therapy Flashcards

1
Q

What is a diuretic?

A

A substance/drug that promotes diuresis

Increased renal excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage is the normal fractional excretion of Na+?

A

Less than or equal to 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Aldosterone increases the expression of which channels/transporters?

A

Na/K/ATPase
ENaC
K+ channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do loop diuretics work and give an example?

A

Act on the loop of Henle
Block NKCC2 cotransporter
Eg. Furosemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do thiazides work and give an example?

A

Act on early DCT
Block NaCl cotransporter
Eg. Metolazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do K+ sparing diuretics work and give an example?

A

Act on late DCT and CD
Block ENaC channels
Eg. Amiloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do aldosterone antagonists work and give an example?

A

Eg. Spironolactone

Competitive inhibition of aldosterone on principle cells in late DT and CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does mannitol work?

A

Use small molecules to increase osmolarity of filtrate

Increased water excretion (decreased water reabsorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are carbonic anhydrase inhibitors used as a diuretic?

A

Prevents uptake of bicarbonate as it cannot from water and CO2 to enter the cells
However can lead to metabolic acidosis due to all the bicarbonate in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do loop diuretics affect magnesium and calcium?

A

Magnesium and calcium reabsorption rely on the gradient of the thick ascending limb LOH
Therefore loop diuretics inhibit their reabsorption
Increased loss of calcium and magnesium
Can cause hypocalcaemia and hypomagnesiumia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why are loop diuretics chosen to help heart failure failure and acute pulmonary oedema?

A

They are very potent diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can we use loop diuretics to treat?

A 
Heart failure
Pulmonary oedema
Nephrotic syndrome
Renal failure
Liver cirrhosis 
Hypercalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why are thiazides good diuretics for the elderly?

A

Blocking Na+ reabsorption increases the Ca2+ reabsorption

Good for the elderly who are prone to osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why are thiazides ineffective in renal failure?

A

Less potent as only 5% sodium reabsorption inhibited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are thiazides widely used for and why?

A

Hypertension

Decreased effective circulating volume and cause vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the potential problem when using thiazides?

A

Hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why are K+ sparing diuretics often a bad choice?

A

Mild diuretics therefore cannot cope with large volume increases
Can produce severe hyperkalaemia esp if used in conjunction with ACEi, K+ supplements or in pts with renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the preferred drug to treat ascites and oedema in cirrhosis?

A

Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which diuretics are often used in conjunction for heart failure?

A

Spironolactone

Loop diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why do we have to be careful when using diuretics?

A

Decreased circulatory volume and reduce perfusion pressure to the kidneys
This can activate RAAS
Causes water retention (counter productive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe nephrotic syndrome

A

Increase in glomerular BM permeability to proteins
Proteinuria
Low plasma albumin - decreased oncotic pressure - oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is ascites?

A

Free fluid in the peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe hepatic encephalopathy

A

Reversible syndrome of impaired brain function
Occurs in cirrhosis with advanced liver failure
Causes confusion and comas
Signs - constructional apraxia (cannot draw a 5 pointed star) and flapping tremors
Includes elevated ammonia levels in blood
Hypokalaemia can cause this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name some adverse effects of diuretics

A 
Potassium abnormalities 
Decreased blood volume - postural hypotension, dehydration 
Increased uric acid levels - gout
Glucose intolerance 
Raised LDLs
Erectile dysfunction (thiazides)
Gynaecomastia (spironolactone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How can alcohol affect blood volume levels?

A

Inhibits ADH release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does coffee affect the kidney?

A

Increases GFR
Decreased Na+ reabsorption
Increased loss of Na+ and water
Diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define end stage renal failure (ESRF)

A

When death is likely without renal replacement therapy

eGFR < 15 ml/min

28
Q

Give some symptoms/signs of ESRF

A 
Tiredness - overwhelming fatigue physically and mentally 
Difficulty sleeping 
Difficulty concentrating 
Volume overload - oedema, SoB
Nausea/vomiting/reduced appetite 
Restless legs/cramps
Pruritus (itchy)
Sexual dysfunction/reduced fertility 
Increased infections
29
Q

What percentage of patients with CKD are hypertensive?

A

80-85%

30
Q

If you have no ADH, how much urine could be produced a day?

A

30 L/day

31
Q

Give some symptoms of uraemia

A

Reduced appetite
Nausea/vomiting
Pruritus

32
Q

Why do lots of drugs require dose alteration with CKD?

A

Reduced metabolism and/or elimination of the drug

Drug sensitivity can be increased

33
Q

What are the treatment options when the kidneys fail?

A

Haemodialysis
Peritoneal dialysis
Transplant
Conservative care

34
Q

Describe haemodialysis

A

Artificial pump in system to keep at high enough pressure
Anti-coagulant added
Gets rid of waste products in blood over artificial membrane
Enters back into venous system
A fistula has to be created between an artery and vein

35
Q

How often does haemodialysis have to be performed?

A

4 hours

3 times a week

36
Q

What are the advantages and disadvantages of haemodialysis?

A

Advantages: less responsibility, days off treatment
Disadvantages: travel to hospital/waiting, ‘tied’ to your dialysis time, restrictor on travel, restrictions on fluid and food intake

37
Q

Approximately how many tablets per day do people on haemodialysis have to take?

A

19

38
Q

What are the contraindications for haemodialysis?

A

Failed vascular access
Heart failure
Coagulopathy

39
Q

What are some complications of haemodialysis?

A

Lines: infection, thrombosis, venous stenosis
Thrombosis, bleeding, access failure - steal syndrome
CVS instability
Feel chronically unwell
Accumulate morbidities

40
Q

Describe peritoneal dialysis

A

Waste products cross semi-permeable peritoneal membrane into the peritoneal cavity
Can do 4-5 bags throughout the day (30 min each)
Or can do overnight

41
Q

What are the advantages and disadvantages to peritoneal dialysis?

A

Advantages: independence, less fluid/food restrictions, fairly easy to travel, renal function may be better preserved
Disadvantages: frequent daily exchanges, responsibility of own care

42
Q

Approximately how many medications does a patient on peritoneal dialysis have to take per day?

A

10 tablets

SC EPO injection

43
Q

What are the contraindications for peritoneal dialysis?

A

Failure of peritoneal membrane
Adhesions, previous abdo surgery, hernia, stoma
Patient or carer unable to connect/disconnect themselves
Obese/large muscle mass

44
Q

How often do patients on peritoneal dialysis get peritonitis?

A

Once every 20 months on average

45
Q

Give some complications of peritoneal dialysis

A

Peritonitis
Ultrafiltration failure
Leaks
Development of hernia

46
Q

Describe home/nocturnal haemodialysis

A

Same as haemodialysis but at home and possibly overnight
Allows more dialysis hours so better clearance
Requires someone at home with you - as if it goes wrong you can bleed out v rapidly

47
Q

What are the advantages of home haemodialysis?

A

Patient often feels better
Patient often needs fewer medications
Can pick your own schedule
Can do it overnight so doesn’t interfere

48
Q

Does a transplant have a higher or lower mortality/morbidity than dialysis?

A

Lower

Better quality of life too

49
Q

For how long is the peri-operative risk after transplant?

A

3 months

50
Q

What are the peri-operative risks of kidney transplant?

A

Dampening of immune system:
Malignancy
Infection
Risk of diabetes and hypertension from meds (steroids)

51
Q

What vessels do they connect renal transplants to?

A

Iliac vessels

52
Q

What are the different types of transplant?

A

Live donor (related or unrelated)
Deceased after brain death (DBD)
Deceased after circulatory death (DCD)

53
Q

Kidney transplants are matched according to …

A

Tissue match - blood type and HLA
Length of time on waiting list
Age

54
Q

What is the average wait for a kidney from a deceased donor?

A

3 years

55
Q

What is the average life of the transplanted kidney from a live related donor?

A

12 years

56
Q

What is the average life of the transplanted kidney from a live unrelated donor?

A

11 years

57
Q

What is the average life of a transplanted kidney form a DBD donor?

A

10 years

58
Q

How many immunosuppressants are you generally on after a kidney transplant?

A

3

59
Q

What are the problems with being on immunosuppressants after a kidney transplant?

A

LOTS of side effects

Including being nephrotoxic

60
Q

Dialysis tends to prolong survival by how long?

A

2 years

61
Q

What is the average life expectancy of people diagnosed with ESRD aged 25-29 years?

A

18 years from diagnosis

62
Q

What is the greatest killer in dialysis patients?

A

Cardiac disease

63
Q

What is the greatest killer in transplant patients?

A

Malignancy

64
Q

What is your daily fluid allowance if you are anuric and on dialysis?

A

500 ml

65
Q

What is your daily fluid allowance if you are on dialysis and pass urine?

A

500 ml plus the volume of urine that you pass

Urinary System (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions