Diuretics/CHF

Question 1

2 Kinds of Diuresis

Answer 1

Water Diuresis
Solute Diuresis (how diuretics work)

Question 2

2 Effectors of Responses to Na Depletion

Answer 2

AGNII-Renin System and Symp Nervous system act to increase fluid volume and Na retention

Question 3

3 Edamatous Diseases (general point and specific points on how they cause)

Answer 3

Shift ECF out of caps into ISF, tricking kidneys to think losing fluid so it starts Na/water retention.
Congestive Heart Failure - increases venous pressure
Cirrhosis - elevates hepatic circ pressure and decreased albumin production to retain water in caps
Renal Nephrotic Syndrome - lose albumin in urine

Question 4

Increased Arterial Pressure and Edema

Answer 4

Usually doesn’t cause, because arteriolar constriction (main culprit for increased AP) elevates pressure upstream, not downstream in caps

Question 5

Response of Healthy vs. CHF Subjects to Increased Na Consumption

Answer 5

In a few days healthy person’s output will catch up and reach a new steady state (at somewhat higher weight). CHF won’t be able to catch up and will continue accumulating positive balance

Question 6

Diuretics vs. Digitalis on Starling Curve

Answer 6

Symptomatic relief, but don’t increase CO so don’t affect CO/LVEDP relationship of normal Starling curve vs. shifts the curve towards normal by increasing CO but doesn’t affect LVEDP

Question 7

2 Best Spots for Diuretic Action

Answer 7

Best (esp acute like pulmonary edema): Thick ascending LoH

Other (more long term management): early distal tubule

Question 8

Thiazide

Answer 8

Early distal tubule acting diuretic

Question 9

Transient Response to Sustained Diuretic (2)

Answer 9

Early weight loss and increased excretion, but then other parts of kidney adjust to form new steady state at this lower weight and weight loss stops. However person must stay on diuretic and Low NaCl diet or else it’ll go right back up
Also person will feel like shit at the beginning bc some fluid loss comes from plasma and the body gets really fucking pissed when you do that

Question 10

3 Imperfections w/ Diuretics

Answer 10

Treat symptom, not problem
In beginning patient feels like ass, not better
Help restore NaCl balance but shit on other ion and water balances

Question 11

Aquaretics

Answer 11

Antagonists for vasporessin Rs, inhibiting water but not solute reabsorption