Brainscape's Knowledge GenomeTM

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


See full index

Block 9 Week 2 > Duan > Diuretics I > Flashcards

Duan > Diuretics I Flashcards

1
Q

what are the 5 major fxns of the kidney?

A
  1. filtration & reabsorption
  2. regulation
  3. secretion
  4. excretion
  5. gluconeogenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what does the kidney regulate?

A

body fluid volume & osmolarity
electrolyte balance
acid-base balance
BP

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

what does the kidney secrete?

A

EPO
1,25-dihydroxy vitamin D3
renin-angiotensin-aldosterone
prostaglandin

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

what does the kidney excrete?

A

metabolic pdts
foreign substances
XS stuff (water, etc)

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

what is the functional unit of the kidney?

A

nephron

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

what are the 2 major components of a nephron?

A

glomerulus

tubule system

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

what is the glomerulus?

A

a compact cluster of convoluted capillaries

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

what does the glomerulus do?

A

filtration > remove substances from blood before it flows into the convoluted tubule

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

what is the tubule system the site of?

A

reabsorption
secretion
excretion

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

where does filtration occur?

A

glomerulus

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

where does reabsorption occur?

A

desc & asc limb of the loop of Henle

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

where does secretion occur?

A

desc & asc limb of the loop of Henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

where does excretion occur?

A

distal convoluted tubule

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

what is the 1st step in urine formation?

A

bulk transport of fluid (usu passive) from blood to kidney tubule

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

what triggers the 1st step of urine formation?

A

“push” of blood flow + hydraulic pressure thruout the whole nephron (esp in the glomerulus & Bowman’s capsule)

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

why do things go thru the pores in the endothelium of the glomerulus?

A

extremely high BP in the structure

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

what 2 things do NOT filter thru the glomerulus?

A

blood cells & proteins

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

what is the mechanism of filtration?

A

bulk flow (passive) by starling forces of filtration

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

what is the driving force behind filtration?

A

pressure gradient (NFP > net filtration pressure)

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

NFP = ?

A

(favoring force) - (opposing force)

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

what is the favoring force?

A

capillary BP

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

what is the opposing force? (2 things)

A 
blood colloid osmotic pressure (COP)
capsule pressure (CP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what direction does the favoring force go?

A

OUT of the capillary

INTO the tubule

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

what direction does the opposing force go?

A

INTO the capillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is GFR?

A

volume of fluid filtered from the glomerular capillaries into Bowman’s capsule per unit time

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

GFR = ?

A

(urine conc x urine flow) / plasma conc

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

what do you use for creatinine?

A

creatinine clearance based on serum creatine level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Ccr = ?

A

(Ucr x V) / Pcr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what 5 factors alter filtration pressure & change GFR?

A 
increased renal blood flow
decreased plasma protein
hemorrhage
molecular weight
molecular charge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what causes increased renal blood flow?

A

vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what does increased renal blood flow do to GFR?

A

increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what does decreased plasma protein do to GFR?

A

increase

causes edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what does hemorrhage do to GFR?

A

decrease

via decreased capillary BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what 3 things regulate GFR?

A

renal autoregulation
neural regulation
hormonal regulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

the 3 things that regulate GFR also regulate 2 more things:

A

renal BP

resulting blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

T/F: blood flow through the cortex is slow

A

FALSE

it’s rapid!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is a cortical nephron?

A

nephron w/ glomeruli in the outer cortex & short loops of Henle that extend a short distance into the medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

the majority of nephrons are (cortical/juxtamedullary)

A

cortical (70-80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

is cortical interstitial fluid hyperosmotic?

A

nope

it’s isosmotic at 300mOsm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is a juxtamedullary nephron?

A

glomeruli in inner part of cortex & long loops of Henle that extend deep into the medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

T/F: blood flow through the vasa recta in the medulla is slow

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

is medullary interstitial fluid hyperosmotic?

A

YES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what do juxtamedullary nephrons do?

A

maintain osmolality
filter blood
maintain acid-base balance
concentrate urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

reabsorption has how many steps?

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what is the 1st step of reabsorption?

A

active or passive extraction of substances from the tubular fluid into the renal interstitium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is the 2nd step of reabsorption?

A

transport substances from interstitium into bloodstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what drives the transport processes in reabsorption?

A

Starling forces
passive diffusion
active transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

where is the concentration of interstitial fluid HIGHEST?

A

inner medulla (1200)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

where is the concentration of interstitial fluid the LOWEST?

A

cortex (300)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

when does reabsorption happen in the PCT?

A

when pH needs to be maintained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what ions are reabsorbed back into the bloodstream in the PCT?

A

bicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what things are ACTIVELY TRANSPORTED into the blood in the PCT?

A

glucose
amino acids
K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what does sodium get absorbed with?

A

HCO3 mostly

Cl in late PCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what % of organic solutes are reabsorbed?

A

70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what substances are actively secreted from the blood into the PCT?

A

H+

toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what is NHE3?

A

a Na+/H+ exchanger (Na from urine to cell, H from cell to urine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is CA?

A

carbonic anhydrase

converts CO2 + H2O > bicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

the descending limb of the loop of henle is permeable to what?

A

highly permeable to H2O!

allows for reabsorption of H2O thru osmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

the ascending limb is not very permeable to what?

A

H2O

aka the diluting segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

which limb of the loop of Henle is responsible for 15% of reabsorption but can increase to 50%?

A

ascending

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is actively transported OUT of the ascending limb into the interstitium?

A

NaCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what happens in the thick ascending limb?

A

passive & active transport of salts OUT of the tubules to be reabsorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what supplies the energy for the Na/K/2Cl transporter?

A

Na/K ATPase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what direction does the Na/K/2Cl transporter move things?

A

Lumen > cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

how does Cl move out of the cell into the interstitium/blood?

A

Cl channels
AND
K-Cl symport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what happens to most of the K in the tubules?

A

cycles back into the lumen thru K channels

67
Q

how are Mg & Ca reabsorbed?

A

passively

via paracellular shunt pathway (go btwn cells from lumen to interstitium/blood)

68
Q

what is the fxn of the loop of Henle?

A

to create a conc gradient in the medulla of the kidney

69
Q

how does the loop of Henle create a conc gradient?

A

countercurrent multiplier system (electrolyte pumps)

70
Q

what is the loop of Henle concentrating?

A

urea

creates an area of high urea conc deep in the medulla near the collecting duct

71
Q

what are the 3 countercurrent mechanisms?

A
  1. loss of H2O (filtrate entering desc limb becomes more conc)
  2. blood in vasa recta removes water leaving the loop
  3. asc limb pumps out Na, K, Cl > filtrate becomes hypo-osmotic
72
Q

is the DCT permeable to water?

A

NO

“relatively impermeable”

73
Q

what happens to the urine in the DCT?

A

DCT creates more DILUTE urine

74
Q

how does the DCT create dilute urine?

A

absorb NaCl

75
Q

how are Na and Cl transported in the DCT?

A

Na & Cl cotransporter (NCC)

76
Q

how is Ca reabsorbed in the DCT?

A

actively

77
Q

what regulates Ca reabsorption in the DCT?

A

PTH > parathyroid hormone

78
Q

what are the 2 cell types in the collecting tubule?

A

principal cells

intercalated cells

79
Q

what do intercalated cells do?

A

acid-base homeostasis

80
Q

what are the 2 types of intercalated cells?

A

alpha & beta

81
Q

what 2 hormones act on the principal cells?

A

aldosterone

vasopressin/ADH

82
Q

what does aldosterone do at the collecting tubule (principal cells)?

A

affects expession of Na channels (ENaC) & Na/K ATPase pumps > regulates Na permeability & final level of K+ in urine

83
Q

what does vasopressin/ADH do to the principal cells of the collecting tubule?

A

determines expression of aquaporin channels (for water) so it controls water permeability

84
Q

how does aldosterone affect the electrical potential in principal cells?

A

increase

85
Q

how does aldosterone affect Na reabsorption & K secretion?

A

increases both

86
Q

what drives the reabsorption of Cl & efflux of K in the principal cells?

A

inward diffusion of Na via ENaC > leaves lumen + potential

87
Q

how does aldosterone affect the channels of the principal cells?

A

increases activity of both apical Na+ channels & Na/K ATPase

88
Q

what channel does ADH regulate?

A

aquaporin-2 (AQP2) into apical membrane of principal cells

89
Q

what effect does LOW ADH have on principal cells & urine?

A

low H2O permeability
dilute hypotonic urine
(getting rid of water)

90
Q

what effect does HIGH ADH have on principal cells & urine?

A

high H2O permeability
Concentrated hypertonic urine
(you’re holding onto all your water)

91
Q

which way does water move through aquaporins?

A

into the cell

92
Q

what do alpha intercalated cells secrete?

A

acid in the form of H+ ions

93
Q

how do apha intercalated cells secrete H+?

A

apical H+ ATPase & H+/K+ exchanger

94
Q

what do alpha intercalated cells reabsorb?

A

bicarb

95
Q

how do alpha intercalated cells reabsorb bicarb?

A

band 3 > a basolateral Cl-/bicarb exchanger

96
Q

what do beta intercalated cells secrete?

A

bicarb

97
Q

how do beta intercalated cells secrete bicarb?

A

pendrin > specialized apical Cl/bicarb exchanger

98
Q

what do beta intercalated cells reabsorb?

A

acid

99
Q

how do beta intercalated cells reabsorb acid?

A

basal H+ ATPase

100
Q

what is the general trend for secretion & reabsorption at alpha & beta intercalated cells?

A 
secrete apical (c-c)
reabsorb basal (b-b)
101
Q

what is excretion?

A

loss of fluid from body in the form of urine

102
Q

amount of solute excreted = ?

A

amt filtered + amt secreted - amt reabsorbed

103
Q

how is osmolarity affected when there is XS water in the body?

A

lower

104
Q

how is osmolarity affected when there is a deficit of water & extracellular fluids in the body?

A

HIGH

105
Q

what are the 2 basic requirements for forming concentrated or dilute urine?

A
  1. ADH secretion

2. high osmolarity of renal medullary interstitial fluid (osmotic gradient for water reabsorption)

106
Q

if there is no ADH, what does the urine look like?

A

large volume, dilute urine

107
Q

in the presence of ADH, what does the urine look like?

A

small volume, concentrated urine

108
Q

where do ALL diuretics act (except aldosterone agonists)?

A

luminal surface

109
Q

where are osmotic diuretics filtered?

A

at the glomerulus

110
Q

What happens to diuretics not filtered at the glomerulus?

A

transported into nephron by organic acid or organic base transported in the proximal tubule

111
Q

what decreases diuretic access to the tubule lumen?

A

decreased renal blood flow
decreased GFR
increased levels of drugs also transported by the organic acid & base transporters

112
Q

what drugs are also transported by the organic acid & base transporters?

A 
alpha-ketoglutarate
uric acid
histamine
cimetidine
catecholamines
choline
abx
probenecid
113
Q

what 4 things affect diuretic effectiveness?

A
  1. where the diuretic acts in the nephron
  2. transport mechanism affected
  3. osmolarity
  4. reabsorption of Na+ w/o H2O
114
Q

diuretics that act PROXIMALLY are strong or weak?

A

WEAK
this is despite the fact that 70-80% of the filtered load is handled there
BUT their actions are counteracted by distal reabsorption mechanisms!

115
Q

diuretcs that act DISTALLY are weak or strong?

A

WEAK

only 5-10% of filtered load is involved

116
Q

are loop diuretics weak or strong?

A

STRONG

117
Q

why are loop diuretics strong?

A
  1. Na/K/2Cl cotransporter is inhibited
  2. Affected site handles large fraction of filtered load
  3. more distal mechanisms cannot compensate
118
Q

what does the interstitium need to be like to create CONCENTRATED urine?

A

hypertonic medullary interstitium

119
Q

how do you create a hypertonic medullary interstitium?

A

lose H2O & gain Na in descending limb

reabsorb Na w/o H2O in ascending limb

120
Q

how do you create a hypotonic filtrate?

A

reabsorb Na w/o H2O in ascending limb & DCT

121
Q

what does dilute urine require?

A

hypotonic filtrate

122
Q

what do loop diuretics do?

A

block reabsorption of Na w/o H2O in the ascending limb

impairs BOTH concentration & dilution of urine

123
Q

what do you need to make ANY urine, concentrated or dilute?

A

reabsorption of Na w/o H2O in the ascending limb

124
Q

how do diuretics that act DISTAL to the loop of Henle affect concentrated or dilute urine production?

A

influence dilution but NOT concentration of the urine

125
Q

why are diuretics used?

A

reduce extracellular fluid volume

126
Q

how do diuretics reduce ECF volume?

A 
decrease total Na+ content
via
reabsorption back into the plasma
OR
secretion in the urine
127
Q

what are the 7 types of diuretics?

A
  1. carbonic anhydrase inhibitors
  2. osmotic diuretics
  3. adenosine A1 receptor antagonists
  4. loop/high ceiling diuretics
  5. thiazide & related
  6. K+ sparing
  7. anti-diuretics & ADH antagonists
128
Q

which classes of diuretics are NON K+ sparing?

A

CA inhibitors
Thiazide & related
Loop/high ceiling
osmotic

129
Q

what class is mannitol?

A

osmotic diuretic

130
Q

how does hypokalemia result from diuretic use?

A

K & H are exchanged for Na in the distal nephron

131
Q

what are the sx of hypokalemia?

A

ECG abnormalities, cardiac arrhythmias, muscular weakness, drowsiness, confusion, loss of sensation, increased binding of cardiac glycosides

132
Q

what drugs should you use for CHF?

A

thiazides
loop diuretics
aldosterone antagonists

133
Q

what drugs should you use for hepatic cirrhosis & ascites?

A

thiazide
loop
K sparing diuretics

134
Q

what drugs should you use for pulmonary edema?

A

loop diuretics

135
Q

what drugs should you use for cerebral edema?

A

osmotic diuretics

136
Q

what is the goal w/ renal edema?

A

maintain kidney fxn

137
Q

what drugs should you use to treat nephrotic syndrome?

A 
thiazide diuretics
(and decrease salt intake)
138
Q

what drugs should you use for acute renal failure?

A

osmotic

loop

139
Q

what drugs should you use for chronic renal failure?

A

aggressive RX w/ loop

140
Q

what are the 4 non-edematous conditions you can treat w/ diuretics?

A

HTN
nephrolithiasis
hypercalcemia
nephrogenic diabetes insipidus

141
Q

how should you treat HTN?

A

decrease salt intake

add thiazides, +/- K sparing or loop

142
Q

how should you treat nephrolithiasis?

A

decrease salt intake

thiazides to increase Ca reabsorption

143
Q

how should you treat hypercalcemia?

A

loop to inc Ca excretion
normal saline to prevent contraction of extracellular space
+/- K sparing as needed

144
Q

how should you treat nephrogenic diabetes insipidus?

A

thiazide or loop to reduce plasma volume & contract extracellular space

145
Q

what is diabetes insipidus?

A

polyuria d/t decreased ADH

146
Q

why can you treat diabetes insipidus w/ thiazides or loop?

A

salt depletion & contraction of ECF > inc proximal tubule reabsorption of Na > dec volume of fluid reaching distal tubule

147
Q

what are the 2 types of diabetes insipidus?

A

central

nephrogenic

148
Q

what is central DI?

A

dec ADH d/t injury, tumor, infection

149
Q

how do you treat central DI?

A

arginine vasopression
vasopressin analogs
chlorpropamide

150
Q

what are the vasopressin analogs?

A

desmopressin & lypressin

151
Q

how do you give the vasopressin analogs?

A

IM, SC, or intranasal

152
Q

what is chlorpropamide & what does it do?

A

a sulfonylurea

increases the actions of ADH

153
Q

what is nephrogenic DI?

A

decreased ADH RESPONSIVENESS d/t hypercalcemia, hypokalemia, post-obstructive renal failure, lithium

154
Q

what is the treatment for nephrogenic DI?

A

ADD THIAZIDES

DELETE LOOPS

155
Q

what drugs do you give to pts w/ nephrogenic DI?

A 
amiloride
NSAIDS (indomethacin)
156
Q

what does amiloride do w/ DI?

A

blocks Li uptake

157
Q

why do you treat DI w/ NSAIDs?

A

decrease prostaglandin synthesis > increased response to ADH

158
Q

what is SIADH?

A

syndrome of inappropriate secretion of ADH

159
Q

how do you treat SIADH?

A

loop diuretics
demeclocycline
vaptans
lithium

160
Q

what do loop diuretics do for SIADH pts?

A

decrease the ability to conc the urine

161
Q

what does Demeclocycline do in SIADH pts?

A

decrease ADH actions (but cannot use if pt has liver dysfxn)

162
Q

what are vaptans?

A

nonpeptide V2 receptor antagonist for use in SIADH pts

163
Q

what does lithium do for SIADH pts?

A

decrease ADH actions

not used clinically, can be ineffective, can damage kidney

Block 9 Week 2 (5 decks)

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