EX 7 Diuretics Flashcards
condition wherein there is an increased urine output
diuresis
agents used to induce diuresis
diuretics
Twin, bean-shaped organ of the body
kidneys
main function is to CLEAR the HARMFUL, TOXIC substances by filtering the blood
kidneys
kidneys are responsible for regulating
- blood pH
- blood volume
- blood pressure
- osmolality,
- production of some hormones
kidney size
roughly the size of the fist
kidney location
retroperitoneally (located behind the peritoneal membranes; alongside the vertebral column)
pushed down by the liver which is why it is slightly lower than the other kidney
right kidney
kidney weight
0.5% of the total body weight
cardiac output received by the kidneys
around 25%
filters about 150 L of blood every day
adult kidney
Located in the MIDDLE of the kidney
Renal hilum
POINT OF ENTRY & EXIT of all the nerves that go into and come out of the kidney
Renal hilum
Thin tubes of muscles that CARRY the URINE from the KIDNEY INTO THE BLADDER
ureter
Located in the PELVIS between the pelvic bone
bladder
HOLLOW, muscular, BALLOON-shaped organs
bladder
Bladder ____________ as it fills with urine
expands
Bladder can approximately hold up to _______________ of urine
1.5 to 2 cups
Smooth TRANSPARENT sheet of dense connective tissue that GIVES KIDNEYS DISTINCT SHAPE
renal capsule
2 main parts of the cross section image of the kidney
- renal medulla
- renal cortex
renal medulla is made up of _______________ renal pyramid
10 to 18
Primarily COLLECTED IN RENAL PELVIS area → ureter → bladder
urine
Basic functional unit of the kidney
nephron
2 parts of the nephron
- renal corpuscle
- renal tubule
glomerulus, capillaries, and
Bowman’s capsule
renal corpuscle
PCT, nephron lobe (Loop of Henle), DCT, collecting ducts
renal tubule
regulation of BP and the
GLOMERULAR FILTRATION RATE (amount of blood that passes
through the glomeruli each minute)
Juxtaglomerular complex
Juxtaglomerular complex location
between the distal convoluted tubule and afferent arterioles
Three types of cells in the Juxtaglomerular complex
- Macula densa cells
- Juxtaglomerular cells
- Extraglomerular mesangial cells
Site of action of diuretic agents
renal tubule
Carries out ISOOSMOTIC REABSORPTION reabsorption of glucose and numerous ions
PCT
Major site for NaCl and NaHCO3 reabsorption
PCT
about 65-70% of the total
reabsorption of sodium
PCT
loop of henle consists of
Thick ascending limb (TAL)
Permeable to sodium chloride, not water
TAL of loop of henle
Approximately 25% of the sodium is
reabsorbed to this segment
TAL of loop of henle
Major site of Ca and Mg REABSORPTION
TAL of loop of henle
Permeable to sodium chloride, but IMPERMEABLE TO H20
DCT
approximately 5% of sodium
reabsorption
DCT
diuretics that target DCT
thiazides inhibits NCC (NaCl cotransporter)
diuretics that target loop of henle
loop diuretics
diuretics that targets PCT
carbonic anhydrase inhibitors
Controlled by aldosterone
collecting duct
steroid hormone secreted
by the adrenal cortex
aldosterone
approximately 1-2% of sodium
reabsorption
collecting duct
diuretics that targets collecting duct
K-sparing diuretics
diuretics are also known as
water pill
help the kidneys to GET RID OF EXTRA H2O & SALT through the process of urination
diuretics
indications of diuretics
- HTN
- edema
- glaucoma
- HF
- kidney and liver problems
- poison cases
Diuretics classification
- Carbonic anhydrase inhibitors
- Loop diuretics
- Thiazides diuretics
- Potassium-sparing diuretics
- Osmotic diuretics
- Aldosterone receptor antagonists
Lipschitz value ≥ 1
POSITIVE diuretic effect
Lipschitz value ≥ 2
POTENT diuretic effect
drug with 1.8 Lipschitz value
HCTZ
drug with 4 Lipschitz value
furosemide
increase excretion of renal sodium
natriuretic
increase excretion of solute-free water
aquaretic
Most commonly used diuretic
thiazide
Drug of choice for hypertension without comorbidities
thiazide
May produce hypokalemia
thiazide
thiazide drugs (HICC)
HCTZ, Indapamide, Clopamide, Chlorthalidone
Inhibit the Na+-K+-2Cl- cotransporter (NKCC2 cotransporter)
loop diuretics
risk of HYPERkalemia, do not produce HYPOkalemia
K-sparing diuretics
Inhibit aldosterone-sensitive sodium reabsorption, less potassium and hydrogen ion are exchanged –> less potassium and hydrogen are lost
K-sparing diuretics
May be used alone or in conjunction with loop or thiazide diuretics
K-sparing diuretics
K-sparing diuretics (TEAS)
Triamterene, Eplerenone, Amiloride, Spironolactone
a Potassium-sparing diuretic
aldosterone receptor antagonist
Does not act directly on the sodium transport but antagonizes actions of aldosterone
aldosterone receptor antagonist
Aldosterone receptor antagonist (ES)
Eplerenone, Spironolactone
Reduce formation of H+ and HCO3- from CO2 and H2O by inhibiting carbonic anhydrase
carbonic anhydrase inhibitor
enzyme responsible for catalyzing the reaction between the CO2 and H2O into carbonic acid
and bicarbonate
carbonic anhydrase
Promotes renal Na+, K+, HCO3- and water excretion
carbonic anhydrase inhibitor
Not typically used for their diuretic capacity
carbonic anhydrase inhibitor
carbonic anhydrase inhibitors (MAD)
Methazolamide, Acetazolamide, Dichlorphenamide
or the treatment and prevention of acute MOUNTAIN SICKNESS (aka ALTITUDE SICKNESS) and some types of epilepsy
Acetazolamide
treat certain INHERITED MUSCLE DISORDERS
Dichlorphenamide
Expand extracellular fluid and plasma volume to increase renal
blood flow which dilutes urine in loop of Henle
osmotic diuretics
osmotic diuretics ____________________________ of blood and renal filtrate
increase osmolarity
osmotic diuretics are only given through ___________
IV
osmotic diuretic (M)
mannitol