Fluid and Electrolyte Balance: Part 1

Question 1

Functions of the kidney

Answer 1

Cleansing and maintenance of extracellular fluid volume and composition (ECF)

Question 2

Electrolytes hugely impacted by kidneys

Answer 2

Potassium, chloride and sodium

Question 3

Three renal processes effecting ECF

Answer 3

Filtration
Reabsorption
Secretion

Question 4

Filtration is a ______ process and occurs in the ________

Answer 4

Nonselective

Glomerulus

Question 5

Reabsorption includes…

Answer 5

99% water, electrolytes and nutrients

Question 6

What determines concentration and composition of urine?

Answer 6

Reabsorption

Question 7

How do diuretics primarily work?

Answer 7

By disrupting solute reabsorption at specific sites on the nephron

Question 8

What percent of reabsorption occurs at the proximal convoluted tubule?

Answer 8

65%

Question 9

Potassium sparing diuretics work ______ from the glomerulus

Answer 9

Farther

Question 10

Diuretics block..

Answer 10

Na+ and Cl- reabsorption which prevents passive reabsorption of H2O, allowing H20 to be excreted

Question 11

Carbonic anhydrase inhibitors

Answer 11

Work closest to the glomerulus, most potent diuretics that we have, used as eyedrops for glaucoma

Question 12

Diuretics can cause,, (adverse effects)

Answer 12

Hypovolemia
Acid-base imbalances
Disturbance of electrolyte levels

Question 13

Classification of diuretics

Answer 13

Loop / High ceiling
Thiazide
Osmotic
Potassium sparing 
Carbonic anhydrase (lower intraocular pressure)

Question 14

Loop diuretics are the most…

Answer 14

Effective (Diuresis occurs even when GFR is low)

Question 15

Furosemide (Lasix) is most…

Answer 15

Commonly prescribed

Question 16

Lasix: PO action within..

Answer 16

60 min

Question 17

Lasix: IV action begins in _____; lasts ______

Answer 17

5 minutes

2 hours

Question 18

IV Lasix dosage

Answer 18

Give 20-40mg over 1-2 minutes or infusion of 4mg / min

Question 19

Loop diuretics therapeutic uses

Answer 19

• When massive fluid loss is necessary
• Congestive heart failure
• Cardiac or renal insufficiency
• Hypertension

Question 20

Loops - CHF

Answer 20

Decreases some of the need for the heart to push a large amount of fluid through the body

Question 21

Adverse effects of loop diuretics

Answer 21

Hyponatremia, dehydration, hypotension, hypokalemia, ototoxicity, hyperglycemia

Question 22

Because of ototoxicity, loops should not be used with…

Answer 22

Aminoglycosides

Question 23

Loops drug interactions

Answer 23

Potassium sparing diuretics (+)
Antihypertensive agents (+)
Ototoxic drugs (-)
Lithium (-)
NSAIDS (-)
Digoxin (-)

Question 24

Loops and Lithium

Answer 24

Lithium used for Bipolar / Schizophrenia; loops increase lithium toxicity (making people feel like they are losing their minds)

Question 25

NSAIDS and loops

Answer 25

NSAIDS decrease efficacy of loops

Question 26

Digoxin os used for…

Answer 26

Myocardial contractility > CHF

Question 27

Loops and Digoxin

Answer 27

Loops cause hypokalemia which is the only thing that increases risk of digoxin toxicity

Question 28

Thiazide diuretics

Answer 28

Increases secretion of Na+, Cl-, K+, H2O

Question 29

Thiazides are ineffective with…

Answer 29

Scant urine flow, inability to promote diuresis, dependent on kidney function

Question 30

What thiazide is the most commonly used?

Answer 30

Hydrochlorothiazide

Question 31

Hydrochlorothizaide PO onset

Answer 31

2 hours

Question 32

Take thizazides in the…

Answer 32

Morning to prevent nocturia

Question 33

Therapeutic uses of thiazides

Answer 33

Primary hypertension
Edema
Diabetes insipidus

Question 34

Thiazides for Diabetes insipidus

Answer 34

Paradoxical reaction; give thiazide to patients who have to pee all of the time and it has the opposite effect (almost restores natural balance)

Question 35

Adverse effects of thiazides

Answer 35

Hyponatremia, hypokalemia, dehydration

Question 36

Thiazides drug interactions

Answer 36

Same as loops but can be combined with ototoxic drugs