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ILE I > ILE U4 D1 > Flashcards

ILE U4 D1 Flashcards

1
Q

Adults are _% water

A

50-60%

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2
Q

Children are _% water

A

75%

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3
Q

The elderly is _% water

A

45%

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4
Q

Blood plasma has high concentrations of

A

Na, Cl, Bicarb, protein

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5
Q

The IF has high concentrations of

A

Na, Cl, bicarb, lower level of protein

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6
Q

ICF has high levels of

A

K, phos, mag, and protein

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7
Q

How does H2O move across cell membranes?

A

Passively, largely through osmosis and facilitated diffusion

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8
Q

H2O movement depends on

A

The concentration of the environment

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9
Q

Passive movement occurs __ the concentration gradient

A

down (high -> low)

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10
Q

Channels offer ___ and ___

A

insulated and larger passageways for molecules to cross

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11
Q

Ligand gating

A

Channel opens in response to (ligand) binding

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12
Q

Voltage gating

A

Channel opens in response to change in membrane potential

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13
Q

Posttranslational modification

A

Channel gates in response to modification (like phosphorylation)

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14
Q

_K:_Na in K:Na pump?

A

2K:3Na

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15
Q

Isotonic solution

A

same concentration inside membrane as outside membrane

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16
Q

Hypertonic solution

A

Higher concentration outside membrane than inside membrane

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17
Q

Hypotonic solution

A

Solution outside membrane has lower concentration than inside membrane

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18
Q

Capillary wall is made up of

A

Thin membrane of endothelial cells

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19
Q

How do substances go through capillary walls ?

A
  1. Junctions between endothelial cells
  2. vesicular transport
  3. Diffusion
  4. Filtration
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20
Q

The rate of filtration at any point depends of forces called

A

Starling forces

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21
Q

J[v]

A

Net fluid flux

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22
Q

K[f]

A

Filtration coefficient

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23
Q

P[c]

A

Capillary pressure

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24
Q

P[I]

A

interstitial pressure

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25
Q

sigma

A

reflection coefficient

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26
Q

pi[c]

A

capillary oncotic pressure

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27
Q

pi[I]

A

interstitial oncotic pressure

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28
Q

Colloids

A

large molecules that are not freely permeable to the membrane

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29
Q

Colloids are more present in ____ than in interstitium

A

vascular fluid

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30
Q

Most prominent vascular colloid

A

albumin

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31
Q

hypoproteinemia

A

Low levels of vascular colloids

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32
Q

What does hypoproteinemia cause?

A

edema

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33
Q

What can changes in sodium concentration cause?

A

edema

34
Q

Osmolality mostly measures

A

extracellular sodium concentration

35
Q

hyponatremia causes cellular

A

edema

36
Q

hypernatremia causes cellular

A

dehydration

37
Q

Tonicity

A

term used to describe the in-vivo osmolality of a fluid; the manner in which the infused fluid will effect transcellular fluid flux.

38
Q

T/F; the kidney can generate new nephrons

A

F

39
Q

Strongest diuretic

A

Loop

40
Q

Loop diuretic ADRs

A

OHH DAANG

  1. ototoxicity (ears)
  2. hypokalemia
  3. hypomagnesemia
  4. Dehydration
  5. Allergy
  6. Alkalosis
  7. Nephritis
  8. Gout
41
Q

Loops lose/gain Ca

A

lose

42
Q

Loop diuretic mechanism

A

Inhibit Na/K/Cl transport system of THICK ASCENDING LoH

43
Q

What inhibits loops?

A

NSAIDs

44
Q

When do you use loop diuretics?

A

edematous states, hypertension, hypercalcemia

45
Q

Ethacrynic acid drug type

A

loop diuretic

46
Q

ethacrynic MoA

A

similar to other loops (furosemide) but MORE ototoxicity

47
Q

Thiazide diuretics MoA

A

Inhibits NaCl reabsorption in early DISTAL CONVOLUTED TUBULE, dilates capacity of nephron, decreased Ca excretion

48
Q

When would you use a thiazide?

A

Hypertension, hypercalciuria, osteoporosis, diabetes insipidus

49
Q

Thiazide ADRs

A

HyperGLUC

  1. Hyperglycemia
  2. Hyperlipidemia
  3. Hyperuricemia
  4. Hypercalcemia
50
Q

K sparing diuretics MoA

A

Inhibit Na channel in cortical collecting duct either directly or by interfering with aldosterone

51
Q

K sparing diuretics that directly inhibit Na channel in cortical collecting duct

A

triamterene and amiloride

52
Q

K sparing diuretics that interfere with aldosterone

A

Spirinolactone and eplerenone

53
Q

Diuretic’s efficacy in edema therapy depends on

A

Amount of filtered Na normally reabsorbed at its site of action, distal to its site of action, adequate drug delivery to site of action, amount of Na that reaches site of action

54
Q

When are diuretics appropriate?

A

When reduced water and sodium intake are ineffective

55
Q

All diuretics act by reducing Na uptake in the

A

renal tubules; just differ in place within the tubules

56
Q

FeNa

A

Fractional excretion of Na

57
Q

Which are more powerful;

Loop>/

A

Loop > K-sparing/thiazides

58
Q

The effectiveness of thiazides and loop diuretics is dependent on

A

Drug concentrations in tubular lumen

59
Q

How do thiazides and loop diuretics reach the tubular lumen?

A

active transport via proximal tubular cells

60
Q

Spirinolactone gains access to ____ via _____ in the ____

A

Spirinolactone gains access to mineralocorticoid receptors in the cortical collecting duct through diffusion from the systemic circulation

61
Q

natriuresis

A

excretion of Na in urine

62
Q

To achieve natriuresis, what must occur?

A

threshold of loop or thiazide diuretic concentration (“ceiling dose”)

63
Q

Ceiling dose for furosemide

A

40 mg IV

64
Q

If a patient has chronic kidney disease, is their ceiling dose reduced or increased?

A

reduced, because renal absorption is reduced according to decrease in GFR

65
Q

Primary driving force for GFR

A

hydrostatic pressure gradient across the glomerular capillary wall

66
Q

Myogenic reflex

A

Acute changes in renal perfusion pressure evoke reflex constriction or dilatation of the afferent arteriole in response to increased or decreased pressure

67
Q

TGF

A

changes the rate of filtration and tubular flow by reflex vasoconstriction or dilatation of the afferent arteriole. TGF is mediated by specialized cells in the thick ascending limb of the loop of Henle called the macula densa(sense solute concentrations and tubular flow rate)

68
Q

Angiotensin II

A

When reduced renal blood flow, renin is released from GRANULAR cells within the wall of the AFFERENT ARTERIOLE near the MACULA DENSA in a region called the JUXTAGLOMERULAR APPARATUS. ATII evokes vasoconstriction of the EFFERENT ARTERIOLE, and the resulting increased glomerular hydrostatic pressure elevates GFR to normal levels

69
Q

mGFR

A

Measured GFR; used to determine kidney damage

70
Q

ideal filtration marker is defined as

A

a solute that is freely filtered at the glomerulus, nontoxic, neither secreted nor reabsorbed by the kidney tubules, and not changed during its excretion by the kidney

71
Q

Inulin

A

fructose polysaccharide with molecular wgt– 5.2 kD

Freely filtered through glomerulus - gold standard for measuring GFR, but test is invasive

72
Q

Methods to measure GFR:

A
  1. CrCl
  2. Cockcroft-Gault
  3. Modification of diet in renal disease (MDRD)
  4. Chronic kidney disease epidemiology collaboration
    All based on creatinine
73
Q

Normal range for CrCl

A

Adults 0.6-1.2mg/dL

74
Q

CrCl equation

A

[(140-(age)) x lean body weight (kg) ] / (serumCr x 72)

^ x 0.85 if woman

75
Q

With kidney disease, CrCl should be adjusted to

A

BSA (body surface area)

76
Q

Using the Cockcroft-Gault equation with creatinine values measured by most laboratories in the United States today will result in a

A

10-40% overestimate

77
Q

BUN

A

Blood urea nitrogen - concentration of nitrogen (in urea) in serum (NOT RBCs)

78
Q

Normal BUN

A

8 –23 mg dL

79
Q

Elevated BUN indicates

A

Higher production (high protein diet), less tubular reabsorption,

80
Q

Azotemia

A

clinical condition of elevated BUN (READ TABLE 11-1 in Chapter 11 of the Handbook of Laboratory Values to see causes of azotemia according to broad classification of pre-renal, intra-renal, or post-renal azotemia).

81
Q

BUN/serum creatinine ration (normal)

A

10-15:1. Greater than 20:1 in renal disease

ILE I (18 decks)

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