Lecture 12- Renal- Diuretics and Dialysis Flashcards
2 main indications for diuretics
HTN
CHF
diuretics inhibit
water reabsorption
in CHF, the heart is weakened so this decreases CO which decreases GFR which then causes an … of aldosterone which will … Na and H2O reabsorption leading to ….
increase
increase
increased ECV/ edema
6 classes of diuretics
osmotic CA inhibitors loop thiazides K+ sparing aquaretics
… diuretics retain water by increasing osmotic pressure; they act on water-permeable segments of the nephron (PT and descending LOH)
osmotic
…. diuretics reduce Na reabsorption; proximal tubule is major site of action
CA inhibitors
… diuretics act in the thick ascending limb to inhibit Na reabsorption via the Na/K/2Cl symporter
loop
… diuretics block the NaCl symporter in the early distal tubule
thiazide
… diuretics has 2 classes that both act in the late distal tubule and cortical collecting duct to inhibit sodium reabsorption AND potassium secretion
K+ sparing
2 classes of K+ sparing diuretics?
aldosterone antagonists
ENaC blockers
…. are ADH receptor anatagonists in the late distal tubules and collecting duct. water is eliminated without the loss of solutes
aquaretics
mannitol is an example of …
an osmotic diuretic
bumetanide, ethacrynic acid and furosemide are examples of
loop diuretics
metolazone is an example of a
thiazide diuretic
amiloride, spironolactone and triamterene are examples of
K+ sparing diuretics
mannitol gains access to tubule by …. and are poorly reabsorbed
glomerular filtration
CA inhibitors gain access to tubule via
secretion
CA inhibitors reduce Na reabsorption by inhibiting CA, thus reducing the H+ available for the ….
Na/H antiporter
most of the diuretic effect of CA inhibitors is in the PT where 1/3 of Na reabsorption relies on the ….
Na/H antiporter
T/F CA inhibitors are extremely effective
false. downstream segments will increase Na reabsorption when tubular Na increases
… are the most powerful diuretics
loop diuretics
furosemide (lasix) is a … diuretic
loop
where do loop diuretics work?
ascending loop
loop diuretics are secreted into the
proximal tubule
loop diuretics inhibit the …. symporter in the thick ascending limb which inhibits Na reabsorption and causes the urine leaving the loop to not be …. which means no …. is established in the medulla interstitium so water is not reabsorbed along collecting duct
Na/K/2Cl
dilute
osmotic gradient
thiazide diuretics act in the
early distal tubule
thiazide diuretics act in the … by blocking the
early distal tubule
NaCL transporter
spironolactone is a common
aldosterone antagonist (K sparing diuretic)
amiloride is a …
ENaC channel blocker (K sparing)
aldosterone antagonists block aldosterones ability to increase…. in … cells
Na transporters
principal
ENaC channel blockers block Na reabsorption across the … membrane
apical
CA inhibitors cause metabolic…
acidosis
loop and thiazide diuretics cause metabolic …
alkalosis
K sparing diuretics cause metabolic …. because H+ secretion in distal tubule and cortical collecting duct is …
acidosis
inhibited
except for …. all other diuretics alter calcium excretion
K sparing
osmotic and CA inhibitors both act in proximal tubule and … reabsorption of calcium in this segment so … is increased
reduce
excretion
… diuretics stimulate calcium reabsorption in the distal tubule and thus reduce excretion
thiazide
