Lecture 5+6+DLA Flashcards
edematous states
increased NaCl reabsorption → water retention & blood
volume
ex: HF hepatic ascites nephrotic syndrome premenstrual edema
non-edematous states
hypertension
hypercalcemia
diabetes insipidus
diuretics
Inhibitors of renal ion transporters that decrease the
reabsorption of Na+ at different sites in the nephron
(natriuretics)
used:
managing abnormal fluid retention
hypertension
site of action of CA inhibitors
proximal tubule (reabsorption of water, K, and Na/ secretion of organic acid and base secreting systems
site of action of thiazides
distal convoluted tubule (reabsorption of Cl and Na)
site of action of the K sparing and ADH antagonists?
collecting duct (reabsorption of Na and water / secretion of H and K)
site of action of loop diuretics
thick ascending loop of henle (reabsorption of Na, K, and Cl also Ca and Mg)
loop diuretics
furosemide
Highest efficacy in removing Na+ & Cl from body
Act on ascending limb of Loop of Henle
applications:
managing edema associated with HF, hepatic, and renal disease
moderate to severe hypertension
MOA of loop diuretics
act on the ascending limb of loop of henle
Block NKCC2 Na+ /Cl- /K+ cotransporter
more Na, K, and Cl in tubular fluid = more water excretion
actions of loop diuretics
- Increased urine output
- Increased K+ excretion
- Increased Ca2+ excretion
- Increased Mg2+ excretion
- Increased prostaglandin synthesis
- Decreased renal vascular resistance
- Increased renal blood flow
adverse effects of loop diuretics
- Ototoxicity
- Hyperuricemia
- Acute hypovolemia
- Hypokalemia
- Hypomagnesemia
- Allergic reactions
clinical applications of thiazides?
hypertension
HF (mild-mod)
hypercalciuria (useful for kidney stones)
diabetes insipidus
premenstrual edema
examples of thiazides
Hydrochlorothiazide
Chlorthalidone (longest duration)
Metolazone (most potent)
MOA of thiazides
act at the distal convoluted tubule
block the NCCT Na/Cl transporter
more Na and Cl in tubular fluid
more water excretion
actions of the thiazides
- Increased Na+ & Cl- excretion
- Increased K+ excretion
- Increased Mg2+ excretion
- Decreased urinary Ca2+ excretion
- Decreased peripheral vascular resistance
adverse of thiazides
Hypokalemia • Hyponatremia • Hyperuricemia • Hyperglycemia • Hyperlipidemia • Hypersensitivity • Sexual dysfunction
K sparing examples (aldosterone)
Aldosterone antagonists:
Spironolactone and Eplerenone