Nephro Meds & Medication Use Concepts - Final Wrap Up Flashcards
What happens in the Glomerulus w/ the Bowman’s Capsule?
Filtration
What occurs in the Proximal Tubule?
Reabsorption: Na, K, Glucose, Amino Acid, Bicarb, Protein
Secretion: H+, Foreign Substances, Anions & Cations
Where do Carbonoic Anhydrase Inhibitors & Osmotic Diuretics work?
Proximal Tubule
What does the Loop of Henle do?
Concentrates Urine
What occurs in the Descending Loop of Henle?
Water Reabsorption
&
Na diffuses In
What occurs in the Ascending Loop of Henle?
Active Na Reabsorption
&
Water Stays In
What happens in the Distal Tubule?
ADH mediated Water & Sodium Reabsorption
Bicarb Reabsorption
&
Secretion of K+, Urea, NH3+
Where in the Kidney do Thiazides work?
Distal Tubule
What occurs in the Collecting Duct?
ADH-mediated Water & Na Reabsorption
&
Final Concentration
How is Chronic Kidney Disease defined?
> 3 Months of Damage or GFC < 60
What is Stage 1 CKD?
Damage w/ GFR > 90
What is Stage 2 CKD?
Damage w/ GFR: 60-89
What is Stage 3 CKD?
GFR: 30 - 59
What is Stage 4 CKD?
GFR: 15-29
How is Kidney Failure defined?
GFR < 15
Which meds are Carbonic Anhydrase Inhibitors?
Acetazolamide
Methazolamide
Dichlorophenamine
How do Carbonic Anhydrase Inhibitors work?
Inhibits Calcium & H+ Secretion in the PCT
&
Blocks Bicarb & Na Reabsorption
What are some considerations when giving Carbonic Anhydrase Inhibtors?
Bicarb Loss
HYPOK Metabolic Acidosis
Tolerance
What are the side effects of Carbonic Anhydrase Inhibitors?
Vision & Taste Changes
GI effects
Which meds are Osmotic Diuretics?
Mannitol
&
Urea
How do Osmotic Diuretics works?
Big solute that pulls water in and increases Osmotic Gradient in the PCT
What are the concerns when using Osmotic Diuretics?
↓Intracellular Volume
&
Hypernatremia
How does Mannitol affect Urinary pH?
No Effect on Urinary pH
Mannitol pulls fluid from intracellular space to expand ________, and redistributes it into the kidneys for elimination
Mannitol pulls fluid from intracellular space to expand intraVASCULAR, and redistributes it into the kidneys for elimination
When is Mannitol used?
Renal Failure Prophylaxis
Increased ICP or IOP
Oliguria
What needs to be intact in order for Mannitol to be effectivne in decreasing ICP?
Blood Brain Barrier must be intact
What are the side effects of Mannitol?
Pulmonary Edema
Hypovolemia
Electrolyte Problems
Why has Urea fallen out of favor?
Venous Thombosis
Tissue Necrosis
↑BUN
Which meds are Loop Diuretics?
Furosemide
Bumetanide
Torsemide
Ethacrynic Acid
How do Loop Diuretics work?
Stop Sodium & Chloride Reabsoption in the Ascending Loop & PCT
Along with Sodium and Chloride, what other electrolytes are lost with Loop Diuretics?
Calcium
&
Magnesium
What is the Renovascular Effect caused by Loop Diuretics?
Renal Vasodilation, ↑RBF, & Hypotension d/t Prostaglandins
What is the Braking Phenomenon?
Acute Tolerance to Loop Diuretics
Besides electrolyte imbalances, Loop Diuretics can also cause ______ & ______
Besides electrolyte imbalances, Loop Diuretics can also cause DEAFNESS & CROSS SENSITIVITY TO SULFA DRUGS
What can happen when Loop Diuretics are given with Antibiotics?
Nephrotoxicity
Which meds are Thiazide Diuretics?
-thiazide
Indapamide
Metolazone
Chlorthalidone
How do Thiazides work?
Competes for Na-Cl Cotransporter int he DCT to stop Reabsorption
What electrolyte imbalances can Thiazides cause?
HYPOK
&
HYPERcalcemia
What are the side effects of Thiazides?
Hyperglycemia
Hyperuricemia
↓Renal & Liver Fxn
Which meds are Potassium Sparing Diuretics?
Amiloride
Triamterene
Spironolactone
Eplerenone
How do Amiloride & Triamterene work?
Stops Sodium Reabsorption from Aldosterone & Active Counterr Transport of Sodium & Potassium in the Collecting Duct
How do Spirinolactone & Eplerenone work?
Competes for Aldosterone Receptors in the DCT
When are K Sparing Diuretics used?
Refractory Edema from CHF & Cirrhosis d/t Increased levels of Aldosterone
How do K Sparing Diuretics affect Urea & Glucose levels?
No Effect; Just HyperKalemia
How is Acute Hyperkalemia treated?
Calcium Gluconate
Insulin
Albuterol
Lasix
Kayexalate
What are other GI Potassium Binders besides Kayexalate?
Patiromer
&
Sodium Zirconium Cyclosilicate
(Better for Acute Therapy
What do VAPTANS do?
ADH/Vasopressin V1 or V2 Receptor Blockers
