Nephro Meds & Medication Use Concepts - Final Wrap Up

Question 1

What happens in the Glomerulus w/ the Bowman’s Capsule?

Answer 1

Filtration

Question 2

What occurs in the Proximal Tubule?

Answer 2

Reabsorption: Na, K, Glucose, Amino Acid, Bicarb, Protein

Secretion: H⁺, Foreign Substances, Anions & Cations

Question 3

Where do Carbonoic Anhydrase Inhibitors & Osmotic Diuretics work?

Answer 3

Proximal Tubule

Question 4

What does the Loop of Henle do?

Answer 4

Concentrates Urine

Question 5

What occurs in the Descending Loop of Henle?

Answer 5

Water Reabsorption

&

Na diffuses In

Question 6

What occurs in the Ascending Loop of Henle?

Answer 6

Active Na Reabsorption

&

Water Stays In

Question 7

What happens in the Distal Tubule?

Answer 7

ADH mediated Water & Sodium Reabsorption

Bicarb Reabsorption

&

Secretion of K⁺, Urea, NH₃⁺

Question 8

Where in the Kidney do Thiazides work?

Answer 8

Distal Tubule

Question 9

What occurs in the Collecting Duct?

Answer 9

ADH-mediated Water & Na Reabsorption

&

Final Concentration

Question 10

How is Chronic Kidney Disease defined?

Answer 10

> 3 Months of Damage or GFC < 60

Question 11

What is Stage 1 CKD?

Answer 11

Damage w/ GFR > 90

Question 12

What is Stage 2 CKD?

Answer 12

Damage w/ GFR: 60-89

Question 13

What is Stage 3 CKD?

Answer 13

GFR: 30 - 59

Question 14

What is Stage 4 CKD?

Answer 14

GFR: 15-29

Question 15

How is Kidney Failure defined?

Answer 15

GFR < 15

Question 16

Which meds are Carbonic Anhydrase Inhibitors?

Answer 16

Acetazolamide

Methazolamide

Dichlorophenamine

Question 17

How do Carbonic Anhydrase Inhibitors work?

Answer 17

Inhibits Calcium & H⁺ Secretion in the PCT

&

Blocks Bicarb & Na Reabsorption

Question 18

What are some considerations when giving Carbonic Anhydrase Inhibtors?

Answer 18

Bicarb Loss

HYPOK Metabolic Acidosis

Tolerance

Question 19

What are the side effects of Carbonic Anhydrase Inhibitors?

Answer 19

Vision & Taste Changes

GI effects

Question 20

Which meds are Osmotic Diuretics?

Answer 20

Mannitol

&

Urea

Question 21

How do Osmotic Diuretics works?

Answer 21

Big solute that pulls water in and increases Osmotic Gradient in the PCT

Question 22

What are the concerns when using Osmotic Diuretics?

Answer 22

↓Intracellular Volume

&

Hypernatremia

Question 23

How does Mannitol affect Urinary pH?

Answer 23

No Effect on Urinary pH

Question 24

Mannitol pulls fluid from intracellular space to expand ________, and redistributes it into the kidneys for elimination

Answer 24

Mannitol pulls fluid from intracellular space to expand intraVASCULAR, and redistributes it into the kidneys for elimination

Question 25

When is Mannitol used?

Answer 25

Renal Failure Prophylaxis Increased ICP or IOP Oliguria

Question 26

What needs to be intact in order for Mannitol to be effectivne in decreasing ICP?

Answer 26

Blood Brain Barrier must be intact

Question 27

What are the side effects of Mannitol?

Answer 27

Pulmonary Edema Hypovolemia Electrolyte Problems

Question 28

Why has Urea fallen out of favor?

Answer 28

Venous Thombosis Tissue Necrosis ↑BUN

Question 29

Which meds are Loop Diuretics?

Answer 29

Furosemide Bumetanide Torsemide Ethacrynic Acid

Question 30

How do Loop Diuretics work?

Answer 30

Stop Sodium & Chloride Reabsoption in the Ascending Loop & PCT

Question 31

Along with Sodium and Chloride, what other electrolytes are lost with Loop Diuretics?

Answer 31

Calcium & Magnesium

Question 32

What is the Renovascular Effect caused by Loop Diuretics?

Answer 32

Renal Vasodilation, ↑RBF, & Hypotension d/t Prostaglandins

Question 33

What is the Braking Phenomenon?

Answer 33

Acute Tolerance to Loop Diuretics

Question 34

Besides electrolyte imbalances, Loop Diuretics can also cause ______ & \_\_\_\_\_\_

Answer 34

Besides electrolyte imbalances, Loop Diuretics can also cause **DEAFNESS** & **CROSS SENSITIVITY TO SULFA DRUGS**

Question 35

What can happen when Loop Diuretics are given with Antibiotics?

Answer 35

Nephrotoxicity

Question 36

Which meds are Thiazide Diuretics?

Answer 36

-thiazide Indapamide Metolazone Chlorthalidone

Question 37

How do Thiazides work?

Answer 37

Competes for Na-Cl Cotransporter int he DCT to stop Reabsorption

Question 38

What electrolyte imbalances can Thiazides cause?

Answer 38

HYPOK & HYPERcalcemia

Question 39

What are the side effects of Thiazides?

Answer 39

Hyperglycemia Hyperuricemia ↓Renal & Liver Fxn

Question 40

Which meds are Potassium Sparing Diuretics?

Answer 40

Amiloride Triamterene Spironolactone Eplerenone

Question 41

How do Amiloride & Triamterene work?

Answer 41

Stops Sodium Reabsorption from Aldosterone & Active Counterr Transport of Sodium & Potassium in the Collecting Duct

Question 42

How do Spirinolactone & Eplerenone work?

Answer 42

Competes for Aldosterone Receptors in the DCT

Question 43

When are K Sparing Diuretics used?

Answer 43

Refractory Edema from CHF & Cirrhosis d/t Increased levels of Aldosterone

Question 44

How do K Sparing Diuretics affect Urea & Glucose levels?

Answer 44

No Effect; Just HyperKalemia

Question 45

How is Acute Hyperkalemia treated?

Answer 45

Calcium Gluconate Insulin Albuterol Lasix Kayexalate

Question 46

What are other GI Potassium Binders besides Kayexalate?

Answer 46

Patiromer & Sodium Zirconium Cyclosilicate (Better for Acute Therapy

Question 47

What do VAPTANS do?

Answer 47

ADH/Vasopressin V1 or V2 Receptor Blockers