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nephrology Flashcards

1
Q

3 nephron processes

A

filtration
reabsorption
secretion

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2
Q

What is filtration?

A

Passes from plasma into the renal tubule

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3
Q

What is reabsorption

A

Moves back up into the plasma from the tubule

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4
Q

What is secretion?

A

Moves into the tubule from the plasma

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5
Q

What are 6 uses for diuretics?

A 
Glaucoma
Metabolic Alkalosis
Acute Mountain Sickness
Acute Renal Failure (ARF)
Acute Kidney Injury (AKI)
Electrolyte imbalances
Hypertension
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6
Q

What are 5 ions effected by diuretics?

A 
Na+
Mg2+
Ca2+
Cl- 
HCO3-
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7
Q

What is the glomerulus?

A

First stop in the nephron
Blood pressure – controls filtrate formation
No medication sites of action
Filter allows small particles and ions to pass and form the ultrafiltrate

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8
Q

proximal tubules reabsorb what?

A

65% of NaCl, K+, Ca2+, Mg2+
85% of NaHCO3
Close to 100% of glucose and amino acids

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9
Q

Proximal tubules secrete what?

Site of action?

A

Organic acid and bases

Site of action
Carbonic anhydrase inhibitors (CAI) proximal tubular
Adenosine antagonist

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10
Q

Carbonic anhydrase Inhibitors (CAI) 3 agents

A

Acetazolamide (Diamox)
Dorzolamide (Trusopt)*
Brinzolamide (Azopt)

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11
Q

Carbonic anhydrase Inhibitors (CAI) MOA

A

Inhibits enzyme responsible for dehydration of H2CO3

Reduces aqueous humor production in the eye

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12
Q

Carbonic anhydrase Inhibitors (CAI) indications

A

Glaucoma, urinary alkalization, metabolic alkalosis, acute mountain sickness

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13
Q

CAI kinetics

A

Absorbs well: oral and ocular
Increase urine pH; onset 30 min, duration 12 hr, peak 2 hr
Excretion: proximal tubular secretion

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14
Q

CAI contraindication and adverse reactions?

A

Adverse Reactions
Renal stones, potassium wasting, drowsiness, hypersensitivity reaction
Contraindication
Hepatic cirrhosis

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15
Q

Loop of henle reabsorption

A

15-25% NaCl, K+

Secondary: Ca2+, Mg2+

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16
Q

Secretion and site of action for loop of henle

A

Secretion
Some K+
Site of action
Loop diuretics

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17
Q

Loop diuretic agents

A

Furosemide (Lasix)
Bumetanide (Bumex)
Torsemide (Dexadex)
Ethacrynic acid (Edecrin)

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18
Q

Loop diuretic MOA

A

Inhibits Na+/K+/2Cl- transporter

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19
Q

indication for loop diuretics

A

Edema, hypercalcemia, hyperkalemia, anion overdose

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20
Q

kinetics for loop diuretics

A

Orally well absorbed; duration of action
Torsemide 1 hour; 4-6 hours
Furosemide 2-3 hours; 2-3 hours

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21
Q

adverse effects for loop diuretics

A

Hypomagnesemia, hyperuricemia, ototoxicity, allergic reaction

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22
Q

Contraindications for loop diuretics

A

Overuse in hepatic cirrhosis, renal failure, or heart failure
Sulfonamide allergy*

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23
Q

what decreases the effectiveness of loop diuretics

A

NSAIDs – decrease effectiveness of loop

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24
Q

If your patient had an sulfa allergy related to furosemide, what other loop diuretic could you use

A

Ethacrynic acid

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25
Q

Conversion of loop diuretics

A

PO to IV conversion
Furosemide 2:1 (40 mg PO = 20 mg IV)
Torsemide and Bumetanide 1:1

Conversion between agents
Furosemide 40 mg = Torsemide 20 mg = Bumetanide 1 mg

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26
Q

Distal Convoluted Tubule

reabsorption, secretion and site of action

A 
Reabsorption
4-8% of Na+, Cl-
Secretion
Ca+ by parathyroid control
Site of action
Thiazide diuretics
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27
Q

2 types of thiazide agents

A

Hydrochlorothiazide (Hydrodiuril)

Chlorothiazide (Diuril)

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28
Q

MOA of thiazides

A

Inhibits NaCl transporter

Enhances Ca+ reabsorption

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29
Q

indication of thiazides

A

Hypertension, heart failure, nephrogenic diabetes insipidus, nephrolithiasis

30
Q

3 thiazide like diuretics

A

Metolazone (Zaroxolyn)
Indapamide (Lozol)
Chlorthalidone (Thalitone)
a sulfonamide group and having same MOA

31
Q

thiazide kinetics

A

Absorbed slowly

Chlorthalidone slowest but longer duration of action

32
Q

adverse reaction for thiazide kinetics

A

Hyponatremia, hypokalemia, hyperuricemia, hyperlipidemia, allergic reaction, photosensitivity

33
Q

contraindications for thiazide kinetics

A

Overuse in hepatic cirrhosis, renal failure, or heart failure

34
Q

When are thiazide diuretics ineffective?

A

GFR less than 20 ml/min except metolazone

Chlorothiazide is the only thiazide in IV formulation

35
Q

Cortical collecting tubule

reabsorption, secretion, site of action

A 
Reabsorption
2-5% Na+
Secretion
K+ and H+
Site of action
Potassium sparing diuretics
Adenosine antagonists
36
Q

2 potassium sparing agents

A

Spironolactone (Aldactone)

Eplerenone (Inspra)

37
Q

MOA of potassium sparing agents

A

Prevents K+ secretion by antagonizing mineralocorticoid receptors (preventing aldosterone from binding)

38
Q

indications for potassium sparing agents

A

Hypokalemia (prevention and treatment), primary

Spironolactone: hyperaldosteronism, polycystic ovary disease, hirsutism

39
Q

kinetics for potassium sparing agents

A

Spironolactone: onset, duration, and peak – slow – several days to reach therapeutic levels
Triamterene: onset 2-3 hours, duration 7-9 hours

40
Q

adverse reactions for potassium sparing agents

A

Hyperkalemia
Triamterene – kidney stones
Spironolactone only – gynecomastia, impotence, tumorgenic

41
Q

contraindications for potassium sparing agents

A

Hyperkalemia, renal impairment, hepatic impairment

Spironolactone – Addison’s disease

42
Q

drug interactions for potassium sparing agents

A

Eplerenone only: strong CYP3A4 agents: fluconazole, diltazem, grapefruit juice

43
Q

Medullary collecting duct

reabsorption, secretion, site of action

A 
Reabsorption
Water
Secretion
None
Site of action
Vassopressin
44
Q

ADH antagonist indirectly

A

Lithium (Lithobid)
Demeclocycline (Declomycin)
MOA – not known

45
Q

ADH antagonist directly

A

Conivaptan (Vaprisol)
Tolvaptan (Samsca)
MOA – Inhibits vasopressin receptors
*never seen in practice

46
Q

Indications for ADH antagonists

A

Congestive heart failure, syndrome of inappropriate ADH secretion (SIADH)

47
Q

Direct ADH Antagonist kinetics and adverse reactions

A

Kinetics
Onset 2-4 hrs, peak 4-8 hrs, duration ~24 hrs
Adverse reactions
Nausea, dry mouth, thirst

48
Q

Direct ADH Antagonist contraindications

A

Hypovolemia, hyponatermia

49
Q

2 osmotic diuretics

A

Glycerol

Mannitol

50
Q

MOA of osmotic diuretics

A

Increase osmotic pressure in the glomerulus, decreasing reabsorption of water and electrolytes

51
Q

indications for osmotic diuretics

A

Cerebral edema, acute glaucoma, bronchial hyper-responsiveness

52
Q

Adverse reactions for osmotic diuretics

A

Glycerol – nausea, vomiting, diarrhea

Mannitol – excessive volume expansion  heart failure, edema, pulmonary congestion

53
Q

Kinetics and contraindications for osmotic diuretics

A

Kinetics
Poorly absorbed, quickly excreted
Contraindications
Hypersensitivity

54
Q

Glomerular Filtration Rate (GFR)

A

Most common method for measuring kidney function
Volume of plasma filtered across the glomerulus per unit of time
Normal GFR range: 90-120 mL/min
Difficult to measure directly

55
Q

Serum Creatinine (SCr)

A 
Endogenous substance – by product of muscle metabolism
100% cleared by kidneys
90% glomerular filtration
10% through tubular secretion
Direct measure
24 hr urine collection
Indirect measure
Calculation based on SCr
56
Q

Ideal Body Weights calculation

A

Males: 50 kg + (2.3 kg x inches over 5 ft)
Females: 45.5 kg + (2.3 kg x inches over 5 ft

57
Q

Clinical Presentation for acute kidney infection

A

Increase in serum creatinine (Scr)
Decrease in glomerular filtration rate (GFR)
Accumulation of nitrogenous waste
Inability to regulate fluid, electrolytes, and acid-base balance
Weight gain (edema)
Foamy urine
Changes in urinary habits

58
Q

4 types of renal disease

A

pre renal
postrenal
intrinsic
functional

59
Q

functional damage for renal disease

A

Hemodynamic changes without hypotension or structural damage

60
Q

intrinsic damage for renal disease

A

Structural damage
urine sediment- casts, cellular debris
RBC + WBC in urine- 2-4
urine Na+ - >40

61
Q

postrenal for renal disease

A

obstruction of urine flow

urine WBC 1+

62
Q

Prerenal azotemia for renal disease

A

Decrease renal perfusion
urine Na+ 20
urine/ SCr- > 40:1

63
Q

Non-oliguria

A

Adults: > 400 mL/day or > 0.5 mL/kg/hr
Pediatric: >1 mL/kg/hr

64
Q

Oliguria

A

Adults: < 400 mL/day or < 0.5 mL/kg/hr for > 6 hrs
Pediatric:
Infants: 0.5 mL/kg/hr for 24 hours
Older: <500 mL/1.73 m2

65
Q

Anuria

A

< 50 mL/day (Adults and pediatrics)

Most severe patients because they are not making urine

66
Q

Medication induced AKI– Vasoconstriction into kidney

A 
NSAIDS
Cyclosporine
Tacrolimus
Amphotericin B
Radiocontrast agents
Vasopressors
67
Q

Medication induced AKI– Vasodilation out of the kidney

A

ACEIs, ARBs

Diltiazem, Verapamil

68
Q

medication induced AKI– Direct toxicity to renal tubules

A

Aminoglycosides
Amphotericin B*
Cisplatin and carboplatin
Radiocontrast agents*

69
Q

patient risk factors for AKI

A 
History of chronic kidney disease
Increased age
Comorbid conditions:
Diabetes
Dehydration
Patient already on AKI inducing medication
70
Q

Treatment of AKI

A

evaluate fluid status
identify cause
supportive therapy

Pharm Renal & GU (2 decks)

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