Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Part 22: Renal Function & BP Modulation > Flashcards

Part 22: Renal Function & BP Modulation Flashcards

1
Q

what is the normal blood pressure?

A

120/80 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the target BP in patients with CV risk, diabtes, or kidney disease?

A

<130/80 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is considered a dangerous BP (hypertensive crisis)?

A

> 180/120 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are 3 strategies to reduce BP?

A
  1. reduce blood volume
  2. reduce vascular resistance
  3. reduce force of heart contraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

why is high BP dangerous?

A

puts stress on BV and organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the main functions of the kidneys? (4)

A
  1. production of regulatory enzymes & hormones including renin
  2. filtering out waste products, metbolites & chemicals from the blood
  3. regulate water and electrolyte
  4. regulate BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_____ of the kidney are the individual filtering units of the kidneys

A

nephrons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the function of the nephrons?

A

filtering, used to remove substances from the blood and excrete them in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

t/f there are multiple sites of ion & solute reabsorption along the nephron

A

t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

the thick ascending limb of the nephron expresses ion transporters that allow the reabsorption of ____, ____, and ___ from the urinary compartment

A

Na; K; Cl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

the flow of K can go back into the urinary compartment of the acsending loop and creates a _____ (positive/negative) potential that increases the reabsorption of _____ions such as ___ and ____ back into the blood

A

positive; Mg and Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

where do loop diuretics like furosemide act?

A

in the ascending limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the MOA of loop diuretics like furosemide?

A

blocks the NKCC2 to reduce the transport of Na, K, and CL in the thick ascending limb and Mg and Ca reabsorption are also decreased, meaning more will be excreted in urine (along with water)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

can water move in/out of the thick ascending limb of the nephron?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

t/f loop diuretics like furosemide are effective in promoting the excretion of large volumes of fluid

A

t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

furosemide is typically indicated for the management of edema associaed with ____, but can also be used for ____ when patients requires a diuretic effect

A

congestive heart failure; hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which ion transporters are found in teh distal convoluted tubule?

A

Na/Cl co-transporter (NCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

in the distal convoluted tuble, NCC facilitate the reabsorption of ions into the ___

A

blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

which hormone acts on the distal convoluted tubule to increase reabsorption of Ca?

A

PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what type of diuretics block the NCC in the distal convoluted tubule?

A

thiazide-like diuretics, like hydrochlorothiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the MOA of thiazide-like diuretics?

A

block the NCC, reducing the reabsorption of Na in the distal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why are other thiazide-like diuretics typically given over hydrochlorothiazide?

A

they typically have a longer half life than HCTZ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the regular dosing of HCTZ?

A

BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

t/f bc the reabsorption of multiple ions are linked together by co-transport mechanisms, impairing the reabsorption of Na can impact other ions

A

t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

the actions of loop diuretics and thiazide diuretics are most likely to cause an overall loss of ____ ions, resulting in hypo-___

A

K , kalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are some of the symptoms of hypokalemia?

A
  1. increased blood pH (alkylosis)
  2. muscle weakness
  3. cardiac arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

why might hypokalemia cause muscle weakness and cardiac arrhythmias?

A

due to the importance of K ions in action potential generation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

t/f patients on loop and thiazide duiuretics should have regular blood monitoring for K levels

A

t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

t/f it would be reasonable to recommned a patient taking a thiazide or loop diuretic to eat bananas

A

t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the benefit of K sparing diuretics?

A

they do not cause a net excretion of K in urine and promote reabsorption of K in the collecting tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

K sparing diuretics act at what part of the nephron?

A

collecting tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

____ is the final segment of the nephron where Na reabsorption can occur before excretion in urine

A

collecting tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

in the collecting duct, Na follows its ____ and ____ gradient from the nephron lumen into the ___-cell through Na channels

A

concentration and electrical; principle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

how is the transport of Na ions in the collecting tubule different than in other sections of the nephron?

A

only Na is going through the channels, there is no co-transport with Cl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how does reabsorption of Na in the collecting duct force more K to be excreted into the urine?

A

Na causes a build up of + charge in the principle cells that pushes out the K

36
Q

aldoesterone stimulates _____ receptors in the prinicple cells, which causes increased gene transcription and upregulation of the _____ channel and the ____ pump

A

mineralocorticoid; ENAC Na channels; NA/K pump

37
Q

aldosterone _____ (increases/decreases) the reabsorption of Na into the blood and also causes _____ (increased/decreased) excreted of K

A

increases; increased

38
Q

how do K sparing diuretics work to lower the amount of K excreted in the urine?

A

they reduce the reabsorptio of Na in the collecting tubule principle cells, which will have the secondary effect of reducing excretion of K

39
Q

what are the 2 classes of K sparing diuretics?

A
  1. aldosterone receptor antagonists

2. ENAC blockers

40
Q

what class of diuretics does spironolactone belong to?

A

aldosterone receptor antagonist K sparing

41
Q

what class of diuretics does amiloride belong to?

A

ENAC blocker K sparing diuretic

42
Q

spironilactone is a ____ molecule with affinity for ____ receptors and ____ receptors

A

steroid; androgen and aldosterone

43
Q

what off target effect is important to consider when thinking about giving spironolactone as a diuretic?

A

its anti-androgen effects, like the supression of testosterone production

44
Q

spironolactone is also indicated for patients with elevated ____ production, to counter the Na and water retention

A

aldosterone

45
Q

what is the MOA of amiloride?

A

blocks the Na channels in the principle cell membrane, reducing the amount of Na reabsorbed in the collecting tubule

46
Q

why do the K sparing diuretics only have a mild diuretic effect?

A

only a small portion of total body Na is reabsorbed in the collecting tubule where these agents act

47
Q

when might K sparing diuretics be a good therapeutic option?

A
  1. pt has low K

2. if patient is already on a diuretic and requires another

48
Q

what is renin?

A

an enzyme released by the kidneys, stimulated by a drop in renal arterial BP

49
Q

why is renin released by the kidneys when renal arterial BP is low?

A

filtration of the blood in the kidneys is highly dependent on BP to achieve adequate glomerular filtration

50
Q

what is angiotensin?

A

a peptide made by the liver

51
Q

renin cleaves angiotensin into ___

A

angiotensin 1 (AT1)

52
Q

angiotensin converting enzyme (ACE) converts angiotensin 1 into _____

A

angiotensin 2 (ATII)

53
Q

_____ is the active compound that stimulates angiotensin 2 type 1 receptors in the adrenal cortex, causing the release of ____

A

angiotensin 2; aldosterone

54
Q

aldosterone causes a _____(increase/decrease) in BP

A

increase

55
Q

stimulation of ATII receptors in BV causes increased _____ions in the vascular smooth muscle

A

intracellular Ca

56
Q

increases intracellular Ca in vascular smooth muscle caused by the stimulation of AT2 receptors in BV, leads to ___

A

vasoconstriction and increased BP

57
Q

AT2 receptor is a _____ coupled receptor

A

Gq

58
Q

renin is also released in response to activation by teh ____ nervous system

A

sympathetic

59
Q

ACE inhibitors reduce the conversion of ____ to ____

A

AT1 to AT2

60
Q

how do angiotensin receptor blockers (ARBs) work?

A

competitive antagonists of the AT2 receptor, which reduced the actions of angiotensin 2 in target tissues

61
Q

what is the MOA of renin inhibitors?

A

prevent the formation of AT1 near the begining of teh RAS

62
Q

to what class of drugs does ramipril belong?

A

ACE inhibitor

63
Q

what agents are commonly one of the first agents chosen for patients with hypertension?

A

ACE inhibitors

64
Q

how do ACE inhibitors like ramipril lower BP?

A

help stop the conversion of AT1 to AT2 which would act on BV to constrict and to release aldosterone to retain water, both which would raise BP

65
Q

ACE metabolizes _____ into inactive products

A

braykinin (BK)

66
Q

what is bradykinin?

A

a peptide that causes vasodilation

67
Q

what is the benefit of ACE inhibitors reducing the ability of ACE to metabolize bradykinin?

A

more active bradykinin, which causes vasodiltion and decreaseed bP

68
Q

what is an ADR of ACE inhibitors preventign the breakdown of bradykinin?

A

more bradykinin in the blood can lead to a dry persistent cough in some patient (not infectious, but can be bothersome)

69
Q

activation of the Gq pathway of the angiotensin receptor causes increased ____ activation, which increases intracellular levels of ____ and ____, which results in increased intrcaellular ____ion levels, which results in ____ (vasoconstriction or vasodilation)

A

phospholipse C; DAg & IP3; Ca; vasocnstriction

70
Q

in the adrenal cortex, activation of the Gq pathway of teh angiotensin receptor causes the secretion of ____

A

aldosterone

71
Q

what class of antihypertensives does Lorsartan belong to?

A

competitive antagonists of AT2 receptor

72
Q

how does losartan work?

A

blocks the AT2 receptor, so the Gq pathway that causes the adrenal cortex to release aldosterone and Ca that would both increase BP

73
Q

losartan prevents physiologic effects of AT2 in the ____ and ___

A

heart and kidney

74
Q

to what class of antihypertensives does aliskiren belong to?

A

direct renin inhibitor

75
Q

why are direct renin inhibitors not prescribed as much as other antihypertensives when they are belived to be just as effective?

A

they are new and the older drugs have more data and evidence

76
Q

aliskiren was approved for use in Canada in the year ____

A

2007

77
Q

t/f renin inhibitors like aliskiren prevent the activation of teh whole RAS

A

t

78
Q

all drugs affecting the RAS are contraindicated in which group? why?

A

pregnancy; RAS is importnat to fetal development

79
Q

what are the 4 steps of dosage adjustments for renal impairment?

A
  1. estimate the patient’s renal function by calculating their creatinine clearance
  2. determine the % renal excretion of drug
  3. determine normal dosing interval
  4. determine empiric dosage adjustments
80
Q

what is creatinine?

A

a metabolic byproduct that is almost completely removed frpm the body by the kidneys

81
Q

the serum level of creatinine is relatively ___ (high/low) for a person with good renal function

A

low

82
Q

the creatinine clearanec estimates the rate of ____

A

glomerular filtration

83
Q

what is the normal ClCr for men?

A

100-120 mL/min

84
Q

what is the normal ClCr for women?

A

90-100 mL/min

85
Q

what ClCr indicates renal impairment that may require dose adjustments?

A

<60 mL/min

Pharmacology (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions