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Professional Development > Part 29 > Flashcards

Part 29 Flashcards

1
Q

Diuretics function and major applications (2)

A

Increase output of urine

  • treat hypertesnion
  • mobilize edematous fluid
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2
Q

Diuretics mechanism of action

A

Blockage of Na+ and Cl- reabsorption, which prevents the passive reabsorption of water and causing water and solutes to be retained in the nephron promoting their excretion

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3
Q

Drugs whose site of action is early in the nephron have….
As a result they…

A

…opportunity to block greatest amount of solute reabsorption, produce greatest amount of diuresis

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4
Q

Loop diuretics work at the…
They are the most…

A

…ascending loop of henle, the most effective diuretics available

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5
Q

K+ sparing diuretics work at the…
They are very ___ diuretics because they don’t cause much ____, but can be helpful to reduce ____

A

…distal convoluted tuble and collecting duct

weak, diuresis, hypokalemia

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6
Q

Furosemide (Lasix) mech of action, where is it excreted?

A

acts at thick ascending limb of loop of henle blocking reabsorption of Na+ and Cl-, preventing passive reabsorption of water

The liver excretes it

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7
Q

Loop diuretics have activity even during…

A

…renal failure

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8
Q

Furosemide (Lasix) length of action for oral and IV

A

Oral - diuresis lasts 8 hours after 1 hour absorption
IV, diuresis lasts for 2 hours within minutes

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9
Q

Furosemide (Lasix) therapeutic uses (3)

A
  • reserved for rapid mobilization of fluid such as pulmonary edema with congestive heart failure
  • uncontrolled hypertension
  • Electrolyte imbalances
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10
Q

Furosemide (Lasix) ADR’s (7)

A
  • Dehydration
  • Thrombosis or embolism
  • hypotension
  • ototoxicity
  • hyperglycemia
  • hyperuremia (gouty attack)
  • hyperlipidemia
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11
Q

Furosemide (Lasix) can be administered ___ to minimize unfavorable effects

A

Intermittent schedule

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12
Q

Furosemide (Lasix) drug interactions (3)

A
  • Digoxin effects can be potentiated by loss of K+
  • used in combo with aminoglycoside can increase hearing damage
  • K+ sparing diuretics can counterbalance K+ wasting effects therby reducing risks of hypokalemia
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13
Q

Furosemide (Lasix) dosage oral, why is taking it in morning important

A

20 to 80mg/day single dose, administration at night will result in urination all night long

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14
Q

Hydrochlorothiazide (hydrouracil) drug class, mehc of action

A

Thiazide diuretic,

Blocks reabsoroption of sodium and chloride in early segment of distal convoluted tuble

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15
Q

Hydrochlorothiazide (hydrouracil) requires ___ to function, unlike ____

A

Adequate GFR, loop diuretics which can promote fluid loss with significant renal impairment

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16
Q

Hydrochlorothiazide (hydrouracil) indications (what is it the DOC for?) (4)

A
  • HTN
  • Edema
  • diabetes insipidus
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17
Q

Hydrochlorothiazide (hydrouracil) ADR’s (4)

A
  • hypokalemia
  • hyperglycmia
  • hyperlipidemia
  • produces fetal harm and shouldn’t be used during pregnancy
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18
Q

Spironolactone (aldactone) mech of action, drug class

A

Blocks action of aldosterone at distal tubule, retention of K+and increased excretion of Na+,
K+ sparing diuretic

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19
Q

Spironolactone (aldactone) may take up to ___ to exert effects

A

48 hrs

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20
Q

Spironolactone (aldactone) indications (5)

A
  • hypertension
  • edema
  • hepatic cirrhosis
  • heart failure
  • primary aldosteronism
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21
Q

Spironolactone (aldactone) ADR’s (2)

A
  • hyperkalemia (never combine with K+ supplements or other K+ diuretics
  • endocrine effects similar to other steroid hormones
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22
Q

Elperenone (Inspra) vs Spironolactone (aldactone)

A

Acts like spironolactone, K+ sparing diuretic but has lower affinity for andorgen receptors removing endocrine effects

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23
Q

Elperenone (Inspra) ADR

A

hyperkalemia

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24
Q

Triamterene (dyrenium) mech of action, drug class

A

Dirsupts Na/K ATPase exchange in distal nephron, a direct inhibitor acting very quickly but only producing minimal diuresis
-K+ sparing diuretic

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25
Q

Triamterene (dyrenium) therapeutic uses (2)

A

-used alone or incombo to treat hypertension and edema

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26
Q

Osmotic diuretic compound used in medicine

A

-mannitol

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27
Q

Mannitol (osmitrol) mech of action and drug class

A
  • pharmacologically inert
  • creates osmotic force within lumen of nephron,

Osmotic diuretic

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28
Q

Mannitol (osmitrol) administration

A

IV injection

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29
Q

Mannitol (osmitrol) therapuetic uses (3)

A
  • prophylaxis of renal failure
  • reduciton of inracranial pressure
  • reducjtion intraocular pressure
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30
Q

Mannitol (osmitrol) ADR’s (2)

A
  • can precipiptate congestive heart failure
  • edema by pulling water into interstitial spaces
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31
Q

Carbonic anhydrase inhibitors (acetazolamide (diamox)) function

A

Sulfonamide without antibacterial activity, primarily used for other pharmacologic actions such as treatment of glaucoma rather than diuretic effect because much less effacious than thiazides or loop diuretics

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32
Q

acetazolamide (diamox)) mehc of action

A
  • Inhibitss carbonic anhydrase located intracelluarly on apical membrane of proximal convoluted tubular epithelium
  • HCO3- is retained in lumen resulting in marked elevation of urinary pH - loss of HCO3- causes hyperchloremic metabolic acidosis and decreased diuretic efficacy after several days of therapy
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33
Q

acetazolamide (diamox) therapeutic uses (3)

A
  • Glaucoma
  • mountain sickness
  • edema rarely used
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34
Q

acetazolamide (diamox) ADR’s (4)

A
  • metabolic acidosis
  • hypokalemia
  • renal stone formation
  • drowsiness and parasthesias
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35
Q

(T/F) Loop diuretics can be used with caution in pregnancy

A

true

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36
Q

Hydrochlorothiazide (hydrouracil) drug interactions (3)

A
  • digoxin
  • antihypertensive drugs
  • lithium
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37
Q

Even though albumin is a small enough protein to pass thru the fenestrations of the renal corpuscle, it doesn’t because….
Why is maintaining protein in plasma important?

A

….albumin is negatively charged as well as the filter so it repels it back into the circulation

It helps maintain oncotic pressure

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38
Q

Albumin (protein) in urine tested on disptick is a sign of…

A

…nephrotic syndrome

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39
Q

Afferent arterioels are branches of the ____ arteries and each supply a single ____

A

interlobular, glomerulus

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40
Q

Efferent arterioles divide to form the ___

A

Peritubular microcirculation

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41
Q

Why should you avoid NSAIDS and ASA with vomiting and diarrhea?

A

These irreversibly block prostaglandins in the endothelium, preventing their release to act as dilators of the afferent arterioles that need to dilate to increase GFR

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42
Q

Factors that impact afferent or efferent arteriole tone (5)

A
  • angiotensin II
  • ADH/vasopressin
  • prostaglandins
  • Endothelins
  • Epi/norepi
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43
Q

Endothelin definition

A

Proteins that constrict blood vessels and raise pressure, kept in balance by other mechanisms but when over-expressed contribute to hypertension

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44
Q

In order to compensate for lowered GFR pressure, we will vaso___ the afferent and vaso___ the efferent arteries

A

dilate, constrict

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45
Q

Sympathetic innervation of the bladder vs parasympathetic innervation of the bladder

A

Sympathetic allows for smooth muscle contraction of the bladder, parasympathetic allows for relaxing of internal urethral sphincter

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46
Q

With one kidney removed, blood flow in the remaining kidney will…

A

…compensate quite well nearly double within a few weeks

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47
Q

Increase hydrostatic pressure in Bowman’s capsule, often due to urethral obstruction, can cause…

A

…edema of the kidney

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48
Q

Urine volume is a poor indicator of _____

A

Renal dysfunction

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49
Q

Low urine output may be one of 3 categories

A

prerenal - the blood before the kidney
intrarenal - within the kidney
postrenal - in the ureters, bladder, or urethra

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50
Q

Polyuria, oliguria, and anuria values in mL/day

A

poly - >2L
oligo - <500mL
an - 0-100mL

51
Q

A CBC is beneficial in evaluation of renal function for these 2 reasons

A

1) checks erythropoietin function
2) checks infection of kidney

52
Q

The main organ responsible for balancing electroyltes in the body

A

kidney

53
Q

Renal threshold

A

The amount of glucose (190-220mg/dL) of glucose that will result in sugar in the urine

54
Q

BUN definition

A

Blood urea nitrogen, waste product of nitrogenous breakdown such as muscle in the body, useful measure in assessing kidney function

55
Q

Creatinine definition

A

Breakdown of product of muscle in the body, useful measure in assessing kidney function

56
Q

4 intrarenal disease possibilities

A

1) acute tubular necrosis
2) glomerular
3) vascular
4) tubulointerstitial

57
Q

In a young patient (20’s) with hypertension, need to see if possible pathology source is…

A

…renal artery stenosis

58
Q

3 common presentations of renal dysfunction

A
  • hematuria
  • proteinuria
  • azotemia
59
Q

Azotemia definition

A

Increased plasma conc. of BUN in bloodstream, without symptoms

60
Q

Uremia definition

A

Toxic effects felt as wastes accumulate in the body resulting from renal failure, sometimes being excreted thru the skin, typically causese elevated BUN and creatinine

61
Q

What kills from renal failure?

A

-hyperkalemia causing arrhythmia of heart and eventual death

62
Q

BUN normal value range

A

Between 10-20mg/dL at all times

63
Q

What are 4 things that can decrease BUN?

A
  • Overhydration
  • liver failure
  • neg nitrogen balance
  • pregnancy
64
Q

Normal creatinine level and elevated BUN level indicates a ___renal disease

A

Pre

65
Q

BUN/Creatinine ratio

A

A useful measurement to determine the type of renal disease present

66
Q

Creatinine is a direct reflection of ____ because it is always ____

A

Renal filtration rate, filtered

67
Q

Only __renal disorders will affect creatinine levels

A

Intra

68
Q

Rhabdomyolysis definition

A

An emergency disease that if left untreated leads to kidney failure, indicated by presence of myoglobin in urine, muscle pain, and weakness.

69
Q

4 causes of elevated creatinine

A
  • rhabdomyolysis
  • acromegaly
  • myesthenia gravis
  • muscular dystrophy
70
Q

Ceatinine clearance definition

A

A test that helps determine if kidneys are functioning normally by gauging the amount of creatinine in the urine compared to that in the blood

71
Q

Serum creatinine concentration is the most common way to estimate ___, what is its relationship to that value?

A

GFR, the change in serum creatinine is inversely related logarithmically (i.e. creatinine from 1 to 2 is GFR 1 to .5)

72
Q

24 hr urine collection definition, what are some issues with it?

A

Gold standard test for measuring kidney function, involves having patient pee first thing in morning and then collect every following urination up until completing first pee the next morning, patient compliance is the biggest issue with it

73
Q

Inulin clearance definition and function

A

A lab test using a compound called inulin that is only filtered by kidney, and is therefore a 100% accurate test of GFR, no longer done anymore

74
Q

Healthy individuals without chronic illness can have unlimited ___ intake because it doesn’t have comorbidity associated with it. In theory, intake of this should equal ___ of it

A

Salt, excretion

75
Q

Fractional excretion of Na+ in urine is extremely useful in distinguishing the most 2 common causes of acute kidney injury, what should it be in euvolemic patients in Na+ balance with normal renal function?

A
  • prerenal azotemia
  • acute tubular necrosis

<1%, if >1% can conclude it is acute tubular necrosis
UNLESS on diuretics

76
Q

Specific gravity of serum, what is urine typically?

A

1.010, somewhere above that unless over hydrating then it will be diluted and lowered

77
Q

Prerenal azotemia vs ATN urinalysis

A

normal or with hyaline casts, brown granular casts and cellular debris

78
Q

Positive heme without positive blood on urinalysis, is indicative of this disease…

A

…rhabdo

79
Q

+1 or +2 urine glucose on urinalysis is indicative of serum glucose levels of…

A

190-220

80
Q

Leukocyte esterase on urinalysis indicates….
nitrite reduction on urinalysis indicates…

A

WBC in urine

Infection

Infection

81
Q

Bright red blood tainted urine indicates the bleed is coming from the ___, while dark red indicates it is coming from the ____

A

lower urinary tract, kidney

82
Q

A urine specimen that does not test positive via urinalysis for urobiligen is ___ a urine specimen that tests positive for bilirubin via urinalysis is ___

A

bad, bad

83
Q

Micral test for microalbuminuria definition

A

The gold standard test for early detection of glomerular disease, test for microalbumin in the urine

84
Q

Microscopic urine analysis detects for these 3 things

A
  • cells
  • crystals
  • casts
85
Q

In a blood positive urinalysis, diabetic, kidney infected, metabolic, or kidney stone patient, what should be ordered alongside a urinalysis?

A

Microscopic urine analysis

86
Q

Red cells on a microscopic urine analysis is indicative of what anatomic location? What about red cell casts and what disease? What about white cell casts and what disease? What disease state is about white blood cells in urine? What do muddy brown casts in urine indicate?

A

Renal pelvis down, nephron (glomerulonephritis), nephron (pyelonephritis), bladder infection, tubular damage

87
Q

Blood present at start of stream and then becomes clear indicates…
Blood present through the middle of the stream indicates…
Blood present at the end of the stream indicates…

A
  • urethral bleeding
  • bladder or above
  • prostate and trigone bleeding
88
Q

Common prerenal diseases (4)

A
  • azoemia
  • congestive heart failure
  • hypovolemia
  • hemorrhage
89
Q

Healthy BUN:Cr ratio

A

between 10:1 and 20:1

90
Q

Common postrenal kidney diseases (2)

A
  • severe acute tubular necrosis
  • obstruction
91
Q

Common intrinsic renal diseases (3)

A
  • glomerulonephritis
  • proteinuria
  • nephrotic syndrome
92
Q

Orthostatic proteinuria

A

Benign condition frequently seen in children where proteinuria is seen after periods of standing but not sitting, can be tested for by sampling first urine in morning

93
Q

What kidney conditions would you use ultrasound to detect? (3) Why is this the preferred imaging modality?

A
  • hydronephrosis
  • kidney stone
  • renal artery stenosis

No radiation

94
Q

Significant bacteruria is when there are ____ml of a single organism

A

100,000 (nonpregnant patient)

95
Q

1 cause of renal artery stenosis, as well as 2 other common ones

A

Atherosclerosis, fibromuscular dysplasia, takayasu arteritis

96
Q

Onset of hypertension before age 30 strongly suggests…

A

…Renal artery stenosis

97
Q

3 clinical features of renal artery stenosis

A
  • unexplained hypokalemia (due to aldosterone release)
  • abdominal bruits
  • abrupt onset of hypertension before age 30
98
Q

The risk factors for Renal artery stenosis are the same as those for….

A

…coronary artery disease

99
Q

A rare but significant symptom of bilateral renal artery stenosis

A

Unexplained flash pulmonary edema

100
Q

2 labs/diagnostic studies for renal artery stenosis (gold standard and the cheaper preferred method)

A
  • Renal arteriogram (invasive but almost guaranteed to find)
  • renal ultrasound (cheaper and less iinvasive)
101
Q

2 Treatments for renal artery stenosis (why are we cautious with one of them)

A
  • medical management of hypertension with ACEI or ARB (use caution because already have decreased GFR)
  • revascularization for severe cases
102
Q

Renal artery stenosis prognosis

A

4 year mortality rate up to 40%, improved survival with treatment

103
Q

Fibromuscular dysplasia affects ___ 2-10x more and its cause is…

A

women, unknown

104
Q

What system is used to classify fibromuscular dysplasia today?

A

Angiographic classification system

105
Q

Fibromuscular dysplasia definition

A

A fibrotic change in one of the layers of vasculature in medium sized vessels that often affects the carotid or renal arteries creating aneurisms that look like “beads”

106
Q

Fibromuscular dysplasia presentation (5)

A
  • hypertension
  • headache
  • pulsatile tinnitus
  • neck pain
  • cervical bruit
107
Q

Fibromuscular dysplasia mech of action

A

Symptoms of hypertension, headache, neck pain, etc are result of ischemia due to stenosis, dissection occlusion of arteries, and rupture of aneurysms

108
Q

Fibromusucular dysplasia prognosis

A

Shorter duration of Hypertension, better outcomes

109
Q

Takayayasu arteritis definition, what sex is it most common in? Where is it most often found?

A

Inflmammatory arteritis of the aorta, females, Asia

110
Q

Takayayasu arteritis clinical presentation (3)

A
  • Female with uncontrolled hypertension
  • <40 years old
  • diminished pulse and limb claudication
111
Q

The human kidney can tolerate ___ minutes of ischemia

A

60-90

112
Q

Treatment of renal artery occlusion

A

-heparin followed by oral coumadin, potentially surgical intervention

113
Q

Polyarteritis nodosa definition

A

Very very rare systemic arterial vasculitis

114
Q

Polyarteritis nodosa 3 diagnostic criteria

A

1) necrotizing vasculitis affecting small arteries
2) no association with primary or secondary glomerulopathy
3) not an ANCA associated vasculitis

115
Q

Polyarteritis nodosa mechanism of action

A
  • autoimmune reaction where immune cells attack the arteries
116
Q

Polyarteritis nodosa treatment (2)

A

Steroids and autoimmune suppression

117
Q

Kawasaki disease clinical presentation (5)

A
  • a fever lasting longer than 5 days
  • bilateral bulbar conjunctival infection
  • oral mucous membrane changes
  • erythema of palms and soles and rash
  • cervical lymph adenopathy
118
Q

Kawasaki disease definition

A

A systemic vasculitis uncommon to be of renal origin

119
Q

Kawasaki disease treatment

A
  • Treatment within 10 days needed
  • high aspirin dose (even in children)
  • IVIG
120
Q

Reye syndrome

A

A severe encephalopathy that also affects the liver resulting from children recovering from viral illness and associated with aspirin treatment

121
Q

Atheroembolitic disease definition

A

Cholesterol crystal embolism occuring due to wide spread atherosclerosis

122
Q

Thrombotic thrombocytopenic purpura characteristics (3)

A

Fever, purpura, CNS signs

123
Q

Hemolytic uremic syndrome

A

Hemolysis often following gastrointestinal infection where toxins cause hemolysis affecting most often children putting them into renal failure

124
Q

Triad of hemolytic uremic syndrome

A
  • Thrombocytopenia
  • hemolytic anemia
  • acute renal failure

Professional Development (32 decks)

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