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Summer 2020 - Physiology 2 - Renal > Pathology, Diuretics, & Anesthesia - Final Wrap Up > Flashcards

Pathology, Diuretics, & Anesthesia - Final Wrap Up Flashcards

1
Q

What do Natriuretic Peptides do ?

A

Long-Term Sodium-Water, Blood Volume, and Arterial Pressure Regulation by Vasodilation and Renal Natriuresis & Diuresis.

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2
Q

How do Natriuretic Peptides affect the CV System?

A

↑Venous Compliance

↓Preload & ↓CVP

↓CO

↓SVR

↓PCWP

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3
Q

How do Natriuretic Peptides affect the Kidneys?

A

↑GFR

Inhibits Renin Release

Inhibits Aldosterone Secretion

Inhibits ADH Secretion

↓Angiotensin II

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4
Q

What stimulates Atrial Natriuretic Peptide release?

A

Atrial Stretch or ↑ECF

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5
Q

Where in the Kidney does ANP act to Decrease Sodium Reabsorption?

A

Collecting Duct

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6
Q

Where is Brain Natriuretic Peptide synthesized?

A

Heart Ventricles

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7
Q

What happens w/ the Chronic use of Diuretics?

A

Decreased Effects

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8
Q

Where in the Kidneys do Loop Diuretics, like Bumex & Lasix work?

A

Thick Ascending Limb of Loop of Henle

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9
Q

Where in the Kidney do Thiazides work?

A

Distal Convoluted Tubule

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10
Q

Where do Potassium-Sparing Diuretics work?

A

Distal Tubule & Collecting Duct

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11
Q

Where in the Kidney does Mannitol & Diamox work?

A

Proximal Tubule

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12
Q

How do Osmotic Diuretics like Mannitol & Urea work?

A

Gets filtered & stuck in the Tubules and draws in fluid with them

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13
Q

How do Loop Diuretics like Lasix, Bumex, and Ethacrynic Acid work?

A

Inhibits the Na-2Cl-K pump in the TAL and stops the Countercurrent System

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14
Q

Thiazides are most commonly used & stops Sodium Reabsorption in the DCT. How do they affect Potassium Levels?

A

Can cause Hypokalemia & Alkalosis b/c increased Sodium in the DCT stimulates Aldosterone sodium pump to exchange Potassium & H+ for Sodium

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15
Q

How do Carbonic Anhydrase Inhbitors, like Diamox, work?

A

↓Na Reabsorption in PCT by decreasing the Bicarb Reabsorption that is coupled to the Sodium, which can cause Acidosis

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16
Q

What is the main use for Diamox?

A

Treats Glaucoma

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17
Q

How do Aldosterone Antagonist like Spironolactone work?

A

Spares Potassium via a decrease in Na Reabsorption & K+ Secretion by competing for aldosterone binding sites in the DCT.

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18
Q

Which class of Diuretics are Amiloride & Triamterene?

A

Sodium Channel Blockers

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19
Q

How do Na Channel Blockers work?

A

Decrease Na Reabsorption by decreasing Na/K-ATPase in the Collecting Tubule, which also spares Potassium

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20
Q

What is the difference b/t Acute Kidney Injury vs. Chronic Kidney Disease?

A

AKI: Acute decline or complete loss of kidney function that eventually recovers back to normal

CKD: Irreversible decrease in Functional Nephrons

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21
Q

What are the leading causes of ESRD?

A

1 - Diabetes

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22
Q

When would you start to see symptoms of CKD?

A

When there are < 70% of Functional Nephrons

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23
Q

How is Chronic Kidney Disease defined?

A

Kidney Damage or Decreased Kidney Function lasting 3 months or more

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24
Q

How much of a decrease in functioning nephrons would result in abnormal electrolytes & body fluid volumes?

A

A decrease below 20-25% of normal

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25
Q

What causes CKD?

A

Renal Vasculature Injury

Glomerulonephritis

Infection

Nephrotic Syndrome

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26
Q

What are some causes of Renal Vasculature Injury?

A

Atherosclerosis

Fibromuscular Dysplasia

Nephrosclerosis

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27
Q

What are some causes of Glomerulonephritis?

A

Antigen-Antibody Complexes

Strep Infection

Lupus

28
Q

What is Nephrotic Syndrome?

A

Loss of Negative Charge in Basement Membrane from Proteinuria

29
Q

What is Pyelonephritis?

A

E. Coli Infection, affecting the Renal Medulla & Impairs Ability to concentrate Urine

30
Q

What are the effects of Uremia?

A

Edema

Anemia

Acidosis

↑Nitrogenous Waste

↑K, Phosphates & Phenol

↑CO for more O2 Carrying Capacity

31
Q

What are the signs of Uremic Syndrome?

A

Anorexia

N/V

Pruritis

Anemia

Fatigue

Coagulaopathy

32
Q

What is the biggest risk factor for ESRD?

A

Obesity b/c it causes DM & HTN

33
Q

How does Renal Failure affect Minute Ventilation

A

Increase Minute Ventilation to compensate for Acidosis

34
Q

How does Renal Failure cause Osteomalacia?

A

Vitamin D is converted by Liver & Kidneys. Inablity to do this causes Secondary Hyperparathyroidism to get calcium from bones

35
Q

How does Renal Failure affect the GI?

A

Gastroparesis

&

Gastric Acid Hypersecretion –> Ulcers

36
Q

What happens to the other Kidney if one of them gets damaged?

A

Renin & Angiotensin II from the damaged kidney affects the good kidney

37
Q

During Dialysis, what does the Rate of Solute Movement depend on?

A

Concentration Gradient

Membrane Permeability & Surface Area

Length of Time

38
Q

How much blood is there in the Dialysis Machine at any given time?

A

500 cc

39
Q

What does Dialyzing Fluid NOT have in it?

A

Phosphate

Urea

Urate

Sulfate

Creatinine

40
Q

When is Hemodialysis indicated?

A

Metabolic Encephalopthy
Coagulopathy
Pericarditis
Refractory GI Problems
HyperKalemia
Fluid Overload
Acidosis
Drug Toxicity

41
Q

What can cause an Increased BUN?

A

↓GFR

↑Protein Breakdown

Sepsis

GI Bleed

42
Q

What is the Normal BUN & Creatinine?

A

BUN: 10-20 mg/dL

Creatinine: 0.8 - 1.3 mg/dL

43
Q

Creatinine Concentration is ______ related to Muscle Mass & _______ related to GFR

A

Creatinine Concentration is DIRECTLY related to Muscle Mass & INVERSELY related to GFR

44
Q

How is the GFR affected by age?

A

5% decrease per decade after 20

45
Q

With Renal Tubular Acidosis, what would you exepct the Urinary pH to be?

A

Urinary pH > 7.0

46
Q

How would impaired Renal Function affect Barbiturates?

A

More Senstive d/t ↓Protein Binding

47
Q

How does impaired Renal Function affect Propofol, Ketamine, & Etomidate?

A

No Difference

48
Q

How are Benzos affected by impaired Renal Function?

A

↑Duration

49
Q

How does impaired Renal Function affect Precedex?

A

↑Duration

50
Q

Which Opioids are safe to use with impaired Renal Function?

A

Fentanyl

Other opioids may accumlate d/t metabolites

51
Q

How are Reglan & Anticholinergics affected by Impaired Renal Function?

A

Ok for 1 time dose, but can accumulate if more

52
Q

What can happen when using Sevoflurane in the setting of Impaired Renal Function?

A

Flouride Accumulation

53
Q

Which NMBs should be avoided in pts. w/ impaired renal function?

A

Pancuronium

Pipercuronium

Doxacurium

Alcuronium

54
Q

What are the NMBs of choice w/ Impaired Renal Function?

A

Cis-Atracurium d/t Hoffman Elimination

55
Q

How is Suggamadex viewed in the setting of ESRD?

A

Should be avoided, but not much data

56
Q

What is the main cause of Peri-Op Renal Failure?

A

Hypovolemia

57
Q

What are the main symptoms of Kidney Stones?

A

Pain & Hematuria

58
Q

Calcium Oxalate is the most common type of Kidney Stone. What caues this buildup?

A

Not enough Dietary Calcium

59
Q

What size Kidney Stones can usually pass on their own?

A

< 4mm

60
Q

What drugs can help pass the stone by decreasing Ureter Tone?

A

Alpha Blockers - Terazosin

61
Q

What procedures are used to treat Kidney Stones?

A

ESWL

Ureteroscopic Fragmentation

Perc. Nephrolithotomy

Double J Stents

62
Q

What are contraindications to ESWLs?

A

Can’t Position

Pregnancy

Infection

Obstruction Below Stones

Prosthesis Near Stones

63
Q

How are kidney stones prevented?

A

Hydration

Avoid Soda

Limit Dietary Protein, Nitrogen, & Sodium

64
Q

What kind of diet may cause Gout?

A

Diet rich in Protein, Fat, & Alcohol

65
Q

How is Gout Treated?

A

NSAIDs

Steroids

Acetazolamide

Colchincine

66
Q

What drugs can prevent Gout?

A

Allopurinal

Uricocurics

Caffeine

CPAP (since gout associated w/ Sleep Apnea)

Summer 2020 - Physiology 2 - Renal (5 decks)

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