Pharm Test 3

Question 1

what is a natriuretic?

Answer 1

something that gets rid of sodium

Question 2

water follows

Answer 2

sodium

Question 3

what are the main targets of diuretics?

Answer 3

• membrane transport proteins(most common)
• water permeable segments of nephrons (Osmotic diuretics)
• enzyme inhibition (Carbonic anhydrase)
• interference with hormone receptors (RAAS)

Question 4

which diabetic drug can be used as a diuretic?

Answer 4

SGLT2 inhibitors

Question 5

how do we get down excess ammonia?

Answer 5

we convert it to urea(made in the liver) and then excrete it through the kidneys

Question 6

Macro anatomy of the urinary tract

Answer 6

renal artery, vein, and ureter exits through the hilum.
ureter comes from the kidney on both sides and connects with the urinary bladder.

the urethra comes from the bladder and exits the body

Question 7

what is the outer portion of the kidney called?

Answer 7

cortex

Question 8

what is the inner portion of the kidney called?

Answer 8

medulla (has medullary pyramids)

Question 9

where does the nephron start?

Answer 9

at the bowman’s capsule

Question 10

the medulla has a very different ______ than what is in the cortex. This effects how much water is going to be absorbed into the ureter vs. blood stream

Answer 10

osmolality

Question 11

what is the primary function of the glomerulus?

Answer 11

filtration

Question 12

most of what gets filtered in the glomerulus gets

Answer 12

reabsorbed later on

Question 13

if the glomerulus can’t get rid of something, how does it exit the body?

Answer 13

it gets secreted in another area of the nephron

Question 14

The renal corpuscle has what 2 components?

Answer 14

the outer component: the capsule. Called bowman’s capsule

the blood component: glomerulus. Efferent and Afferent arterioles

Question 15

what comes after the bowman’s capsule?

Answer 15

the proximal convoluted renal tubule

Question 16

what comes after the proximal convoluted renal tubule?
what are it’s different parts?

Answer 16

the Loop of Henle

Thick descending
thin descending
thin ascending
thick ascending

Question 17

which part of the nephron is in the medulla?

Answer 17

loop of Henle

Question 18

which part of the nephron is in the cortex?

Answer 18

everything above the loop of henle

Question 19

what comes after the loop of henle? What does it dump into?

Answer 19

the distal convoluted tubule. dumps into the collecting tubules which turn into the collecting ducts as more and more tubules feed into it

Question 20

If we see a lot of protein in the urine we would think

Answer 20

that something is wrong with the kidney

Question 21

the distal tubule passes by the ________. Why is this important?

Answer 21

bowman’s capsule

The macula densa cells of the juxtaglomerular apparatus sense sodium delivery and overall fluid pressure and these can activate the RAAS system. Can also regulate the blood flow into the glomerulus directly by increasing or decreasing the size of the afferent arteriole.

Question 22

where are glomeruluri ONLY found?

Answer 22

in the cortex

Question 23

wrapped around the proximal distal convoluted tubules are the what? and what are the responsible for?

Answer 23

peritubular capillaries

secretion and reabsorption

Question 24

What is the capillary system that wraps around the loop of henle? what is it responsible for?

Answer 24

vasa recta

osmolality changes, reabsorbing ions that are going to be taken back up into the medulla as opposed to the cortex

Question 25

what are some things that the kidneys don’t want to secrete a bunch of?

Answer 25

bicarb
glucose

Question 26

what percent of stuff that gets filtrated at the glomerulus gets secreted as urine?

Answer 26

1%

Question 27

what is the juxtaglomerular apparatus?

Answer 27

a section of the distal convoluted tubule that has specialized cell types which are refered to as the macula densa. These monitor the osmolality.

Question 28

what surrounds the afferent arterioles in the kidney?

Answer 28

juxtaglomerular cells.

Question 29

What are juxtaglomerular cells?

Answer 29

specialized cells that act like smooth muscle and contract to limit the amount of blood coming into the capillaries.

Question 30

what do the juxtaglomerular cells do when they don’t have enough blood flow coming into the afferent arterioles?

Answer 30

release NO

Question 31

run through the renal autoregulation of GFR for increased map

Answer 31

map increases
GFR increases
juxtaglomerular cells sense this and stop producing NO which vasoconstricts, protecting the kidneys from damage
decreases GFR which brings us back to homeostasis

Question 32

what are the hormonal and neural regulations that control GFR for increased map?

Answer 32

SNS activation stimulates the release of Epi and Norepi. It also increases renin secretion.
hormonal regulation: epinephrine is hormone that is released

Question 33

what are carbonic anhydrase inhibitors?

Answer 33

drugs that target NaHCO3 secretion= excess bicarb loss

Question 34

where do carbonic anhydrase inhibitors work?

Answer 34

primarily in the proximal convoluted tubule

Question 35

where are receptors for caffeine in the kidney?

Answer 35

in the proximal convoluted tubule

Question 36

what are adenosine receptors in the kidney?

Answer 36

receptors for sodium. This is what caffeine targets

Question 37

What is the cycle of carbonic acid being made in the PCT of the nephron?

Answer 37

NHE3. Na+ gets taken back up into the proximal convoluted tubule and H+ is exchanged out.

The sodium gets pumped out by Na+/K+ ATPase pumps.
water follows sodium

H+ binds to bicarb to form carbonic acid by carbonic anhydrase in the urine.

carbonic anhydrase then splits up carbonic acid into CO2 and water.

CO2 diffuses from higher to lower concentration back into the proximal convoluted tubule

inside the proximal convoluted tubule is water. This binds with CO2 via Carbonic anhydrase to form carbonic acid and then it splits again into H+ and HCO3-

We want to keep HCO3- so there’s another transporter that pumps HCO3- out of the cell.

Question 38

what is carbonic anhydrase?

Answer 38

a enzyme imbedded into the walls of the epithelial cells that puts H+ and HCO3- together to form carbonic acid.
It can also catalyzes the reaction from carbonic acid to water and CO2

Question 39

what is acetazolamide?

Answer 39

a carbonic anhydrase inhibitor.
As we block carbonic anhydrase we have a build up of bicarb which slows down or stops the sodium hydrogen exchanger. now we have excess sodium and excess bicarb staying in the urine and therefor water follows.

Question 40

what is the only bicarb wasting diuretic? what is the consequence?

Answer 40

acetazolamide

We can lower the pH of the body below 7.35