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Emily: Pharm 2 > Quiz 9: Neprology > Flashcards

Quiz 9: Neprology Flashcards

1
Q

What is the purpose of the glomerulus with Bowman’s Capsule:

A
  • filtration

- 25% of plasma that arrives here passes through the filtration barrier to become filtrate

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2
Q

What is reabsorbed out of the proximal tubule:

A
  • NaCl (majority)
  • Glucose
  • potassium,
  • amino acids,
  • bicarb,
  • phosphate,
  • protein,
  • urea,
  • water (follows NaCl)
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3
Q

What is secreted into the proximal tubule:

A
  • Hydrogen
  • Foreign substances
  • Organic anions
  • Cations
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4
Q

T/F: The proximal tubule is isotonic:

A

TRUE

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5
Q

Which diuretic works at the proximal tubule:

A
  • CARBONIC ANHYDRASE INHIBITORS

- OSMOTIC

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6
Q

-Is the proximal tubule:

a. Isotonic
b. hypotonic
c. hypertonic

A

-Isotonic

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7
Q

What is reabsorbed in the descending loop of Henle:

A

-water

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8
Q

What stays inside the tube at the descending loop of Henle:

A

-NaCl

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9
Q

The think ascending loop of Henle is permeable to water:

A

FALSE (It is IMpermeable to water)

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10
Q

What is reabsorbed in the thick ascending loop of Henle (ascending loop in the notes?):

A

-NaCl

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11
Q

What stays within the thick ascending loop of Henle (ascending loop in the notes?):

A

-H2O

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12
Q

What is the active transport system in the thick ascending loop:

A

-sodium potassium pump and cotransport

1 sodium, 2 chloride, 1 potassium

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13
Q

Is the loop of henle:

a. isotonic
b. hypertonic
c. hypotonic

A

All the above.

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14
Q

What diuretic works at the Loop of Henle:

A

LOOP DIURETICS

It really looks like it works at the thick ascending limb

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15
Q

What is reabsorbed in the distal tubule:

A
  • NaCl
  • Water
  • bicarb
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16
Q

What is secreted in the distal tubule:

A
  • Potassium,
  • Urea
  • hydrogen
  • NH3
  • Some medications
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17
Q

What is required for water to be reabsorbed at the DISTAL TUBULE:

A

-ADH required

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18
Q

Is the distal tubule:

a. isotonic
b. hypertonic
c. hypotonic

A
  • isotonic

- hypotonic

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19
Q

What is reabsorbed in the collecting duct:

A
  • water

- NaCl

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20
Q

T/F: Anti-diuretic hormone is needed for water to be reabsorbed in the collecting ducts:

A

TRUE

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21
Q

What can either be reabsorbed or secreted in the collecting ducts:

A
  • Na
  • K
  • H
  • NH3
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22
Q

What diuretic works at the DISTAL TUBULE:

A

-Thiazides

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23
Q

What diuretic works at the COLLECTING DUCT:

A

-Anti diuretic hormone (Aldosterone)

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24
Q

How is chronic kidney disease defined:

A

> 3 months

  • structural or functional abnormalities with or without decrease in GFR
  • GFR < 60 ml/min with or with OUT kidney damage
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25
Q

List the chronic kidney disease stages:

A

STAGES:

1: Damage with nml or inc GFR: GFR > 90 ml/min
2: Damage with mild dec GFR > 60-89 ml/min
3: Moderate dec GFR 30 - 59 ml/min
4: Sever dec GFR: 15 - 29 ml/min
5: kidney failure: GFR < 15 ml/min
6: DIALYSIS

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26
Q

Where do potassium sparing diuretics work:

A

DISTAL TUBULE

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27
Q

Where do xanthines work:

A

PROXIMAL TUBULE

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28
Q

List the carbonic anhydrase inhibitors:

A
  • Methazolamide
  • Acetazolamide
  • Dichlorophenamine
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29
Q

What is the mechanism of action for carbonic anhydrase inhibitors:

A
  • Inhibits carbonic anhydrase which inhibits H+ secretion in the proximal tubule
  • Bicarb and sodium are blocked from re-absorption
  • The effect is short lived due to compenstion at loop of Henle
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30
Q

What are the uses of carbonic acid inhibitors:

A
  • altitude sickness
  • increase interocular pressure
  • Decreased formation of CSF
  • Management of familial periodic paralysis
  • Metabolic acidosis may stimulate ventilation in patient who are hypoventilating as a compensatory response to metabolic alkalosis
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31
Q

What may be a draw back to using acetazolaminde for an increase respiratory drive:

A

-the loss of bicarbonate ions necessary to buffer CO2 may result in the exacerbation of respiratory acidosis in patient with chronic COPD, leading to CNS depresssion

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32
Q

What are the side effect of carbonic acid inhibitors:

A
  • blurred vision
  • changes in taste
  • constipation
  • drowsiness
  • frequent urination
  • loss of appetite
  • N/V
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33
Q

List the osmotic drugs:

A
  • Mannitol

- Urea

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34
Q

What is the method of action of osmotic drugs:

A
  • Non-reabsorbable solute filtered freely at the glomerulous. Uncouples sodium and water reabsorption by increasing the osmotic gradient in the proximal tubule. Sodium reabsorption initially, but water is not, leading to decreased sodium reabsorption distally
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35
Q

What do osmolarities does osmotic alter:

A
  • plasma
  • glomerular filtrate
  • renal tubular fluid
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36
Q

Osmotic increase the excretion of:

A
  • water
  • sodium
  • chloride
  • bicarbonate ion
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37
Q

T/F: Urinary pH is not altered by mannitol-induced osmotic diuresis:

A

TRUE

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38
Q

I.V. Mannitol increases ______ osmolarity which expands the _________ fluid volume.

A
  • plasma

- intravascular

39
Q

Mannitol causes redistribution of fluid to:

A
  • decrease brain buld
  • may increase renal blood flow to the medulla
  • negative effect to CHF patient with poor myocardial function (due to increase intravascular volume.
40
Q

What are the clinical uses of mannitol:

A
  • prophylaxis against acute renal failure
  • differential diagnosis of acute oliguria
  • treatment of increase in ICP
  • Decreasing intraocular pressure
41
Q

Is mannitol nephroprotective:

A

NO, true evidence.

42
Q

Mannitol is no better than plain ____ pre-radiocontrast dye, except in the _____ transplant surgery which has a less incidence of ARF.

A
  • saline

- renal

43
Q

Will mannitol increase urine output in the patient with a severely compromise glomerular or renal tubular function:

A

NO (Mannitol will only help when intravascular volumes are low)

44
Q

Will mannitol increase cerebral blood volume and ICP initially:

A

YES, but will decrease systemic blood pressure

45
Q

What may be used in conjunction of mannitol use:

A
  • corticosteroids

- Hyperventilation

46
Q

What are the side effects of mannitol:

A
  • precipitate pulmonary edema
  • HYPOVOLEMIA (due to water and NaCl secreation)
  • electrolyte disturbances
  • plasma hyperosmolarity (due to water and NaCL secretion)
47
Q

Will urea crass the BBB:

A

YES

48
Q

What are the side effects of urea:

A
  • venous thrombosis

- tissue necrosis after necrosis

49
Q

What lab value will increase after urea administration:

A

B.U.N.

50
Q

List the Loop Diuretics:

A
  • Furosemide
  • Bumetanide
  • Torsemide
  • Ethacrynic Acid
51
Q

What is the method of action of loop diuretics:

A

-inhibits Na and Cl reabsorption in the ASCENDING LOOP and to a lesser extent in the PROXIMAL tubule

52
Q

Furosemide will cause a production of what and results in:

A
  • prostaglandin
  • renal vasodilation and increased renal blood flow

-

53
Q

T/F: Furosemide will redistribute renal blood flow from the ____ to the _____ renal cortex and contribute to the diuretic effect of furosemide.

A
  • inner

- outer

54
Q

What will inhibit furosemide increase in renal blood flow:

A

-NSAIDs

55
Q

What are the clinical uses of loop diuretics:

A
  • mobilization of edema fluid due to renal hepatic, or cardiac dysfunction
  • treatment of increased ICP
  • Inhibition of cellular uptake of calcium for the treatment of hypercalcemia
  • differential diagnosis of acute oliguria
56
Q

How will furosemide effect venous return of the body:

A

-cause peripheral vasodilatation that precedes the onset of diuresis which may help in the management of acute pulmonary edema

57
Q

Will furosemide increase the lymph flow through the thoracic duct:

A

YES

58
Q

How is ICP decreased by furosemide:

A
  • systemic diuresis
  • Decreasing CSF production by interfering with Na transport in glial tissue
  • resolving cerebral edema by improving cellular water transport
59
Q

How is ICP NOT decreased by furosemide:

A
  • changes in cerebral blood flow

- changes in plasma osmolarity

60
Q

Which better decreases ICP:

a. mannitol
b. furosemide

A

-mannitol

61
Q

Which drug will NOT effect ICP if the BBB is broken:

a. Furosemide
b. Mannitol

A

-Furosemide

62
Q

Will a combination of furosemide and mannitol have a synergistic effect.

A

-YES

63
Q

What electrolyte and fluid imbalances will loop diuretics effects:

A

ABNORMAL FLUID/ELECTROLYTE BALANCES:

  • hypOkelemia
  • hypOchloremia
  • HypOnatremia
  • HypOmagnesemia
  • Metabolic alkalosis
64
Q

Could furosemide cause deafness:

A

YES, due to the prolonged electrolyte imbalance

65
Q

What cross sensitivity does loop diuretics have:

A

-interaction with drugs containing a sulfonamide nucleus (THIAZIDES are included)

66
Q

What antibiotic will cause nephrotoxicity with loop diuretics:

A
  • aminoglycoside

- Cephalosporins

67
Q

What antibiotic will cause allergic interstitial nephritis with loop diuretics:

A

Penicillin

68
Q

List the thiazide diuretics:

A
  • chlorothiazide
  • hydrochlorothiazide
  • Indapamide
  • Metolazone
  • Chlorthalidone
69
Q

What is the method of action for thiazide:

A

-compete for the Na-Cl cotransporter in the distal tubule to inhibit re-absorption. Inhibit only urinary diluting capacity, not concentrating capacity.

70
Q

What are the clinical uses for thiazide:

A
  • HTN
  • mobilization of edema
  • Diabetes Insipidus
  • Treatment of hypercalcemia
71
Q

Initially how does thiazides affect HTN:

A
  • Decrease extracellular fluid volume

- Often decrease cardiac output

72
Q

How do thiazide sustain their affect on HTN:

A

-DUE TO PERIPHERAL VASODILATION

—Takes weeks to develop

—Due to a diminished effect of sympathetic nervous system activity at peripheral vascular smooth muscle, which correlates with a decrease in total body stores of sodium

73
Q

What electrolytes will be effected with thiazides:

A
  • HypOkalemia
  • HypOchloremia
  • HypOmagnesium
  • Metabolic alkalosis with chronic administration
74
Q

T/F: Sodium and magnesium dpletion may accompany kaliuresis.

A

TRUE

75
Q

Why will thiazides cause dysrrhythmias:

A

Due to:

  • HypOmagnesemia
  • Hypokalemia
76
Q

What are side affects of hypokalemia:

A
  • Skeletal muscle weakness
  • G.I. ileus
  • Nephropathy characterized by polyuria and azotemia
  • Increased likelihood of developing dig. toxicity
  • Potentiation of nondepolarizing neuromuscular blockers
77
Q

What are thiazides side effects:

A
  • Decreased intravascular volume
  • Hyperglycemia
  • Hyperuricemia
  • Decreased renal or hepatic function
78
Q

List the potassium sparing diuretics:

A
  • Amiloride
  • Triamterene
  • Spironolactone
  • Eplerenone
79
Q

What is the method of action of amiloride and triamterene (potassium sparing diuretics)

A

-inhibit Na reabsorption induced by aldosterone. Inhibit active counter transport of Na an K in the collecting duct

80
Q

What is the method of action of spironolactone and eplerenone:

A

-competes for aldosterone receptor sites in the distal tubule to block Na reabsorption and K secretion

-

81
Q

What drug improves sputum viscosity in patients with cystic fibrosis:

A

-aerosolized amiloride

82
Q

Why is CHF and Cirrhosis of the liver affected by thiazides:

A

-Works in these situations because decreaed hepatic function and metabolism lead to increased plasma concentration of aldosterone.

83
Q

What is the principle effect of a potassium sparing diurects.

A

Hyperkalemia

84
Q

What other drugs increase the side effect risk of:

A

NSAIDS

A.C.E.

-Beta blockers

85
Q

T/F: Thiazide may produce hyperuricemia or hyperglycemia.

A

TRUE

86
Q

What EKG changes will be seen with hypERkalemia:

A
  • Tall peaked T wave
  • Loss of P wave
  • Widened QRS with tall T waves
87
Q

What medication are used for hyperkalemia:

A
  • Calcium glucanate (Possibly magnesium if JUST to stabilize the myocardium)
  • Insulin
  • Albuterol
  • Furosemide
  • Sodium polystyrene sulfonate (Kayexalate)
88
Q

T/F: Calcium decreases the hypERkalemia levels:

A

FALSE (No effect)

89
Q

Calcium does what to the threshold potential of the myocardium:

A

-Lower the threshold potential

90
Q

What drug could worsen the myocardial effects with digoxin.

A

CALCIUM

91
Q

Sodium bicarbinate is used to treat severe _______ ________ and not _______ _______

A
  • metabolic acidosis

- lower potassium

92
Q

Does use of a albuterol work rapidly or slowly in treatment of hyperkalemia:

A

-Rapidly

93
Q

What does sodium plystyrene sulfonate exchange in the colon for a potassium:

A

Sodium

Emily: Pharm 2 (11 decks)

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