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
2
Q
What is reabsorbed out of the proximal tubule:
A
- NaCl (majority)
- Glucose
- potassium,
- amino acids,
- bicarb,
- phosphate,
- protein,
- urea,
- water (follows NaCl)
3
Q
What is secreted into the proximal tubule:
A
- Hydrogen
- Foreign substances
- Organic anions
- Cations
4
Q
T/F: The proximal tubule is isotonic:
A
TRUE
5
Q
Which diuretic works at the proximal tubule:
A
- CARBONIC ANHYDRASE INHIBITORS
- OSMOTIC
6
Q
-Is the proximal tubule:
a. Isotonic
b. hypotonic
c. hypertonic
A
-Isotonic
7
Q
What is reabsorbed in the descending loop of Henle:
A
-water
8
Q
What stays inside the tube at the descending loop of Henle:
A
-NaCl
9
Q
The think ascending loop of Henle is permeable to water:
A
FALSE (It is IMpermeable to water)
10
Q
What is reabsorbed in the thick ascending loop of Henle (ascending loop in the notes?):
A
-NaCl
11
Q
What stays within the thick ascending loop of Henle (ascending loop in the notes?):
A
-H2O
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
13
Q
Is the loop of henle:
a. isotonic
b. hypertonic
c. hypotonic
A
All the above.
14
Q
What diuretic works at the Loop of Henle:
A
LOOP DIURETICS
It really looks like it works at the thick ascending limb
15
Q
What is reabsorbed in the distal tubule:
A
- NaCl
- Water
- bicarb
16
Q
What is secreted in the distal tubule:
A
- Potassium,
- Urea
- hydrogen
- NH3
- Some medications
17
Q
What is required for water to be reabsorbed at the DISTAL TUBULE:
A
-ADH required
18
Q
Is the distal tubule:
a. isotonic
b. hypertonic
c. hypotonic
A
- isotonic
- hypotonic
19
Q
What is reabsorbed in the collecting duct:
A
- water
- NaCl
20
Q
T/F: Anti-diuretic hormone is needed for water to be reabsorbed in the collecting ducts:
A
TRUE
21
Q
What can either be reabsorbed or secreted in the collecting ducts:
A
- Na
- K
- H
- NH3
22
Q
What diuretic works at the DISTAL TUBULE:
A
-Thiazides
23
Q
What diuretic works at the COLLECTING DUCT:
A
-Anti diuretic hormone (Aldosterone)
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
25
List the chronic kidney disease stages:
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
26
Where do potassium sparing diuretics work:
DISTAL TUBULE
27
Where do xanthines work:
PROXIMAL TUBULE
28
List the carbonic anhydrase inhibitors:
- Methazolamide
- Acetazolamide
- Dichlorophenamine
29
What is the mechanism of action for carbonic anhydrase inhibitors:
- 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
30
What are the uses of carbonic acid inhibitors:
- 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
31
What may be a draw back to using acetazolaminde for an increase respiratory drive:
-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
32
What are the side effect of carbonic acid inhibitors:
- blurred vision
- changes in taste
- constipation
- drowsiness
- frequent urination
- loss of appetite
- N/V
33
List the osmotic drugs:
- Mannitol
| - Urea
34
What is the method of action of osmotic drugs:
- 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
35
What do osmolarities does osmotic alter:
- plasma
- glomerular filtrate
- renal tubular fluid
36
Osmotic increase the excretion of:
- water
- sodium
- chloride
- bicarbonate ion
37
T/F: Urinary pH is not altered by mannitol-induced osmotic diuresis:
TRUE
38
I.V. Mannitol increases ______ osmolarity which expands the _________ fluid volume.
- plasma
| - intravascular
39
Mannitol causes redistribution of fluid to:
- 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
What are the clinical uses of mannitol:
- prophylaxis against acute renal failure
- differential diagnosis of acute oliguria
- treatment of increase in ICP
- Decreasing intraocular pressure
41
Is mannitol nephroprotective:
NO, true evidence.
42
Mannitol is no better than plain ____ pre-radiocontrast dye, except in the _____ transplant surgery which has a less incidence of ARF.
- saline
| - renal
43
Will mannitol increase urine output in the patient with a severely compromise glomerular or renal tubular function:
NO (Mannitol will only help when intravascular volumes are low)
44
Will mannitol increase cerebral blood volume and ICP initially:
YES, but will decrease systemic blood pressure
45
What may be used in conjunction of mannitol use:
- corticosteroids
| - Hyperventilation
46
What are the side effects of mannitol:
- precipitate pulmonary edema
- HYPOVOLEMIA (due to water and NaCl secreation)
- electrolyte disturbances
- plasma hyperosmolarity (due to water and NaCL secretion)
47
Will urea crass the BBB:
YES
48
What are the side effects of urea:
- venous thrombosis
| - tissue necrosis after necrosis
49
What lab value will increase after urea administration:
B.U.N.
50
List the Loop Diuretics:
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic Acid
51
What is the method of action of loop diuretics:
-inhibits Na and Cl reabsorption in the ASCENDING LOOP and to a lesser extent in the PROXIMAL tubule
52
Furosemide will cause a production of what and results in:
- prostaglandin
- renal vasodilation and increased renal blood flow
-
53
T/F: Furosemide will redistribute renal blood flow from the ____ to the _____ renal cortex and contribute to the diuretic effect of furosemide.
- inner
| - outer
54
What will inhibit furosemide increase in renal blood flow:
-NSAIDs
55
What are the clinical uses of loop diuretics:
- 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
How will furosemide effect venous return of the body:
-cause peripheral vasodilatation that precedes the onset of diuresis which may help in the management of acute pulmonary edema
57
Will furosemide increase the lymph flow through the thoracic duct:
YES
58
How is ICP decreased by furosemide:
- systemic diuresis
- Decreasing CSF production by interfering with Na transport in glial tissue
- resolving cerebral edema by improving cellular water transport
59
How is ICP NOT decreased by furosemide:
- changes in cerebral blood flow
| - changes in plasma osmolarity
60
Which better decreases ICP:
a. mannitol
b. furosemide
-mannitol
61
Which drug will NOT effect ICP if the BBB is broken:
a. Furosemide
b. Mannitol
-Furosemide
62
Will a combination of furosemide and mannitol have a synergistic effect.
-YES
63
What electrolyte and fluid imbalances will loop diuretics effects:
ABNORMAL FLUID/ELECTROLYTE BALANCES:
- hypOkelemia
- hypOchloremia
- HypOnatremia
- HypOmagnesemia
- Metabolic alkalosis
64
Could furosemide cause deafness:
YES, due to the prolonged electrolyte imbalance
65
What cross sensitivity does loop diuretics have:
-interaction with drugs containing a sulfonamide nucleus (THIAZIDES are included)
66
What antibiotic will cause nephrotoxicity with loop diuretics:
- aminoglycoside
| - Cephalosporins
67
What antibiotic will cause allergic interstitial nephritis with loop diuretics:
Penicillin
68
List the thiazide diuretics:
- chlorothiazide
- hydrochlorothiazide
- Indapamide
- Metolazone
- Chlorthalidone
69
What is the method of action for thiazide:
-compete for the Na-Cl cotransporter in the distal tubule to inhibit re-absorption. Inhibit only urinary diluting capacity, not concentrating capacity.
70
What are the clinical uses for thiazide:
- HTN
- mobilization of edema
- Diabetes Insipidus
- Treatment of hypercalcemia
71
Initially how does thiazides affect HTN:
- Decrease extracellular fluid volume
| - Often decrease cardiac output
72
How do thiazide sustain their affect on HTN:
-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
What electrolytes will be effected with thiazides:
- HypOkalemia
- HypOchloremia
- HypOmagnesium
- Metabolic alkalosis with chronic administration
74
T/F: Sodium and magnesium dpletion may accompany kaliuresis.
TRUE
75
Why will thiazides cause dysrrhythmias:
Due to:
- HypOmagnesemia
- Hypokalemia
76
What are side affects of hypokalemia:
- Skeletal muscle weakness
- G.I. ileus
- Nephropathy characterized by polyuria and azotemia
- Increased likelihood of developing dig. toxicity
- Potentiation of nondepolarizing neuromuscular blockers
77
What are thiazides side effects:
- Decreased intravascular volume
- Hyperglycemia
- Hyperuricemia
- Decreased renal or hepatic function
78
List the potassium sparing diuretics:
- Amiloride
- Triamterene
- Spironolactone
- Eplerenone
79
What is the method of action of amiloride and triamterene (potassium sparing diuretics)
-inhibit Na reabsorption induced by aldosterone. Inhibit active counter transport of Na an K in the collecting duct
80
What is the method of action of spironolactone and eplerenone:
-competes for aldosterone receptor sites in the distal tubule to block Na reabsorption and K secretion
-
81
What drug improves sputum viscosity in patients with cystic fibrosis:
-aerosolized amiloride
82
Why is CHF and Cirrhosis of the liver affected by thiazides:
-Works in these situations because decreaed hepatic function and metabolism lead to increased plasma concentration of aldosterone.
83
What is the principle effect of a potassium sparing diurects.
Hyperkalemia
84
What other drugs increase the side effect risk of:
NSAIDS
A.C.E.
-Beta blockers
85
T/F: Thiazide may produce hyperuricemia or hyperglycemia.
TRUE
86
What EKG changes will be seen with hypERkalemia:
- Tall peaked T wave
- Loss of P wave
- Widened QRS with tall T waves
87
What medication are used for hyperkalemia:
- Calcium glucanate (Possibly magnesium if JUST to stabilize the myocardium)
- Insulin
- Albuterol
- Furosemide
- Sodium polystyrene sulfonate (Kayexalate)
88
T/F: Calcium decreases the hypERkalemia levels:
FALSE (No effect)
89
Calcium does what to the threshold potential of the myocardium:
-Lower the threshold potential
90
What drug could worsen the myocardial effects with digoxin.
CALCIUM
91
Sodium bicarbinate is used to treat severe _______ ________ and not _______ _______
- metabolic acidosis
| - lower potassium
92
Does use of a albuterol work rapidly or slowly in treatment of hyperkalemia:
-Rapidly
93
What does sodium plystyrene sulfonate exchange in the colon for a potassium:
Sodium
