Quiz 9: Neprology Flashcards
What is the purpose of the glomerulus with Bowman’s Capsule:
- filtration
- 25% of plasma that arrives here passes through the filtration barrier to become filtrate
What is reabsorbed out of the proximal tubule:
- NaCl (majority)
- Glucose
- potassium,
- amino acids,
- bicarb,
- phosphate,
- protein,
- urea,
- water (follows NaCl)
What is secreted into the proximal tubule:
- Hydrogen
- Foreign substances
- Organic anions
- Cations
T/F: The proximal tubule is isotonic:
TRUE
Which diuretic works at the proximal tubule:
- CARBONIC ANHYDRASE INHIBITORS
- OSMOTIC
-Is the proximal tubule:
a. Isotonic
b. hypotonic
c. hypertonic
-Isotonic
What is reabsorbed in the descending loop of Henle:
-water
What stays inside the tube at the descending loop of Henle:
-NaCl
The think ascending loop of Henle is permeable to water:
FALSE (It is IMpermeable to water)
What is reabsorbed in the thick ascending loop of Henle (ascending loop in the notes?):
-NaCl
What stays within the thick ascending loop of Henle (ascending loop in the notes?):
-H2O
What is the active transport system in the thick ascending loop:
-sodium potassium pump and cotransport
1 sodium, 2 chloride, 1 potassium
Is the loop of henle:
a. isotonic
b. hypertonic
c. hypotonic
All the above.
What diuretic works at the Loop of Henle:
LOOP DIURETICS
It really looks like it works at the thick ascending limb
What is reabsorbed in the distal tubule:
- NaCl
- Water
- bicarb
What is secreted in the distal tubule:
- Potassium,
- Urea
- hydrogen
- NH3
- Some medications
What is required for water to be reabsorbed at the DISTAL TUBULE:
-ADH required
Is the distal tubule:
a. isotonic
b. hypertonic
c. hypotonic
- isotonic
- hypotonic
What is reabsorbed in the collecting duct:
- water
- NaCl
T/F: Anti-diuretic hormone is needed for water to be reabsorbed in the collecting ducts:
TRUE
What can either be reabsorbed or secreted in the collecting ducts:
- Na
- K
- H
- NH3
What diuretic works at the DISTAL TUBULE:
-Thiazides
What diuretic works at the COLLECTING DUCT:
-Anti diuretic hormone (Aldosterone)
How is chronic kidney disease defined:
> 3 months
- structural or functional abnormalities with or without decrease in GFR
- GFR < 60 ml/min with or with OUT kidney damage
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
Where do potassium sparing diuretics work:
DISTAL TUBULE
Where do xanthines work:
PROXIMAL TUBULE
List the carbonic anhydrase inhibitors:
- Methazolamide
- Acetazolamide
- Dichlorophenamine
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
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
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
What are the side effect of carbonic acid inhibitors:
- blurred vision
- changes in taste
- constipation
- drowsiness
- frequent urination
- loss of appetite
- N/V
List the osmotic drugs:
- Mannitol
- Urea
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
What do osmolarities does osmotic alter:
- plasma
- glomerular filtrate
- renal tubular fluid
Osmotic increase the excretion of:
- water
- sodium
- chloride
- bicarbonate ion
T/F: Urinary pH is not altered by mannitol-induced osmotic diuresis:
TRUE
I.V. Mannitol increases ______ osmolarity which expands the _________ fluid volume.
- plasma
- intravascular
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.
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
Is mannitol nephroprotective:
NO, true evidence.
Mannitol is no better than plain ____ pre-radiocontrast dye, except in the _____ transplant surgery which has a less incidence of ARF.
- saline
- renal
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)
Will mannitol increase cerebral blood volume and ICP initially:
YES, but will decrease systemic blood pressure
What may be used in conjunction of mannitol use:
- corticosteroids
- Hyperventilation
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)
Will urea crass the BBB:
YES
What are the side effects of urea:
- venous thrombosis
- tissue necrosis after necrosis
What lab value will increase after urea administration:
B.U.N.
List the Loop Diuretics:
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic Acid
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
Furosemide will cause a production of what and results in:
- prostaglandin
- renal vasodilation and increased renal blood flow
-
T/F: Furosemide will redistribute renal blood flow from the ____ to the _____ renal cortex and contribute to the diuretic effect of furosemide.
- inner
- outer
What will inhibit furosemide increase in renal blood flow:
-NSAIDs
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
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
Will furosemide increase the lymph flow through the thoracic duct:
YES
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
How is ICP NOT decreased by furosemide:
- changes in cerebral blood flow
- changes in plasma osmolarity
Which better decreases ICP:
a. mannitol
b. furosemide
-mannitol
Which drug will NOT effect ICP if the BBB is broken:
a. Furosemide
b. Mannitol
-Furosemide
Will a combination of furosemide and mannitol have a synergistic effect.
-YES
What electrolyte and fluid imbalances will loop diuretics effects:
ABNORMAL FLUID/ELECTROLYTE BALANCES:
- hypOkelemia
- hypOchloremia
- HypOnatremia
- HypOmagnesemia
- Metabolic alkalosis
Could furosemide cause deafness:
YES, due to the prolonged electrolyte imbalance
What cross sensitivity does loop diuretics have:
-interaction with drugs containing a sulfonamide nucleus (THIAZIDES are included)
What antibiotic will cause nephrotoxicity with loop diuretics:
- aminoglycoside
- Cephalosporins
What antibiotic will cause allergic interstitial nephritis with loop diuretics:
Penicillin
List the thiazide diuretics:
- chlorothiazide
- hydrochlorothiazide
- Indapamide
- Metolazone
- Chlorthalidone
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.
What are the clinical uses for thiazide:
- HTN
- mobilization of edema
- Diabetes Insipidus
- Treatment of hypercalcemia
Initially how does thiazides affect HTN:
- Decrease extracellular fluid volume
- Often decrease cardiac output
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
What electrolytes will be effected with thiazides:
- HypOkalemia
- HypOchloremia
- HypOmagnesium
- Metabolic alkalosis with chronic administration
T/F: Sodium and magnesium dpletion may accompany kaliuresis.
TRUE
Why will thiazides cause dysrrhythmias:
Due to:
- HypOmagnesemia
- Hypokalemia
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
What are thiazides side effects:
- Decreased intravascular volume
- Hyperglycemia
- Hyperuricemia
- Decreased renal or hepatic function
List the potassium sparing diuretics:
- Amiloride
- Triamterene
- Spironolactone
- Eplerenone
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
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
-
What drug improves sputum viscosity in patients with cystic fibrosis:
-aerosolized amiloride
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.
What is the principle effect of a potassium sparing diurects.
Hyperkalemia
What other drugs increase the side effect risk of:
NSAIDS
A.C.E.
-Beta blockers
T/F: Thiazide may produce hyperuricemia or hyperglycemia.
TRUE
What EKG changes will be seen with hypERkalemia:
- Tall peaked T wave
- Loss of P wave
- Widened QRS with tall T waves
What medication are used for hyperkalemia:
- Calcium glucanate (Possibly magnesium if JUST to stabilize the myocardium)
- Insulin
- Albuterol
- Furosemide
- Sodium polystyrene sulfonate (Kayexalate)
T/F: Calcium decreases the hypERkalemia levels:
FALSE (No effect)
Calcium does what to the threshold potential of the myocardium:
-Lower the threshold potential
What drug could worsen the myocardial effects with digoxin.
CALCIUM
Sodium bicarbinate is used to treat severe _______ ________ and not _______ _______
- metabolic acidosis
- lower potassium
Does use of a albuterol work rapidly or slowly in treatment of hyperkalemia:
-Rapidly
What does sodium plystyrene sulfonate exchange in the colon for a potassium:
Sodium
