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Pharmacology > Renal > Flashcards

Renal Flashcards

1
Q

Isosmotic principle

A

extracellular osmolality = intracellular osmolality
mammalian cell membranes cannot sustain an osmotic gradient

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2
Q

60-40-20 rule

A

total body weight = 60% water
ICF = 40% body mass
ECF = 20% body mass

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3
Q

starling forces determine

A

intravascular vs extravascular volume distribution

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4
Q

Osmotic pressure gradients determine

A

intracellular vs extracellular fluid distribution

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5
Q

Diuretic Sites of action:
Osmotic Diuretics
Carbonic anhydrase inhibitors
Loop diuretics
Thiazides
K+ sparing diuretics
Aquaretics

A

Osmotic Diuretics - Proximal Tubule
Carbonic anhydrase inhibitors - Proximal tubule
Loop diuretics - Thick ascending loop of henle
Thiazides - Distal tubule
K+ sparing diuretics - late distal tubule/ collecting duct
Aquaretics - collecting duct

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6
Q

Osmotic Diuretics include

A

mannitol
urea

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7
Q

Osmotic diuretics MOA

A

inhibit nephron H2O and solute reabsorption via generation of a luminally directed osmotic pressure gradient

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8
Q

Osmotic Diuretics use

A

intracranial pressure reduction (mannitol), intraocular pressure reduction (mannitol), hyponatremia (urea)

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9
Q

Carbonic Anhydrase Inhibitors include

A

acetazolamide

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10
Q

Carbonic Anhydrase inhibitors MOA

A

inhibit carbonic anhydrase activity
allowing H+ reabsorption and excretion of Na+
fewer H+ ions to be excreted

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11
Q

Carbonic Anhydrase Inhibitors use

A

Glaucoma
Acute mountain sickness
metabolic alkalosis
urine alkalinization

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12
Q

Loop diuretics MOA

A

inhibit Na+ - K+ - 2Cl- cotransporter in TALH
prevent Na+ from being absorbed
more potent - 20-25% sodium secretion

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13
Q

Loop Diuretics include

A

furosemide
bumetanide
torsemide

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14
Q

Loop diuretic use

A

edematous states
hypercalcemia
hyponatremia

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15
Q

Thiazide/ Thiazide-like diuretics include

A

HCTZ, CTZ, metolazone, chlorthalidone

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16
Q

Thiazide/ Thiazide-like diuretics use

A

HTN, Ca urolithiasis, NDI

17
Q

Thiazide/ Thiazide-like diuretics MOA

A

inhibits Na+ - Cl- cotransporter in early DT (cortical diluting segment)
affects diluting capacity but not concentrating ability
there are mechanisms that allow for the body to reabsorb elsewhere - not as potent as loops

18
Q

K+ sparing diuretic (mineralocorticoid receptor antagonists) MOA

A

Mineralocorticoid receptor antagonists - antagonize aldosterone action in principle cells - inhibit Na+ reabsorption and K+ excretion

19
Q

K+ sparing diuretic use

A

hyperaldosteronism
hypokalemia
HFrEF
resistant HTN
Lithium tox - amiloride

20
Q

K+ sparing diuretic (mineralocorticoid receptor antagonists) includes

A

spironolactone
eplerenone

21
Q

Amiloride is used for

A

lithium toxicity

22
Q

K+ sparing Diuretics (ENaC inhibitors) MOA

A

epithelial sodium channel (ENaC) inhibitors - direct inhibition of apical Na+ uptake via ENaC in principal cells
reverse hypokalemia when using a loop diuretic

23
Q

K+ sparing Diuretics (ENaC inhibitors) includes

A

amiloride
triamterene (trimethoprim)

24
Q

Aquaretics (vaptans) include

A

Tolvaptan
Lixivaptan

25
Q

Aquaretics (vaptans) use

A

Hyponatremia

26
Q

Aquaretics (vaptans) MOA

A

block AVP action in late DT and CD
inhibit urine concentration by preventing AVP - stimulated AQP2 insertion into luminal membrane of principal cells

27
Q

Aquaretics (vaptans) includes

A

talvaptan

28
Q

Cardiorenal Axis

A

Bidirectional functional interaction
heart –> kidneys
if something happens to the heart, something will happen to the kidneys

29
Q

Reno-cardiac

A

kidneys insulted first –> leads to cardiac dysfunction

30
Q

Cardio-renal

A

heart insulted first –> leads to kidney dysfunction

31
Q

Type 5 cardiorenal syndrome is when

A

systemic conditions lead to simultaneous injury and/or dysfunction of heart and kidney

32
Q

Diuretic use in management of ___________ syndromes

A

cardiorenal

33
Q

all Loop Diuretics are pharmacodynamically equivalent - they differ in

A

potency not efficacy

Pharmacology (7 decks)

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