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PHARM 2-EXAM 1 (kinetics/dynamics/renal) > Renal > Flashcards

Renal Flashcards

1
Q

Acid base balance involves

A

Bicarbonate reabsorption

H+ elimination

(maintains urine pH >4.5)

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2
Q

What hormones do the kidneys produce?

A

Renin

Erythropoietin

Vitamin D3

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3
Q

The kidneys receive how much of the cardiac output?

A

25%/minute

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4
Q

RBF is maintained between

A

50-180mmHG

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5
Q

There is a direct relationship between

A

RBF & glomerular filtration

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6
Q

When does filtration to the kidneys cease?

A

MAP below 50

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7
Q

The kidneys can override

A

The SNS and cause vasodilation

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8
Q

What happens when the kidneys release renin?

A

There is an increase in aldosterone secretion, causing an increase in BP

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9
Q

What is the strongest trigger for aldosterone release?

A

HYPERKALEMIA (even more than renin)

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10
Q

Aldosterone will cause reabsorption of_______ and secretion of______

A

Reabsorb Na+ and Water

Secrete K+

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11
Q

Antidiuretic hormone will increase

A

Distal tubular permeability to water

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12
Q

The renin/angiotensin causes

A

The conversion to angiotensin II, which causes vasoconstriction

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13
Q

Renin/ angiotensin will cause reabsorption of ____ & secretion of _____

A

Reabsorb NaCl & Water

Secrete K+

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14
Q

Renin/angiotensin will cause release of

A

Aldosterone & ADH (antidiuretic hormone)

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15
Q

What drugs inhibit RAAS activation?

A

ACE inhibitors

ARBS

BB

Renin antags

Aldosterone antags

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16
Q

ANF will cause vaso______ and may increase RBF & _____

A

Dilation

GFR (afferents are dilated)

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17
Q

Atrial natriuretic factor will increase

A

Urine flow & Na+ EXCRETION (to rid the body of extra fluid)

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18
Q

Renal prostaglandins affect

A

Excretion of substances

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19
Q

Prostaglandin E2 & thromboxane A2 can

A

Modulate renal effects of other hormones

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20
Q

Prostaglandin E2 vaso______

Thromboxane A2 vaso ______

A

Dilate

Constricts

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21
Q

Urine filtrate formation involves these 4 steps

A

Filtration

Reabsorption

Secretion

Elimination

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22
Q

What happens when fluid is filtered in the renal corpuscle?

A

There is passive movement of water & small dissolved molecules from the plasma into the BC filtrate

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23
Q

GFR is increased by

A

RBF

Afferent arteriole vasodilation

Efferent arteriole vasoconstriction

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24
Q

GFR is decreased by

A

Decreased RBF

Afferent constriction

Efferent dilation

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25
Q

NSAIDS ________afferent arterioles, causing potential kidney damage

A

Constrict

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26
Q

ACEI/ARBs ______efferent arterioles, causing kidney_______

A

Dilate

Protection

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27
Q

A decrease in flow & GFR will inhibit prostaglandin production, causing

A

Vasoconstriction

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28
Q

Reabsorption is the movement of substances from

A

The tubular filtrate & back to the plasma

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29
Q

What substances are usually reabsorbed?

A

Water

Electrolytes

Glucose

Amino Acids

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30
Q

Reabsorption can be _____ or ____

A

Active (Na/K ATPase)

Passive (diffusion or osmosis)

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31
Q

Secretion is the

A

Movement of substances from the plasma into the tubular filtrate

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32
Q

What substances are secreted?

A

Organic anions

Drugs

Foreign substances

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33
Q

Secretion can be ___ or ____

A

Active or Passive

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34
Q

Na+ reabsorption is greatest in the

A

Proximal Convoluted Tubule

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35
Q

In the absence of ADH, the final urine will be

A

Dilute

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36
Q

With the presence of ADH, the final urine will be

A

Concentrated

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37
Q

What is the primary therapeutic effect of diuretics?

A

Inhibit Na+ reabsorption

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38
Q

What are the 2 primary reasons we give diuretics?

A

Used for HTN & CHF

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39
Q

What drugs target the PCT?

A

Carbonic Anhydrase Inhibitors

Osmotic Diuretics

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40
Q

What drug works in the Loop of Henle?

A

Loop diuretics

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41
Q

What drug works in the DCT?

A

Thiazides

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42
Q

What drugs work in the collecting ducts?

A

Aldosterone Antagonists

ADH antagonists

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43
Q

Carbonic anhydrase inhibitors (Acetazolamide [Diamox]) work by

A

Blocking carbonic anhydrase activity

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44
Q

Carbonic anhydrase inhibitors decrease the reabsorption of

A

Na+

HCO3-

Water

Causing natriuresis, diuresis & alkaline urine

45
Q

Carbonic anhydrase inhibitors increase the excretion of____

A

K+

46
Q

Carbonic anhydrase inhibitors increase the reabsorption of ____

A

Cl-

47
Q

Carbonic anhydrase inhibitors can lead to this metabolic change

A

Metabolic Acidosis

48
Q

Carbonic anhydrase inhibitors can cause the formation of

A

Kidney stones

49
Q

Carbonic anhydrase inhibitors can cause these electrolyte imbalances

A

Hypokalemia

Hyperchloremia

50
Q

Carbonic anhydrase inhibitors can cause

A

Fatigue

Paresthesias

Tolerance after 2-3 days

51
Q

Osmotic diuretics are

A

Inert chemical substances that are freely filtered by the glomerulus (increasing osmolarity of fluids)

52
Q

Osmotic diuretics decrease the reabsorption of

A

Water

53
Q

Osmotic diuretics are given to treat

A

IOP

Glaucoma

ICP

54
Q

Osmotic diuretics can cause these electrolyte abnormalities

A

Hypokalemia

Hyponatremia

55
Q

Osmotic diuretics can cause this in the vein

A

Thrombophlebitis when infiltrated

56
Q

Osmotic diuretics can cause this, so caution when giving to patients with LV dysfunction or pulmonary edema

A

Increases plasma volume due to initial increase in intravascular volume

57
Q

Osmotic diuretics can worsen

A

cerebral edema in patients with non-intact BBB

58
Q

With long term use, Osmotic diuretics can cause

A

Hypovolemia

59
Q

What is the IV dose of Mannitol?

A

0.25-2g/kg IV

60
Q

What is the onset and duration of Mannitol?

A

IV onset: 10-15 min

Duration: 6-8 hours

61
Q

With Mannitol, the

A

Surgar alcohol doesn’t cross the cell membranes

62
Q

When does Mannitol reduce ICP?

A

~60-90 min

63
Q

Mannitol may prevent

A

Preoperative renal failure in ATN by causing vasodilation, which improves RBF, removes renal toxins & necrotic debris, & is a scavenger of free O2 radical, which may prevent cellular injury

64
Q

Loop Diuretics work by blocking…

A

Na+/K+/2Cl co transporter

65
Q

Loop diuretics decrease the reabsorption of

A

Na+

K+

Cl-

Water

Ca+

Mg+

66
Q

What is natriuresis?

A

Removal of Na+

67
Q

What is the most potent diuretic?

A

Loop Diuretics

68
Q

Loop diuretics cause less

A

Vasodilation than thiazines, leading to a less effect in lowering HTN

69
Q

Loop diuretics can increase the formation of

A

Prostaglandins

70
Q

Loop diuretics can cause these electrolyte imbalances

A

Hypokalemia

Hyponatremia

Hypocalcemia

Hypomagnesemia

71
Q

Loop diuretics can cause this metabolic change

A

Metabolic Alkalosis

72
Q

Which diuretic can lead to gout, renal ischemia injury, & hyperuricemia?

A

Loops

73
Q

Which diuretic can cause ototoxicity & tinnitus?

A

Loops

74
Q

Loop diuretics can increase the nephrotoxic effects of

A

Aminoglycosides & cephalosporins

75
Q

What is the dose of Lasix?

A

20-40mg IV

MAX 200 mg/dose

76
Q

What is the onset & duration of Lasix?

A

Onset: 5-10 min

Duration: 2-6 hours

77
Q

What diuretic can cause an acute tolerance, leading to RAAS activation, resistance in HF patients, and may require the addition of a thiazide?

A

Loops

78
Q

Thiazide diuretics block the

A

Na+/Cl cotransporter

79
Q

Thiazides decrease the reabsorption of

A

Na+

Cl-

Water

80
Q

Thiazides increase the excretion of

A

K+

81
Q

Thiazides increase the reabsorption of

A

Ca+

82
Q

Which diuretic is first line in the treatment of HTN?

A

Thiazides, since they decrease the fluid volume, cardiac output, & cause vasodilation

83
Q

Thiazides are also used to treat

A

Hypocalcemia

84
Q

Thiazides can cause these electrolyte abnormalities

A

Hypokalemia

Hyponatremia

Hypercalcemia

Hypomagnesemia

Hypochloremia

Hypophosphatemia

85
Q

Thiazides side effects include

A

Hyperuricemia

Metabolic Alkalosis

Hypovolemia

HOTN

HYPERglycemia

Cross-reactivity in sulfa allergy

86
Q

In which 2 ways do potassium-sparing diuretics work?

A

Epithelial Na+ channel (ENaC) blockers

Aldosterone receptor antagonists

87
Q

ENaC blockers decrease the reabsorption of

A

Na+

Water

88
Q

What are examples of ENaC blockers?

A

Triamterene

Amiloride

89
Q

Aldosterone receptor antagonists decrease the reabsorption of

A

Na+

Water

90
Q

Aldosterone receptor antagonists inhibit

A

Na+/K+ ATPase

91
Q

What are drug examples of Aldosterone receptor antagonists?

A

Spironolactone

Eplerenone

92
Q

Potassium Sparing diuretics decrease the excretion of

A

K+

93
Q

Potassium Sparing diuretics can cause these electrolyte imbalances

A

Hyperkalemia

Hyponatremia

94
Q

Potassium Sparing diuretics can also cause

A

Metabolic Acidosis

Dehydration

HOTN

Gynecomastia

Decrease Androgen levels

Dry skin

Rash

95
Q

Dopamine receptor Agonists inhibits

A

Na+/H+ exchange

Na+/K+ ATPase

96
Q

Dopamine receptor agonists increase

A

cAMP

97
Q

Higher doses of dopamine receptor agonists will activate the SNS, causing…

A

Beta cardiac stimulation

Alpha vasoconstriction

98
Q

What is an example drug of a dopamine receptor agonists?

A

Fenoldopam

99
Q

Fenoldopam has moderate activity at

A

Alpha 2

100
Q

Fenoldopam increases & decreases…

A

Increases RBF

Decreases SVR

101
Q

Hypookalemia places the patient at greatest risk for

A

Arrhythmia

Potentiating (increasing effect) of muscle relaxants

Paralytic ileus

102
Q

Why will hypokalemia enhance the effects of muscle relaxants?

A

When you are hypokalemic, the is more potassium in the plasma rather than inside the cells.

This will cause the cells to hyper polarize, making it difficult to have an action potential

103
Q

What is the typical wave form seen with hypokalemia?

A

U wave

Prolonged QT

Inverted T waves

104
Q

What are patient risk factors for perioperative acute kidney injury?

A

> 56

Active CHF

Ascites

DM

HTN

Male

105
Q

What is a poor indicator of renal function?

A

MAP

106
Q

Reducing sympathetic stimulation, minimizing increases ni intrathoracic & intraabdomiinal pressures can

A

Help maintain renal blood flow

107
Q

Urine output can be a

A

Poor predictor of function

108
Q

Nephrotoxic agents should be avoided & include

A

NSAIDS

Contrast

Antivirals

Abx

PHARM 2-EXAM 1 (kinetics/dynamics/renal) (4 decks)

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