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pharmacology 2 > Renal > Flashcards

Renal Flashcards

1
Q

Where does Acetazolamine ( Diamox) work ?

A

proximal tubule

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2
Q

What is the main cause of fluid overload?

A

When salt/water intake is greater than losses/excretion.

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3
Q

What is edema?

A

The passage of fluid from vasculature into the interstitial space.

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4
Q

What are some conditions that are examples of fluid overload?

A

CHF, renal failure, cirrhosis

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5
Q

Can fluid overload be in just 1 compartment of the body?

A

Yes, for example, the lungs can be a site of fluid overload.

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6
Q

How do you treat/prevent fluid overload?

A

Fluid restriction and possible diuresis.

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7
Q

Describe blood flow into the kidney.

A

The afferent arteriole brings blood into the glomerulus, a ball of capillary blood vessels.

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8
Q

What are two things that occur in the kidney?

A

Filtration and reabsorption (of water and Na)

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9
Q

Where is the site of filtration?

A

The renal tubule

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10
Q

How does mannitol work ?

A

limits passive water reabsorption that follows active Na+ reabsorption

increase renal tubular osmolarity

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11
Q

What is FENa?

A

Fractional Excretion of Na

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12
Q

What is considered a normal value for FENa, and what does that mean?

A

<1%

Less than 1% of sodium filtered by the kidney is excreted in the urine. The remaining ~99% of Na is reabsorbed.

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13
Q

Where is Na reabsorbed in the kidney?

A

Throughout the renal tubule

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14
Q

Where do diuretics work in the kidney?

A

Throughout the renal tubule

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15
Q

What happens when a patient in renal failure takes diuretics?

A

Because the patient is in renal failure, they are no longer filtering into the renal tubule. This means the diuretic won’t get into the renal tubule either, so it won’t work!

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16
Q

What is the urine flow pathway through the kidney?

A

Glomerulus –> Proximal convoluted tubule –> Proximal straight tubule –> Thick ascending limb of loop of Henle –> Distal convoluted tubule –> Collecting Duct –> Papillary duct –> Minor Calyx –> Major Calyx –> Renal pelvis –> Ureter –> Bladder –> Urethra

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17
Q

What does Acetazolamine do ?

A

it inhibits Carbonic anhydrase

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18
Q

What is carbonic anhydrase?

A

it converts H2CO3 into water and CO2 to conserve HCO3- for the body

H+ + HCO3- –> H2CO3 —(CA)—> H2O + CO2

normal kidney H+ is pumped into the urine and NA+ is reabsorbed . HC03- is also filtered into urine

in order to not lose all the HCO3- (and become acidotic),
H+ binds with HCO3- to make H2CO3 . CA converts H2CO3 into water and CO2 . CO2 and water is reabsorbed back into the body to make more HCO3-

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19
Q

what does inhibition of Carbonic anhydrase do ?

A

it reverses the Na/H pump , therefore Na+ is not reabsorbed and water follows Na+ into urine

there will be excess HCO3- in urine

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20
Q

side effect of Acetazolamide is

A

alkaline urine

pt develops Hyperchloremic metabolic acidosis

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21
Q

Hyperchloremic metabolic acidosis is a side effect of what drug?

A

Acetazolamide

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22
Q

When are pts prescribed Acetazolamide ?

A

moderate-severe alkalosis , altitude sickness, diuresis for heart failure

glaucoma, epilempsy, pseudotumor cerebri, central sleep apnea

decreases formation of CSF and aqueous humor

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23
Q

Acetazolamide has cross-sensitivity with _____ allergy

A

sulfa

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24
Q

this drug is an osmotic diuretic

A

Mannitol

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25
Q

how does mannitol work ?

A

limits passive water reabsorption that follows active Na+ reabsorption

26
Q

where does mannitol work?

A

entire body

27
Q

how does mannitol increase renal blood flow

A

draws water from cell into plasma

28
Q

mannitol can lead to transient______,_____,_______

A

fluid overload, pulmonary edmea , HYPOnatremia

29
Q

after diuresis with mannitol pts can have_________

A

hypernatremia

30
Q

what is the dosage of mannitol ?

A

0.25-1 g/kg

31
Q

extravasation of mannitol will cause

A

tissue injury, compartment syndrome

32
Q

why is mannitol used in Neuro rooms?

A

because it decrease ICP and IOP

33
Q

true of false, mannitol may prevent acute kidney injury in renal transplant , otherwise no evidence for renal protection

A

true

34
Q

what are examples of loop diuretics

A

furosemide (lasix)
torsemide (demadex)
bumetanide (bumex)

35
Q

what do loop diuretics do?

A

prevent salt reabsorption in thick ascending limb of loop of henle

Na-K ATPase Pumps Na+ , K+, Cl- out of urine
loop diuretics bind to Cl- site

ion gets stuck in urine and water follows ions

36
Q

large_____ in urine = large _____ of urine

A

large salt load inn urine = large volume of urine

37
Q

what drug is a first line treatment for acute congestive heart failure?

A

Loop diuretics

relieve congestion , pulmonary edema, swelling, peripheral edema

38
Q

what are the side effects of loop diuretics?

A

hypovolemia and diuresis which will cause renal injury and decrease global perfusion which then cause ischemia

possible cross sensitivity with sulfa allergy

possible ototoxicity

39
Q

what is the dose for loop diuretics

A

0.1-1 mg/kg

40
Q

which drug works at the distal convoluted tubule

A

Thiazides (HCTZ)

41
Q

Thiazides (HCTZ) blocks_____ reabsorption

A

NaCl

42
Q

thiazides (HCTZ) allow excretion of ___,___,___,___

A

Na+, K+, Cl-, HCO3-

43
Q

true or false, thiazides (HCTZ) is often given with another agent

A

ture

44
Q

thiazides (HCTZ) treats

A

HTN, volume overload, pregnancy-associated edema

45
Q

what is the initial effect of thiazides (HCTZ) due to ?

A

decrease extracellular volume

46
Q

what is the sustained effect of thiazides (HCTZ) due to ?

A

peripheral vasodilation

due to diminished peripheral sympathetic activity and total decrease in body store of sodium

47
Q

what are the side effects of thiazides (HCTZ)?

A

hyponatremia , hypovolemia , orthostatic hypotension , hypokalemia

48
Q

hypokalemic hypochloremic metabolic alkalosis is the side effect of what drug ?

A

thiazides (HCTZ)

49
Q

hyperchloremic metabolic acidosis is a side effects of what drug?

A

acetazolemide (diamox)

50
Q

pancreatitis , hyperglycemia, diarrhea, and aplastic anemia is the side effect of which drug

A

thiazides (HCTZ)

51
Q

Where do potassium sparing diuretics work?

A

distal collecting duct

52
Q

Amiloride and triamterene are

A

potassium sparing diuretics

53
Q

How do amiloride and triamterene work?

A

1) they block epithelial Na channels to prevent Na reabsorption
2) they inhibit K secretion into distal renal tubules

54
Q

Potassium sparing diuretics are often used in combination with what other types of diuretics?

A

loop/thiazide

55
Q

What are some side effects of Amiloride or triamterene?

A

HYPOnatremia, HYPERkalemia

56
Q

Are aldosterone antagonists potassium sparing?

A

Yes.

57
Q

“Save Sodium and Pee Potassium” refers to

A

aldosterone

58
Q

What kind of drug is spironolactone?

A

aldosterone antagonist

59
Q

How does spironolactone work?

A

inhibits Na reabsorption and causes K retention

60
Q

Spironolactone is effective in treating

A

volume overload in heart failure and cirrhosis

61
Q

What are side effects of spironolactone?

A

HYPOnatremia, HYPERkalemia, gynecomastia

pharmacology 2 (4 decks)

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