Renal

Question 1

Where does Acetazolamine ( Diamox) work ?

Answer 1

proximal tubule

Question 2

What is the main cause of fluid overload?

Answer 2

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

Question 3

What is edema?

Answer 3

The passage of fluid from vasculature into the interstitial space.

Question 4

What are some conditions that are examples of fluid overload?

Answer 4

CHF, renal failure, cirrhosis

Question 5

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

Answer 5

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

Question 6

How do you treat/prevent fluid overload?

Answer 6

Fluid restriction and possible diuresis.

Question 7

Describe blood flow into the kidney.

Answer 7

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

Question 8

What are two things that occur in the kidney?

Answer 8

Filtration and reabsorption (of water and Na)

Question 9

Where is the site of filtration?

Answer 9

The renal tubule

Question 10

How does mannitol work ?

Answer 10

limits passive water reabsorption that follows active Na+ reabsorption

increase renal tubular osmolarity

Question 11

What is FENa?

Answer 11

Fractional Excretion of Na

Question 12

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

Answer 12

<1%

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

Question 13

Where is Na reabsorbed in the kidney?

Answer 13

Throughout the renal tubule

Question 14

Where do diuretics work in the kidney?

Answer 14

Throughout the renal tubule

Question 15

What happens when a patient in renal failure takes diuretics?

Answer 15

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!

Question 16

What is the urine flow pathway through the kidney?

Answer 16

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

Question 17

What does Acetazolamine do ?

Answer 17

it inhibits Carbonic anhydrase

Question 18

What is carbonic anhydrase?

Answer 18

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-

Question 19

what does inhibition of Carbonic anhydrase do ?

Answer 19

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

there will be excess HCO3- in urine

Question 20

side effect of Acetazolamide is

Answer 20

alkaline urine

pt develops Hyperchloremic metabolic acidosis

Question 21

Hyperchloremic metabolic acidosis is a side effect of what drug?

Answer 21

Acetazolamide

Question 22

When are pts prescribed Acetazolamide ?

Answer 22

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

glaucoma, epilempsy, pseudotumor cerebri, central sleep apnea

decreases formation of CSF and aqueous humor

Question 23

Acetazolamide has cross-sensitivity with _____ allergy

Answer 23

sulfa

Question 24

this drug is an osmotic diuretic

Answer 24

Mannitol

Question 25

how does mannitol work ?

Answer 25

limits passive water reabsorption that follows active Na+ reabsorption

Question 26

where does mannitol work?

Answer 26

entire body

Question 27

how does mannitol increase renal blood flow

Answer 27

draws water from cell into plasma

Question 28

mannitol can lead to transient______,_____,_______

Answer 28

fluid overload, pulmonary edmea , HYPOnatremia

Question 29

after diuresis with mannitol pts can have_________

Answer 29

hypernatremia

Question 30

what is the dosage of mannitol ?

Answer 30

0.25-1 g/kg

Question 31

extravasation of mannitol will cause

Answer 31

tissue injury, compartment syndrome

Question 32

why is mannitol used in Neuro rooms?

Answer 32

because it decrease ICP and IOP

Question 33

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

Answer 33

true

Question 34

what are examples of loop diuretics

Answer 34

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

Question 35

what do loop diuretics do?

Answer 35

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

Question 36

large_____ in urine = large _____ of urine

Answer 36

large salt load inn urine = large volume of urine

Question 37

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

Answer 37

Loop diuretics relieve congestion , pulmonary edema, swelling, peripheral edema

Question 38

what are the side effects of loop diuretics?

Answer 38

hypovolemia and diuresis which will cause renal injury and decrease global perfusion which then cause ischemia possible cross sensitivity with sulfa allergy possible ototoxicity

Question 39

what is the dose for loop diuretics

Answer 39

0.1-1 mg/kg

Question 40

which drug works at the distal convoluted tubule

Answer 40

Thiazides (HCTZ)

Question 41

Thiazides (HCTZ) blocks_____ reabsorption

Answer 41

NaCl

Question 42

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

Answer 42

Na+, K+, Cl-, HCO3-

Question 43

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

Answer 43

ture

Question 44

thiazides (HCTZ) treats

Answer 44

HTN, volume overload, pregnancy-associated edema

Question 45

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

Answer 45

decrease extracellular volume

Question 46

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

Answer 46

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

Question 47

what are the side effects of thiazides (HCTZ)?

Answer 47

hyponatremia , hypovolemia , orthostatic hypotension , hypokalemia

Question 48

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

Answer 48

thiazides (HCTZ)

Question 49

hyperchloremic metabolic acidosis is a side effects of what drug?

Answer 49

acetazolemide (diamox)

Question 50

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

Answer 50

thiazides (HCTZ)

Question 51

Where do potassium sparing diuretics work?

Answer 51

distal collecting duct

Question 52

Amiloride and triamterene are

Answer 52

potassium sparing diuretics

Question 53

How do amiloride and triamterene work?

Answer 53

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

Question 54

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

Answer 54

loop/thiazide

Question 55

What are some side effects of Amiloride or triamterene?

Answer 55

HYPOnatremia, HYPERkalemia

Question 56

Are aldosterone antagonists potassium sparing?

Answer 56

Yes.

Question 57

"Save Sodium and Pee Potassium" refers to

Answer 57

aldosterone

Question 58

What kind of drug is spironolactone?

Answer 58

aldosterone antagonist

Question 59

How does spironolactone work?

Answer 59

inhibits Na reabsorption and causes K retention

Question 60

Spironolactone is effective in treating

Answer 60

volume overload in heart failure and cirrhosis

Question 61

What are side effects of spironolactone?

Answer 61

HYPOnatremia, HYPERkalemia, gynecomastia