renal and GU agents Flashcards
BPH
benign prosthetic hypertrophy
why are kidneys/renal function so important
we die without them, involved in electrolytes allowing our muscles, heart, work and how much water we hold onto
why would we want to manipulate electrolyte and H2O
To manage different diseases?
How can we manipulate electrolytes and H2O
v?
glomerulus filtration
filters electrolytes and non electrolytes and water
what are the elctrolytes
Na, K , Ca, M, HCO3 Cl, and phosphate
_____ % of material is reabsorbed at the renal tubules
and is the site of where most diuretics work
99%
at tubules specifically loop of henle and convuluted tube
what are the 5 classes of diuretics
- loop
- thiazide
- thiazide like
- potassium sparing
- carbonic anhydrase inhibiotrs and osmotic (NOT GOING TO ASK US ABOUT this one)
what are drugs that interfere with normal transport of fluids and electrolytes in the kidney
Diuretics
what are diuretics used for (like what indications)
electrolyte disturbances (can bring K back down)
renal failure (can help them produce more urine and prevent fluid overload)
heart failure (prevent people from becoming fluid overloaded)
edema and hepatic failure
where do loop diuretics work
thick ascending limb
thiazide diuretics work where
distal convuluted tubule
where do K sparing diuretics work
collecting tubules
Proximal convuluted tubules
no a lot of drug action here
some NaHCO3 and NaCl reabsorbed
What does the thick ascending loop do
actively reabsorbs NaCl from the lumen into tissue
impermeable to water
dilutes the filtrate in the tubule due to lack of H2O absorption
Within the thick ascending loop, what transporter is used to reabsorb NaCl
Na/K/2Cl cotransporter
1 NA, 2 CL, and 1 K in together
Na is the main ion
some K leaks back out
What do Loop diuretics do to thick ascending loop
block the Na/K/2Cl/ cotransporter = lack of reabsorption of NaCl and K
HE DOESNT CARE TOO MUCH ABOUT WHAT CHANNEL FOR ANY OF THESE
to be effective some renal funciton must be present (same with thiazide)
K loss cannot be totally recollected later one
lack of reabsorption of NaCl = less water reabsorbed = more dilute urine / increase diuresis
What is the strongest diuretic/why
loop diuretics because acts on the spot where there is the most Na/Cl reabsorption occuring
aka most potent
!!!!!!
work fast
What is the concentration gradient in the cells most important for in regard to the tubule system
why is this significant
important for reabsorption of Ca and Mg
if mess with this electrical gradient - can impact how much absorbed
loop diuretics’ can cause to lose Ca
- may be issue with osteoporosis
absorption of loop diuretics
rapidly absorbed
IV effects are almost immeadiate
Metabolism and excretion of loop diuretics
- eliminated by renal secretion- half life depends on renal function
- act on the luminal side of tubule- diuretic response is positive correlation with their excretion in urine
- any decrease in filtration = prevents diuretics from reaching their site action
What are the different loop diuretics’
furosemide (lasix)
bumetanide (bumex)- only used if cannot tolerant lasix
toresmide (demedex)
“FOUR LASy BUMS- BUM TO-REsMIDE to get DEM-MEDs”
in hospital have patient have a catheter
Furoesmide
Lasix
- most popular loop diuretic used
- lasts for 6 hours aka why it is called Lasix!!!!!!
Side effects of loop diuretics
- HYPOKALEMIA- concomitant K replacement in most cases (K chloride mix) - based on daily dose (can be given IV)
- dehydration
- hyponatremia
- renal toxicity with other agents
- ototoxicity in high doses
