Renal (diuretics) - INCOMPLETE

Question 1

What is isosmotic principle

Answer 1

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

Question 2

What is the “60 - 40 - 20 Rule”

Answer 2

20% of body mass is in ECF
40% of body mass is in ICF
60% of body mass H20 in TBW

Question 3

what does osmotic pressure gradients determine

Answer 3

intracellular vs extracellular fluid distribution

Question 4

what do the Starling forces determine

Answer 4

intravascular vs extravascular distribution
(plasma volume vs interstitial fluid volume)

Question 5

What are the general diuretic classes

Answer 5

osmotic
carbonic anhydrase inhibitors
loop diuretics
thiazide/thiazine-like
K+ sparing diuretics: mineralocorticoid antagonists, EMaC inhibitors
aquaretics

Question 6

where is a majority of the Na+ reabsorbed within the nephron

Answer 6

proximal tubule

Question 7

what are the osmotic diuretics

Answer 7

mannitol and urea

Question 8

what is the MOA of osmotic diuretics

Answer 8

inhibit nephron H20 and solute reabsoprtion via generation of a luminally-directed osmotic pressure gradient

Question 9

what is the use of Osmotic diuretics

Answer 9

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

Question 10

What are the carbonic anhydrase inhibitors

Answer 10

Acetazolamide

Question 11

what is the MOA of carbonic anhydrase inhibitors

Answer 11

inhibit carbonic anhydrase activity
(sodium reabsorption and H_ secretion via apical Na/H exchange)

Question 12

what is the use of carbonic anhydrase inhibitors

Answer 12

glaucoma
acute mountain sickness
metabolic alkalosis
urine alkalization

Question 13

What are the loop diuretics

Answer 13

furosemide
bumetanide
torsemide

Question 14

what is the MOA of loop diuretics

Answer 14

inhibits NA+, K+, 2Cl- co-transporter in TALH
-disrupt both diluting and concentrating ability
-luminal secretion via PT organic anion transporters

Question 15

what is the use of loop diuretics

Answer 15

edematous states
hypercalcemia
hyponatremia

Question 16

what is TALH

Answer 16

thick ascending loop of henle - where loop diuretics work

Question 17

what are the thiazide medications

Answer 17

HCTZ
CTZ
metolazone
chlorthalidone

Question 18

what is the use of thaizide medications

Answer 18

HTN
Ca urolithiasis
NDI

Question 19

what is the MOA of thiazide medications

Answer 19

inhibit Na+, Cl- co-transporter in early DT
-affect diluting capacity, but not concentrating ability
luminal secretion via PT organic anion transporters

Question 20

What are the Mineralocorticoid K+ sparing diuretics

Answer 20

Spironolactone, Eplerenone

Question 21

what is the MOA of Mineralocorticoid K+ sparing diuretics

Answer 21

antagonize aldosterone action in the principe cells (late DT and CD) - inhibit Na+ reabsorption and K+ excretion

Question 22

what is the use of Mineralocorticoid K+ sparing diuretics

Answer 22

Hyperaldosteronism
hypokalemia
HfrEF
resistant HTN

Question 23

What are the ENaC inhibiting K+ sparing diuretics

Answer 23

Amiloride
Triamterene

Question 24

what is the MOA of ENaC inhibiting K+ sparing diuretics

Answer 24

direct inhibition of apical Na+ uptake via ENAcC in principal cells

Question 25

What are the Aqueretics (Vaptans)

Answer 25

Tolvaptan and Lixivaptan

Question 26

what is the MOA of Aqueretics (Vaptans)

Answer 26

block AVP action in the late DT and CD
inhibit urine concentration by preventing AVP-stimulated AQP2 insertion into luminal membrane of principal cells (inhibits H20 abstraction in DT and CD)

Question 27

what is the use of Aqueretics (Vaptans)

Answer 27

Hypoatremia