Renal System and Diuretics Flashcards
CHF, renal failure and cirrhosis make patients more susceptible to what?
Fluid overload
What is the normal fractional excretion of Na? (FENa)
FENa < 1%
T or F. Na is mostly reabsorbed isotonically.
True. Water follows the Na
T or F. Diuretics do not work on patients with renal failure because the diuretic is unable to get into the renal tubule, which is the site of action.
True
T or F. K is the main electrolyte in your vasculature.
False. Na is the main electrolyte in your vasculature. Na=140, K=4
Which two diuretics work in the proximal convoluted tubule and the proximal straight tubule?
Mannitol and Acetazolamide
Which 3 diuretics work in the thick ascending limb of the loop of Henle?
Bumetanide, Ethacrynic Acid, Furosemide
What 2 diuretics work in the distal convoluted tubule?
Thiazide, Metolazone
What 3 diuretics work in the collecting ducts?
Amiloride, Spironolactone, Triamterene
Where does Acetazolamide (Diamox) work and what is the mechanism of action?
It works in the proximal convoluted tubule and is a Carbonic Anhydrase inhibitor. It reverses the Na/H pump. Na reabsorption is inhibited, and water follows Na.
Which diuretic is described by the following:
Carbonic Anhydrase inhibition
Alkaline urine + hyperchloremic metabolic acidosis
Cross sensitivity with sulfa
Acetazolamide
Which diuretic is characterized by the following:
freely filtered and poorly absorbed
increases renal tubular osmolarity
limits passive water reabsorption that follows active Na reabsorption
Mannitol
Which diuretic is characterized by the following:
draws water from cells into plasma -> increased RBF
can lead to fluid overload/pulm edema, hypoNa->hyperNa
Mannitol
Which diuretic is characterized by the following:
can be used to decrease formation of CSF and aqueous humor
Acetazolamide
Which diuretic is characterized by the following:
prevents salt reabsorption in the thick ascending limb of the Loop of Henle
binds to Cl site
possibility of oto-toxicity
Loop Diuretics:
Furosemide (lasix), Bumetanide (Bumex), Torsemide(demadex)
Which diuretic is characterized by the following:
relieve congestion, pulmonary edema, swelling and peripheral edema
Loop Diuretics:
Furosemide (lasix), Bumetanide (Bumex), Torsemide(demadex)
Which diuretic is characterized by the following:
First line treatment for acute CHF
loop diuretics
Which diuretic is characterized by the following:
Side effects = hypoNa, hypoK, hypovolemia
loop diuretics
Which diuretic is characterized by the following:
Diuretics that work here are responsible for 25% of Na reabsorption
loop diuretics
Which diuretic is characterized by the following:
Block NaCl reabsorption
Large Na gradient in the distal tubules -> K excretion
Thiazides (HCTZ)
Which diuretic is characterized by the following:
Treatment for HTN, volume overload, and pregnancy associated edema - initial effect is due to decreased extracellular volume but sustained effect is due to peripheral vasodilation
HCTZ
Which diuretic is characterized by the following:
Side Effects: hypoNa, hypoK, orthostatic HTN
Hypokalemic hypochloremic metabolic alkalosis
HCTZ
Amiloride and Triamterene are what type of diuretics?
K sparing
What is the mechanism of action of Amiloride and where is its site of action?
Distal collecting ducts - K sparing. Block epithelial Na channels to prevent reabsorption of NA. Inhibit K secretion into renal tubules
Which diuretic is characterized by the following:
Often used in combination with loop/thiazide diuretics
K sparing diuretics - Amiloride and triamterene
Which diuretic is characterized by the following:
Block epithelial Na Channels to prevent Na reabsorption
Inhibit K secretion into renal distal tubules
Side effects: hypoNa, HyperK
K sparing (Amiloride and Triamterene)
Which diuretic is characterized by the following:
Inhibits reabsorption of Na, causes K retention
Effective treatment in volume overload w/ heart failure, cirrhosis
Commonly combined w/ other antihypertensive agents
Side Effects: hypoNa, HyperK, gynecomastia
Spironolactone
