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Pharmacology 1 > Test #2 > Flashcards

Test #2 Flashcards

1
Q

Name the renal anatomy

A

Glomerulus

Proximal Convoluted Tubule

Loop of Henle (acending and decending)

Distal Convoluted Tubule

Collecting Duct

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2
Q

Name The 3 Major Kidney Functions

A
  1. Cleans extra cellular fluid and maintains volume and composition.
  2. Maintains acid and base balance
  3. Excretion of metabolic waste and foreign substances
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3
Q

Which one of these three major kidney fuctions is the most important when it pertains to drug therapy?

  1. Cleans extra cellular fluid and maintains volume and composition.
  2. Maintains acid and base balance
  3. Excretion of metabolic waste and foreign substances
A
  1. Excretion of metabolic waste and foreign substances
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4
Q

People sometimes use the term distal nephron. What are they refering to?

A

The distal convoluted tubule and the collecting duct

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5
Q

About how many nephrons does each kidney have?

A

1 million

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6
Q

Kidney’s ________ nephrons with age?

A

lose

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7
Q

Where does filtration occur?

A

occurs at the glomerulus.

Filters are very small so stuff has to fit through tiny holes to get into the plumbing of the nephron

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8
Q

What does the glomerulus filter out?

A

amino acids

electrolytes

glucose

drugs

and most metabolic waste

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9
Q

Name some things that are too large to be filtered out at the glomerulus:

A

Large molecules such as albumin, red blood cells, white blood cells, are too big to fit through the tiny holes so they are nonfilterable at the glomerulus.

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10
Q

True or False

If you see blood or protein on a UA (Urine Analysis) it is ok.

A

false

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11
Q

___________ is the most prevalent filtered substace in the urine.

A

NaCl

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12
Q

We have about _______ liters of extracellular fluid in the body.

A

12.5

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13
Q

Our kidneys can filter approximately ______ Liters a day.

A

180

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14
Q

Our 12.5 L of extracellular fluid gets filtered _____ times a day.

A

14.4

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15
Q

Greater than ______% of everything that is filtered in the glomerulus is reabsorbed.

A

99%

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16
Q

The elecrtolyes, amino acids, glucose ect. is reabosorbed via _____________.

A. Direct Penetration
B. Channels and Pores
C. Active Transport
D. Magic

A

C. Active Transport

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17
Q

In the kidneys, what is responsible for active transport?

A

P-Glycoproteins

They work by grabbing molecules (Solute, glucose ect) and turning 180* and releasing back into the bloodstream.

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18
Q

Solute is activily transported back into our ECF volume, and _______ follows solute right back into the body by ___________.

A

Water , the osmotic gradient-

the passive reabsorption that follows the concentration gradient

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19
Q

Water follows the area of the membrane that is the ________ concentrated

A

most

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20
Q

Solute Reabsorbs __________

A

Actively

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21
Q

Water Reabsorbs __________

A

Passively

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22
Q

Active Tubular Secretion-

A

Where P-Glycoproteins grab stuff from the ECF and place it directly into the plumbing to be secreted.

So these things do not filter through the glomerulus.

There are some specific drugs that are secreted by active tubular secretion.

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23
Q

The Proximal Convoluted Tubule has huge reabsorption capacity. This is where _____% of NaCl is Reabsorbed by active transport.

A

65%

remember that water follows solute.. so 65% of water will be PASSIVELY reabsorbed here.

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24
Q

Diuretics work by _______ the active transport of solute.

A

Disrupting

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25
Q

IF you can prevent the body from actively transporting solute with a diuretic, then where is the water going to stay?

A

In the plumbing so that you can pee it out.

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26
Q

There is not a diuretic that works at the Proximal Convoluted Tubule. Why?

A

because you would lose 65% of your ECF at once and you would shrivel up and die.

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27
Q

What does the Loop of Henle consist of?

A

an Ascending loop and a Decending loop

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28
Q

In the Loop of Henle, there are not any drugs that work at the ________ loop.

A

Decending

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29
Q

In the Loop of Henle, ______% of NaCl gets reabsorbed at the ascending loop.

A

20%

remember that water follows solute.. so 20% of water will be PASSIVELY reabsorbed here.

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30
Q

Loop Diuretic work in the ________ loop in the Loop of Henle.

A

Ascending

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31
Q

_________ diuretics work by preventing the reabsorption of 20% of solute.

A

Loop

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32
Q

The Distal Convoluted Tubule is where _____% of NaCl is actively reabsorbed into the ECF.

A

10

remember that water follows solute.. so 10% of water will be PASSIVELY reabsorbed here.

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33
Q

Diuretics that work at the distal convoluted tubule are _____ as effective as loop diurectics

A

half

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34
Q

In the collecting ducts, you have ________ exchange pumps…

A

Sodium Potassium

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35
Q

The collecting ducts are where _____% of NaCl is actively reabsorbed.

A

5

remember that water follows solute.. so 5% of water will be PASSIVELY reabsorbed here.

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36
Q

__________ is the hormone that is a stimulant for the production of the sodium-potassium exchange pumps

A

Aldosterone

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37
Q

After the Sodium Potassium pumps within the collecting ducts are stimulated by aldosterone, what will they do?

A

after stimulation, these pumps will pull in sodium in exchange for potassium. (potassium wasting)

(they spit out potassium to be excreted in the urine and absorb sodium back into the ECF)

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38
Q

The more __________ your body produces, the more sodium potassium pump action you will have within your collecting ducts.

A

Aldosterone

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39
Q

What is ADH?

A

Anti Diuretic Hormone

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40
Q

What does ADH do?

A

ADH is a hormone within the body that causes the membranes in the collecting ducts to be more permeable to water.

This allows free water to be pulled into the body and thus concentrates the urine.

This is independent of solute.

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41
Q

When you are running a marathon, and your body needs to conserve free water ______ is released and it causes free water to be absorbed which darkens the urine.

A

ADH

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42
Q

Diuretic therapy:
MOA- General diuretics prevent active NaCl reabsorption and by doing this, it will limit the _______ reabsorption of water through the concentration gradient.

A

Passive

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43
Q

The degree of urine flow is directly proportional to the amount of NaCl reabsorption in line…so the Loop diuretics produce ____ urine than thiazide diuretics that work further down the line at the distal convoluted tubule.

A

more

they produce twice as much urine because 20% gets blocked here vs. 10% at the distal convoluted tubule

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44
Q

True or False

Loop Diuretics are less powerful than Osmotic Diuretics

A

False.

Loops are first in line so they prevent 20% of NaCl reaborption

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45
Q

The closer to the glomerulus the ______ powerful the diurectic is.

A

more

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46
Q

The closer to the collecting duct the ______ powerful the diuretic is

A

Less

47
Q

Name the 2 categories of Potassium Sparing Diuretics.

A

Aldosterone Antagonists and Non-Aldosterone Antagonists

48
Q

Loop Diuretics are the __________ effective Diuretics

A

Most

49
Q

What kind of diuretic is Furosemide?

Must know for test

A

Furosemide is a Loop Diuretic

Other loop diuretics are:
Ethacrynic Acid
Bumetamide
Torsemide

50
Q

What is the method of action of loop diuretics?

A

To prevent the active reabsorption of NaCl by 20% at the ascending loop of henle

51
Q

What are the Pharmacokinetics of loop diuretics?

A

they are available in various dosage forms- orally, IV, IM

Diuresis of a pill starts in about 60 minutes and IV startes in around 5 minutes

52
Q

Name the therapeutic uses for loop diuretics

A 
more severe cases
when greater fluid mobilization is needed such as:
CHF
fluid overload
edema from hepatic and renal failure
53
Q

Name the only Non sulfa loop diuretic

A

Ethacrynic acid

54
Q

Dehydration symptoms (one ADRs of diuretics)

A 
orthostasis
dry mouth
dizzy
skin turger
BUN ratio (normal 10-1) when it gets wider it means dehydrated
thirst
55
Q

ADR of loop diuretics

A 
*****hypokalemia most dangerous
dehydration
hypernatremia
hypochloremia
Hypotention
56
Q

Loops and Thiazides together can be dangerous

true or false

A

true

57
Q

IV loop diuretics can cause damage to the ears

True or false

A

true

usually transient ototoxicity
can also increase blood suger

58
Q

Hyperuricemia can be caused by loop diuretics. Why is this important

A

because it increases uric acid which can cause gout

59
Q

Where do Thiazide and Thiazide like diuretics work and what percentage of sodium do they block from getting reabsorbed

A

they work at the distal convoluted tubule

they block 10% of sodium and water from being reabsorbed

60
Q

What was the prototype for Thiazide and Thiazide like diuretics

A

HCTZ

61
Q

What are the therapeutic uses for Thiazides

A

used to treat Hypertension and edema

initial drug of choice for HTN

62
Q

ADR’s for Thiazides

A

the same as loop diuretics except for it increased serum CALCIUM

*****hypokalemia most dangerous
dehydration
hypernatremia
hypochloremia
Hypotention
63
Q

What is different about potassium sparing diuretics compared to loop or thiazides

A

they are diuretics that reduce potassium loss

64
Q

How do potassium sparing diuretics work

A

Aldosterone Antagonists work by blocking the effects of aldosterone

the net effect is less sodium potassium pump production

they retain k and excrete Na

65
Q

What are the therapeutic uses for Potassium sparing diuretics (aldosterone antagonists)

A

cirrosis of the liver
CHF
primary hyperaldosteronism

66
Q

Name 2 aldosterone antagonists

A

spironolactone (more hormonal)

eplerenone (less hormonal)

67
Q

ADR’s of Potassium sparing diuretics (aldosterone antagonists)

A 
hyperkalemia
menstrual irregularities
deepening of the voice
excessive hair growth in girls
gynomastia in men
68
Q

name 2 non-aldosterone antagonists

A

triamterene and amiloride

MOA- block sodium potassium pumps

USES- electrolyte benefits

69
Q

Osmotic Diuretics: Prototype Mannitol

A
  • have to have a filtered needle to administer because it will crystalize as it cools
  1. Four Properties
    A. filtered- small enough
    B. Undergoes minimal reabsorption (stays in Nephron
    C. Not Metabolized
    D. Pharmacology innert (doesnt do anything)
  • Kinetics: has to be IV

Theraputics: prophalaxis of renal failure
intracranial pressure

ADR’s - can make third spacing worse
DEATH

70
Q

volume contraction

A

decrease in total body water

71
Q

Isotonic contraction

A

volume contraction- dehydrated, but serum osmo is 270

causes: vomiting diarrhea, misuse of diuretics

Treatment: normal saline

72
Q

Hypertonic contraction

A

loss of H2O exceeds the loss of Na

Causes: excessive sweating, burns
Treatment: Hypotonic Fluid (.45%NS or D5W)

73
Q

Hypotonic contraction

A

loss of Na exceeds the loss of H2O

Causes: kidney issue, excessive diuretic use

Treatment: hypertonic solution 3%NS SLOWLY

74
Q

Volume Expansion

A

increase in total body water. Can also be classified as isotonic, hypertonic, or hypotonic

75
Q

respiratory system

A

influences pH through control of co2 exhalation

76
Q

kidneys

A

influence pH by regulating bicarb excretion

77
Q

Respiratory Alkalosis

A

produced by hyperventilation

78
Q

Respiratory Acidosis

A

retention of co2 secondary to hypoventilation COPD patients

79
Q

Metabolic Alkalosis

A

increase in serum bicarb levels thus increasing pH

vomiting, excessive gastric acid suctioning

80
Q

Metabolic Acidosis

A

chronic reanal failure, Diabetes Mellitus, ketoacidosis, asprin overdose

81
Q

potassium

A

the most abundant intracellular cation

82
Q

Hypokalemia (most important)

A

when serum sodium levels drop below 3.5 meq/L

Causes: acidotic state, diuretics, vomiting, diarrhea, laxitive use, severe acidosis

Significance: weakness, paralysis, arrhythmias

Treatment: Give K

83
Q

Hyperkalemia

A

typically defined as a K level greater than 5 meq/L

Causes: excessive K administration, spironolactone, epleronone *** Renal Failure

Treatment: if the heart is irritated infuse CA Salt, insulin with D5W, kxelate (sodium polystyrene sulfonate

84
Q

Pulmonary Circulation

A

delivers blood to the lungs

85
Q

Systemic Circulation

A

delivers blood to all other tissues

86
Q

arteries

A

take blood away from the heart

87
Q

veins

A

capacitance vessels (carry a lot of volume)

takes blood back to the heart

88
Q

Hemodynamics

A

the study of the movement of blood through the circulatory system

89
Q

How many total liters of blood

A

5

90
Q

How much is in the pulmonary circulation

A

9%

91
Q

What percentage of blood is in the heart

A

7%

92
Q

What percentage of blood is in systemic circulation

A

84%
64% on venous side
20% in arterial side

93
Q

Blood flow

A

force that drives the blood flow greater than the resistance

94
Q

Determinants of blood flow

A

a. vessel diameter ** most important
b. Vessel length
c. blood viscosity

95
Q

Driving force of heart flow return

A

a. Negative pressure in the right atrium
b. constriction of smooth vascular muscle
c. venous valves and skeletal muscle contractions

96
Q

beta 1 receptors

A

heart rate increases
contractility increases

sympathetic nervous system

97
Q

alpha 1 receptors

A

CONSTRICTION of the arteries and veins which leads to increased afterload

Sympathetic Nervous system

98
Q

Stimulation of muscarinic receptors

A

is part of the parasympathetic nervous system

Decreases HR and contractility

reduces cardiac output

99
Q

lower the preload

A

lower the cardiac output

100
Q

vasodilater

A

is an afterload reducer

101
Q

heart rate

A

increased through the sympathetic nervous system + beta 1 receptors when stimulated -> increase in HR and Contractility

102
Q

Myocardial contractility

A

the force of contraction of the ventricals - beta 1 vs. muscarinic stimulation + more stretch

103
Q

cardiac afterload (arteries):

A

the force that the heart has to overcome to pump blood

the greatest determinant is arteriole vasoconstriction and vasodilation

104
Q

Starlings law

A

force of ventricular contraction is proportional to the stretch

soggy boggy- ends up not pumping as well

the greater the stretch the greater the contraction

105
Q

Cardiac preload (veins)

A

how much volume gets to the heart

reduced preload: over diuresis, dehydrated,vasodilater

106
Q

vasodilater

A

afterload reducer

107
Q

natriuretic peptides

A

protectors of volume overload

108
Q

Baroreceptors

A

pressure sensor- stimulates the sympathetic nervous system

109
Q

sympathetic

A

stimulate beta 1 receptors to increase contractility and alpha 1

110
Q

parasympathetic

A

muscarinic receptors

111
Q

alpha 1 receptors

A

cause constriction of both arteries and veins

decrease contractility HR

112
Q

Atrial Natriuretic Peptide

A

released from stretching in the atria

113
Q

Brain Natriuretic Peptide

A

released from stretching in the ventricals

114
Q

C natriuretic Peptide

A

released from stretching in the veins and the arteries

Pharmacology 1 (6 decks)

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