Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CRAAB 6 > Trachte: ADH and Diuretics > Flashcards

Trachte: ADH and Diuretics Flashcards

1
Q

How much plasma does the kidney filter each day?

A

180 L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the kidney do?

A
  1. Returns ions/nutrients to blood via specific transporters

2. Excretes toxins/metabolites in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does using different permeabilities to water and different ionic transport processes over the course of the nephron affect the kidney?

A

It results in DRASTICALLY different OSMOLARITIES in different regions of the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where do carbonic anyhydrase inhibitors act?

A

Proximal tubule

*Aren’t really used clincially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where do loop diuretics act? What do they do?

A

Ascending limb of the loop of Henle
Inhibit Na/K/2Cl pump

EXTREMELY useful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where do thiazide diuretics act? What do they do?

A

Distal convoluted tubule

Inhibit Na/Cl transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drugs are especially useful in hypertension?

A

Thiazide diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where do K sparing diuretics work? What do they do?

A

Cortical collecting tubule

Inhibit aldosterone receptors or block Na exchange for K and H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where do antidiuretic hormones work? What do they do?

A

Medullary collecting duct

Recruit aquaporin channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where do osmotic diuretics work?

A

Proximal tubule or descending limb of the loob of henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the major loop diuretics?

A

Furosemide (lasix)

Bumetanide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What normally happens in the ascending loop of henle?

A

The ascending loop of Henle normally accounts for 25% of Na reabsorption in the kidney.

NORMALLY…
Na/K/2Cl pump in the thick ascending limb of the Loop of Henle>
Na/K/CL are pumped out but water remains inside (no aquaporins)>
HYPO-OSMOLAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do the loop diuretics do in the ascending loop of henle??

A

LD prevent the DECREASE in osmolarity>

greater retention of ions and water in later segments of the nephron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What effect do loop diuretics have on urine composition?

A
  1. Increased NaCl excretion

2. Increased K excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the major uses of loop diuretics?

A
  1. pulmonary edema
  2. edematous conditions
  3. Hyperkalemia
  4. Acute renal failure
  5. anion overdose (bromide, fluoride, iodide)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the major thiazide diuretics?

A

Chlorthalidone
Hydrochlorothiazide
Metalazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do thiazide diuretics do?

A

Block the NaCl transporter in the distal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What normally happens in the distal convoluted tubule? What happens when you block this transport mechanism?

A

Accounts for 8% of NaCl reabsorption

Blocking this mechanism results in EXCRETION of water, Na, Cl and K in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why does K get excreted with thiazide diuretics?

A

Some of the increased Na is exchanged for K in the cortical collecting tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are thiazides primarily used for?

A
  1. HTN
  2. HF
  3. Nephrolithiasis caused by hypercalcemia
  4. Nephrogenic diabetes insipidus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the major SE of thiazides?

A
  1. Hyperglycemia
  2. Hyperuricemia
  3. Hypokalemia
  4. hyperlipidemia
  5. hyponatremia
  6. allergic rxns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do thiazides cause hyperglycemia?

A

Thiazides are sulfonylureas>
bind to SUR on K channel controlling insulin release>
opens the channel and hyperpolarizes the beta cell>
suppresses insulin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the K sparing diuretics and what are the mechanisms by which they act?

A
  1. Inhibit aldosterone receptors (spironolactone)

2. inhibit the Na exchange for K and H in the cortical collecting duct (amiloride, triamterene)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do K sparing diuretics spare K?

A

By blocking the exchange of intaluminal Na for extraluminal K, less K is excreted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the major use of K sparing diuretics?

A

Hyperaldosterionism or to prevent K wasing caused by other diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does eplerenone do?

A

Prevents fibrotic changes in kidneys and hearts caused by aldosterone, and has been shown to improve survival in heart failure

27
Q

What are the side effects of K sparing diuretics?

A

Hyperkalemia
Hypercholeremic metabolic acidosis
Acute renal failure
Kidney stones

28
Q

What K sparing diuretic causes gynecomastia?

A

Spironolactone

29
Q

What are 2 antidiuretic hormones?

A
  1. Vasopressin

2. Desmopressin

30
Q

What are antidiuretic hormones used for?

A

Treat diabetes insipidus

bed wetting!

31
Q

What is the MOA of antidiuretic hormones?

A

Stimulation of G protein coupled receptors in the collecting duct>
recruits aquaporin channels>
water moves by osmosis through the AQP cahnnels>
hyperosmolar medullary region of the kidney

32
Q

How are vasopressin and desmopressin administered?

A

parenterally
intranassally
orally

33
Q

What can be used to treat syndromes involving inappropriate ADH secretion?

A

Convaptan- ADH antagonist

34
Q

What antibiotic has some activity as an ADH antagonist?

A

Demecocyline

35
Q

What is the major osmotic diuretic?

A

Mannitol

36
Q

How does mannitol cause a retention in water?

A

It’s NOT reabsorbed by the nephron so it exerts an OSMOTIC effect to retain water.

37
Q

What is mannitol used for?

A
  1. reduce body water

2. reduce intracranial/intraocular pressure

38
Q

What are toxicities associated with mannitol?

A
  1. Extracellular volume expansion
  2. Dehydration, hyperkalemia, hypernatremia
  3. hyponatremia when renal function is impaired
39
Q

What is a major carbonic anhydrase inhibitor?

A

Acetazolamide (diamox)

40
Q

Are anhydrase inhibitors useful as diuretics?

A

Not really….CA is too important of an enzyme. Blocking it leads to a number of SE.

41
Q

what are CAIs used for?

A
  1. Glaucoma
  2. urinary alkalinization
  3. Metabolic acidosis
  4. Acute mountain sickness
42
Q

What are hte SE of CAIs?

A
  1. Hyperhchloremic metabolic acidosis
  2. renal stones
  3. renal K wasting
43
Q

What do organic anion transport inhibitors do?

A

Transport small hydrophillic molecules into or OUT of the nephron. Driven by symport or antiport exchange of molecules for dicarboxylates.

44
Q

What are OATIs used to treat?

A

Gout!

45
Q

How do you treat gout?

A
  1. Reduce inflammation w/ NSAIDS (NOT salicylates)

2. Reduce uric acid

46
Q

What drugs reduce uric acid? How do they work?

A
  1. Allopurinol- inhibits xanthine oxidase

2. Probenicid or sulfinpyrazone- inhibits a renal organic acid transporter to facilitate excretion

47
Q

What is colchicine?

A

Microtubule inhibitor with anti-inflammatory properties

48
Q

How do probenicid and sulfinpyrazone work?

A

Inhibit uric acid reabsorption by organic acid transporter

49
Q

Why are loop diuretics ototoxic?

A

Also block the pump in the ear, which is critical for K concentrations in the ear

50
Q

What do loop diuretics do to extracellular Na, K, Cl and water?

A

Decrease Na, K, Cl and reduce water

51
Q

Why are we so sensitive to K imbalance?

A

Theres very little in our extracellular fluid, so if you change it slightly it can have a large effect. There is a far greater amount of Na, so altering it does not do much.

52
Q

Why is it important to monitor electrolytes when giving loop diuretics?

A

They have the potential to be toxic

53
Q

How do thiazides prevent uric acid secretion?

A

Thiazide and UA are transported by same transporters so they interfere with the transfer of UA

54
Q

What affect do thiazides have on extracellular Na, K, Cl and water?

A

Deplete Na, K and water
Much less than loop diuretics
have milder affect so they’re safer to use

55
Q

What part of the bp equation do thiazides affect?

A

BP= HR x SV X TPR (Decrease SV!…also decreases TPR)

This affects the venous return curve

56
Q

What are the compelling reasons/perfect conditions for use of thiazides in HTN? What are ACE inhibitors good for?

A

Stroke- lower bp and reduce incidence of stroke
Diabetes- they do elevate glucose, but are still ok
CAD

ACE inhibitors are ALWAYS GOOD b/c they are synergetic with other drugs.

They have milder affects than loop diuretics

57
Q

What effects do K sparing diuretics have on extracellular na, k, cl and water?

A

Mild decrease in Na
ELEVATE K levels
Little affect on Cl or water

58
Q

How does aldosterone work?

A

Aldosterone works on a receptor in the cytosol. Once activated it is a transcriptional activator or inhibitor.

59
Q

Where is aldosterone synthesized?

A

Adrenal gland (glomerulosa- the outermost layer)

60
Q

What are the compelling reasons for use?

A

Heart failure

post MI

61
Q

Where does ADH come from?

A

Posterior Pituitary

62
Q

What stimulates the release of ADH?

A 
Decrease in blood volume
Increase osmolarity (osmosensor in the brain)
63
Q

What receptors does it stimulate?

A

Gs aplha- g protein that couples between the receptor that stimulates adenylate cyclase

64
Q

What do thiazides do to UA?

A
  1. inhibit secretion of UA by OAT1
  2. Serve as substrates for URAT

Net effect is to INCREASE blood UA

CRAAB 6 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions