Week 3 renal

Question 1

Answer 1

a) kidney
b) Ureters　尿管
c) Bladder
d) Urethra　尿道

Question 2

Answer 2

1) Glomerular
2) Proximal Tubule 60-70% Na + H2O
3) Loop of Henle / descending
4) Loop of Henle /ascending 20-25%
5) Distal tubule 5-10%
6) Collecting ducts ADH

Question 3

Tubular reabsorption vs tubular secretion

Answer 3

Reabsorption Back to blood
Secretion Blood to tubule

Question 4

a) Glomerulus:?

b) Afferent arteriole?

c) Efferent arteriole:

Answer 4

a) Place where exchange/filtration occurs between the circulatory and urinary systems
b) brings blood to the nephron
c) takes blood back to the body ** Think A before E in terms of where they lie in relation to the glomerulus ***

Question 5

What substances reabsorb?

Answer 5

Body excretes ALL creatine

Question 6

Condition causing fluid overload? 5

Answer 6

Heart failure(very common)
Liver diseases
Kidney diseases
Hyperaldosteronism
Corticosteroid therapy

Question 7

Diuretics how to work? 3

Answer 7

Drug inc rate of urine production

Drug reduces extracellular fluid volume

Drug blocks reabsorption of Na (water follows Na)

Question 8

Thiazide diuretics

Medications name

Answer 8

Hydrochlorothiazide
Chlorothiazide
Chlorthalidone
Metolazone
Indapamide

Question 9

Thiazide diuretics

a) act on where?
b) Inhibit what?

Answer 9

a) distal convoluted tubules
b) Sodium reabsorption

Sodium carry water, so inhibit this
Urine output increase
K excreted (排出）

Question 10

Thiazide diuretics

Limitation

Answer 10

Oral dosage only
Can only affect 10% of sodium load
Loose effect after 1-2 weeks

Question 11

Why Thiazide-induced hypokalemia?

Answer 11

More pee=more lose K

Muscle weakness and cramps
Cardiac arrhythmias 不整脈

Question 12

Loop diuretics

Medications name

Answer 12

Furosemide (Lasix)
Bumetanide
Torsemide

Question 13

Loop diuretics

a) act on where?
b) Inhibit what?

Answer 13

a) ascending Loop of Henle
b) Sodium reabsorption

Question 14

Loop diuretics

Advantage

Answer 14

Most effective diuretic (20-25%)
Oral and IV forms
High ceiling diuretics

Question 15

Loop diuretics

indication

Answer 15

Moderate/severe edema
HTN from volume overload

Question 16

Thiazide and loop diuretics

ADRs

Answer 16

Hypokalemia (normal 3.5-5)
Hyperglycemia
Calcium wasting (loop only)
Ototoxicity (Loop only)

Dehydration (total volume water)
Hypovolemia (too low water in blood)

Question 17

Nursing intervention for thiazide and loop 3

Answer 17

Monitor BP often
Changing position
Fall risk elderly

Question 18

Potassium-Potassium-Sparing

a) act on where?
b) What action?

Answer 18

a) Distal tubule
b) Block sodium channels
Prevent secretion of K

Question 19

Potassium-Potassium-Sparing

Medication name

Answer 19

Amiloride
Triamterene

Amiloride+ Hydrochlorothiazide= Moduretic
Triamterene+ Hydrochlorothiazide= Dyazide

Question 20

Potassium-Potassium-Sparing

limitation

Answer 20

Weak diuretics
Typically used in combination with thiazide diuretics
(to maintain neutral K balance)

Question 21

Potassium-Potassium-Sparing

ADR

Answer 21

• *Hyperkalemia**
• renal impairment
• Diabetics
• Elderly

Muscular weakness
Paralysis
Cardiac arrhythmias

Question 22

Aldosterone antagonists

a) act on where?
b) Inhibit what?

Answer 22

a) distal tubule and collecting duct
b) Blocking the action of aldosterone

Aldosterone= increase sodium reabsorption
ADH=only water

Question 23

Aldosterone and ADH work together to?

Answer 23

Increase water reabsorption

Aldosterone acts in the distill tubule
ADH works in collecting duct

Question 24

Aldosterone antagonists

Medications name

Answer 24

Spironolactone
Eplerenone

Spironolactone+ Hydrochlorothiazide = Aldactazide

Question 25

**Aldosterone antagonists** a) indication b) ADRs

Answer 25

a) Patients with increased levels of aldosterone - Heart failure - Live failure b) Hyperkalemia Hormonal effects (spironolactone only) -gynecomastia -breast tenderness

Question 26

Peripheral edema cause?

Answer 26

Results from inadequate water excretion 🡪 too much water is being reabsorbed Can occur in legs, face, lungs, abdomen

Question 27

Osmotic diuretics, action?

Answer 27

"Water magnet" In renal tubule-- trap water in tubule to cause diaresis In blood--draw blood from tissues into blood - cerebral edema - high intraocular pressure in glaucoma

Question 28

Osmotic Diuretics name

Answer 28

Glycerin Mannitol Urea

Question 29

Carbonic Anhydrase Inhibitors, name

Answer 29

Acetazolamide

Question 30

Carbonic Anhydrase Inhibitors a) action b) used for

Answer 30

a) In tubule, Carbonic Anhydrase necessary for reabsorption of bicarbonate - without bicarbonate, sodium ions not reabsorption efficiently - result increased urine and alkaline urine b) Edema Glacoma Some drug overdose

Question 31

Nursing considerations diuretics meds

Answer 31

Administer in the morning Other risk of hypovolemia -diarrhea -vomiting Monitoring -K -Na -BUN Creatinine

Question 32

Creatinine clearance Normal Mild impairment Moderate impairment Sever impairment

Answer 32

Question 33

What thiazide primary used for?

Answer 33

HTN

Question 34

Which meds are ADR of hypokalemia? a) hydrochlorothiazide b) torsemide c) amiloride d) spironolactone e) acetazolamide

Answer 34

c, d

Question 35

In which part of the nephron does the most sodium and water reabsorption take place?

Answer 35

Proximal tubule 60-70%

Question 36

Dehydration, hypovolemia and hypokalemia are all ADR of which drug? a) Furosemide b) Amiloride c) Eplerenone d) Metolazone e) Mannitol f) Chlorthalidone g) Torsemide

Answer 36

a,d,f,g

Question 37

Which of the following is the primary use for Acetazolamide? a. Hypertension b. Glaucoma c. Edema d. Cataract

Answer 37

b

Question 38

Which of the following drugs action is not to cause diuresis but to move fluid from one place to another? a. Glycerin b. Acetazolamide c. Eplerenone d. Metolazone

Answer 38

a

Question 39

Which of the following is an adverse reaction of Spironolactone? a. Orthostatic hypotension b. Hypovolemia c. Ototoxicity d. Erectile dysfunction

Answer 39

d

Question 40

You would need to educate patients about excessive potassium intake due to the risk of hyperkalemia for which of the following drugs? (Select all that apply) a. Hydrochlorothiazide b. Torsemide c. Amiloride d. Spironolactone e. Acetazolamide

Answer 40

c, d