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88 Cards in this Set

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  • Back
Which immunosuppressant:
Derivative of 6-mercaptopurine
Azathioprine
Which immunosuppressant:
Causes phocomelia
Thalidomide
Which immunosuppressant:
Nephrotoxic in 75% of pts
Cyclosporine--preventable with mannitol diuresis
Which immunosuppressant:
SE: acne, osteoporosis, HTN, hyperglycemia, immunosuppression -- infection
Glucocorticoids
Which immunosuppressant:
Inhibits secretion of IL-2 and other cytokines
Tacrolimus and cyclosporine
Which immunosuppressant:
Alkylating agent that requires bioactivation in liver
Cyclophosphamide
Which immunosuppressant:
Inhibits dihydrofolate reductase
MTX
What arachidonic acid product has actions that oppose that of prostacyclin?
Thromboxane
What substances are well known for causing hemolytic anemia in patients with G6PD deficiency?
Fava beans
Sulfonamides
PRimaquine
INH
High dose ASA
Ibuprofen
Nitrofurantoin
Dapsone
Naphthalene
Which enzyme deficiency:
Fructose intolerance
Aldolase B
Which enzyme deficiency:
Essential fructosuria
Fructokinase deficiency
Which enzyme deficiency:
Classic galactosemia
Galactose-1-phosphate uridylyltransferase deficiency
What might you see in a first trimester ultrasound of a fetus with Down syndrome?
Inc'd nuchal translucency
Which protozoan:
Diarrhea in campers and hikers
Giardia
Which protozoan:
Itchy vaginitis
Trichomonas
Which protozoan:
Sandfly is the vector
Leishmania
Which protozoan:
Anopheles mosquito is the vector
Plasmodium
Which protozoan:
Sodium stibogluconate is the treatment
Leishmania
Which protozoan:
Suramin or melarsoprol is the treatment
Trypanasoma
Which protozoan:
Maltese cross seen in RBCs
Babesia
Which protozoan:
Treat with metronidazole
Giardia, entameba, or trichomonas
Which protozoan:
Severe diarrhea in AIDS patients
Cryptosporidium
What is the result of a glycolytic enzyme deficiency?
RBC hemolysis
What is the result of a deficiency in pyruvate dehydrogenase?
Neurologic defects
What co-factors are required for the function of pyruvate dehydrogenase? What other enzyme requires the same co-factors?
TLC for No One
Thiamine pyrophosphate
Lipoic Acid
CoA
FAD
NAD
alpha-ketoglutarate DH
How does the presentation of a right parietal lobe lesion differ from the presentation of a left parietal lobe lesion?
Non-dom lesion: Right; hemi-spatial neglect

Dom lobe lesion (left): agraphia, acalculia, left to right disorientation
What is the clinical appearance of internuclear ophthalmoplegia? With what disorder is it commonly
associated?
Lateral gaze paralysis of adduction
Nystagmus in abductor

Assocd w/MS
Which protozoan:
Ixodes tick is the vector
Babesia
Juxtaglomerular apparatus:
Components
Role
JG cells of afferent arteriole and macula densa (Na+ sensor, part of DCT)

JG cells secrete renin in response to low renal BP, dec'd Na+ delivery to distal tubule, and inc'd symp tone (beta-1)
What are the functions of Ag-II?
Vasoconstriction-->Inc BP

Constricts efferent arteriole of
glomerulus-->Inc'd FF to preserve renal fn

Aldosterone release from adrenal gland

ADH release posterior pituitary-->H2O reabsorption

Stimulates hthal-->thirst
Which kidney is taken during living donor transplantation? Why?
Left kidney taken because it has a longer renal vein
Describe the anatomic path the ureters take.
Pass UNDER uterine artery and UNDER ductus deferens (Water--ureters--under the bridge--artery, ductus deferens)
Describe the breakdown of the body's fluid compartments (water, potassium, and sodium).
HIKIN: 60-40-20: HIgh K Intracellular

60% total body water
40% ICF (high K+)
20% ECF (high Na+)
Glomerular filtration barrier:
Role
Composition
Responsible for filtration of plasma according size and net charge

Composed of:
-Fenestrated capillary endothelium (size barrier)
-Fused BM with hepran sulfate (neg charge barrier)
-Epithelial layer consisting of podocyte foot processes
Equation for renal clearance of substance x.

What does it mean in relation to GFR (relatively)?
Cx = UxV/Px (UV over P)--
Cx is clearance ox X
Ux is urine [ ] of X
V = urine flow rate
Px is plasma concentration of X

Cx<GFR: Net tubular reabsoprtion of X

Cx>GFR: Net tubular secretion of X

Cx = GFR: No net secretion or reabsorption
What substance can be used to measure GFR?

Why?
What's a normal GFR?
Backup measure of GFR?
Inulin can be used to caluclate GFR because it is freely filtered and is neither reabsorbed nor secreted

NL GFR ~100

Can also use creatinine, but it slightly overestimates GFR bc creatinine is moderately secreted by renal tubules
What substance can be used to measure effective renal plasma flow?

Why?
ERPF can be estimated using PAG clearance because it's both filtered and actively secreted in proximal tubule.

ALL PAH entering kidney is excreted.
Equation for filtration fraction.

Normal FF?
Filtration Fraction = GFR/RPF

Note: GFR can be estimated with Cr
RPF best estimated w/PAH
What is the effect of NSAIDs on filtration fraction? How?
NSAIDs decrease prostaglandin synthesis

PGs impt for dilation of afferent renal arteriole

Fewer PGs-->constriction of afferent arteriole and dec'd filtration.

In other words: Dec'd RPF, dec'd GFR, so FF remains constant)
What is the effect of ACE inhibitors on filtration fraction? How?
ACE inhibitors inhibit formation of Ag-II

Ag-II constricts efferent arterioles.
Inhibiting this will:
Dec RPF
Inc GFR
so FF increases
Effect on RBF, GFR, FF:
Constriction of the afferent arteriole
Dec GFR
Dec RBF
No change to FF
Effect on RBF, GFR, FF:
Constriction of the efferent arteriole
Inc GFR
Dec RBF
Inc FF
Effect on RBF, GFR, FF:
Dilation of the afferent arteriole
Inc GFR
Inc RBF
No change to FF
Effect on RBF, GFR, FF:
Dilation of the efferent arteriole
Decd GFR
Inc RBF
Dec FF
Effect on RBF, GFR, FF:
Increase in serum protein
Dec GFR
No change to RBF
Dec FF
Effect on RBF, GFR, FF:
Ureter stone obstruction
Dec GFR
No change RBF
Dec FF
Effect on RBF, GFR, FF:
ACE inhibitors
Dec GFR
Inc RBF
Dec FF
Effect on RBF, GFR, FF:
Indomethacin, Naprosyn, ibuprofen
Dec GFR
Dec RBF
No change FF
Equations for filtered load and excretion rate.

How can you use this to determine rates of reabsorption and secretion?
Filtered load = GFR x Px
Excretion rate = V x Ux

Reabsorption: filtered - excreted
Secretion: excreted - filtered
Where does glucose reabsorption occur in the kidney?
Proximal tubule by Na/glucose co-transport
Where does amino acid reabsorption occur in the kidney?
Proximal tubule by various carrier systems
Equation for determining plasma osmolality.
Plasma osmolality =
2[Na]plasma + [Gluc]/18 + [BUN]/2.8
Which segment of renal tubule:
Reabsorbs 67% of the fluid and electrolytes filtered by the glomerulus
Proximal tubule
Which segment of renal tubule:
Segment responsible for concentrating urine
Collecting Duct
Which segment of renal tubule:
Site of secretion of organic anions and cations
Proximal Tubule
Which segment of renal tubule:
Always impermeable to water
Thick Ascending Limb
Which segment of renal tubule:
Permeable to water only in the presence of ADH
Late Distal Tubule, Collecting Duct
Which segment of renal tubule:
Site of the Na/2CI/K co-transporter
Thick Ascending Limb
Which segment of renal tubule:
Site of isotonic fluid reabsorption
Proximal Tubule
Which segment of renal tubule:
Site responsible for diluting urine
Thick Ascending Limb
Which segment of renal tubule:
Only site where glucose and amino acids are reabsorbed
Proximal Tubule
Which segment of renal tubule:
Water reabsorption in the Loop of Henle
Thin Descending Limb
How substances are reabsorbed by the kidneys at a greater rate than water?

List in order of greatest difference to least difference.
Glucose
Amino Acids
Bicarb
Phosphate
How substances are reabsorbed by the kidneys at a lesser rate than water?

List in order of greatest difference to least difference.
PAH
Creatinine
Inulin
Urea
Cl-
K+
Na+

("lesser rate" = excreted)
How does sodium absorption differ in the:
First half of proximal tubule
Second half of proximal tubule
Thick ascending limb
Early distal tubule
First half prox tubule: Na coupled with bicarb absorption

Second half prox tubule: Cl- coupled with bicarb absorption

Thick ascending limb: active reasborption of Na+ via K+/Cl-/Na+ pumps, and Na+/H+ pumps, Na/K/ATPase

Early distal tubule: active reabsorption of Na via Na/K/ATPase
What class of drugs inhibits the Na/2Cl/K symporter in the thick ascending limb?
Loop diuretics
Where in the kidney is calcium reabsorbed?

What other organic cation is absorbed here?
Calcium and magnesium both absorbed in thick ascending limb

Calcium is also absorbed in the early distal tubule WHEN PTH IS PRESENT
This region of the kidney is impermeable to water.
Thick ascending limb
What determines how much water is reabsorbed in the distal tubules and collecting ducts?
ADH--increases reabsorption of water
What two types of cells compose the collecting duct and the last segment of the distal tubule?

What do they do?
Principle cells--reabsorb water and Na, secrete K+

Intercalated cells--secrete H+ or HCO3-, reabsorb K+
What are the two types of intercalated cells?
alpha cells--H+ secreting; a for acid
beta cells--HCO3- secreting; b for base
What class of diuretic directly affects principle cells?
Potassium-sparing diuretics
What drug antagonizes aldosterone's action on the principle cells of the collecting duct thereby promoting Na+ excretion and inhibition K+ excretion?
Aldosterone antagonist--spironolactone and eplereonone
Aldosteorne:
When is it secreted?
Effects?
Secreted in response to dec'd blood volume (via ATII) and inc'd plasma [L+]

Causes inc'd Na+ reabsorption, inc'd K+ secretion, inc'd H+ secretion
Atrial natriuretic peptide:
When is it secreted?
Effects?
Secreted in response to inc'd atrial pressure

Causes inc'd GFR and inc'd Na+ filtration with NO COMPENSATORY Na+ REABSORPTION IN DISTAL NEPHRON

Net effect: Na+ loss and volume loss
ADH:
AKA
When is it secreted?
Effects?
ADH (vasopressin)
Secreted in response to inc'd plasma osmolarity and dec'd blood volume

Binds receptors on PRINCIPAL CELLS of distal tubules and collecting duct to inc number of water channels

Thus increases water reabsorption
What effect does aldosterone have on the intercalated cells and principle cells of the collecting duct?
Intercalated cells--stimulates acid secretion

Principle cells--increases Na+ reabsorption and K+ secretion
What are the critical steps involved in excreting dilute urine?
Dilution in thick ascending limb as solute reabsorbed and water remains in lumen (impermeable to water)

Absence of ADH-->distal tubule and collecting duct impermeable to water
What are the critical steps involved in excreting concentrated urine?
Dilution of fluid in thick ascending segment as solute reabsorbed and water remains in lumen (impermeable to water)

Presence of ADH-->distal tubule and CD permeable to water
What factors shift K+ out of cells?
Low insulin
beta-blockers (inhaled albuterol?)
Acidosis (H+ into cell, K+ out of cell)
Digoxin
Cell lysis (leukemia)
What factors shift K+ into cells?
Insulin
beta-agonists
Alkalosis
Cell creation/proliferation
Mannitol:
MOA
Use
AE
Osmotic diuretic; inc'd tubular fluid osmolality, inc'd urine flow

Use in shock, drug OD, elevated ICP

AE: Dehydration
Acetazolamide:
MOA
Use
AE
Carbonic anhydrase inhibitor; causes self-limited NaHCO3 diuresis and reduction in total body HCO3- stores

Use in glaucoma, urinary alkalinization, alkalosis, altitude sickness

AE: Hyperchloremic metabolic acidosis

ACIDazolamide causes ACIDosis
Furosemide:
MOA
Use
AE
Sulfonamide LOOP DIURETIC

Inhibits cotransport system (Na/K/2Cl) of thick ascending limb of loop of Henle

Prevents concentration of urine, results in inc'd CALCIUM EXCRETION (LOOPS LOSE CALCIUM)

Use: Edematous states (CHF, cirrhosis, nephrotic syndrome), HTN, hyperCa2+

AE: OH DANG
Ototoxicity, hypokalemia, dehydration, Allergy (sulfa), Nephritis (interstitial), gout
HCTZ:
MOA
Use
AE
Thiazide diuretic; inhibits NaCl reabsorption in early distal tubule, reducing diluting capacity of nephron

dec'd Ca2+ excretion (RETAINS CALCIUM!!)

Use: HTN, CHF, hypercalciuria, diabetes insipidus

AE: Hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, sulfa allergy (HyperGLUC)
What are the 2 strongest classes of diuretics? AE related to this?
Loops and thiazides, can cause contraction alkalosis
ACE inhibitors:
Prefix/suffix
MOA
use
AE
Effect on GFR
-pril
MOA: inhibit ACE, reduce levels of Ag-II, prevent inactivation of bradykinin (potent vasodilator)

Renin release is increased due to loss of feedback inhibition

Use: HTN, CHF, diabetic renal dz

AE: Cough, angioedema, proteinuria, taste changes, hypotn, pregnancy problems (fetal renal damage!!!)******, rash, inc'd renin, lower AgII, hyperkalemia

"CAPTOPRIL"

Significantly decrease GFR by preventing constriction of efferent arterioles
Patients with calcium kidney stones should avoid this diuretic.
Loop diuretics (would put more Ca2+ in urine)

Thiazides would help!