Ch 9 Diuretics, Fluid, And Electrolyte Balance

Front 1

Define filtration

Back 1

both nutrients and waste move from glomerulus to Bowman's capsule by high pressure glomerulus

Front 2

In Reabsorption, chiefly _____ moved from _____ to ______, often done by active transport

Back 2

nutrients
tubule to blood

Front 3

In secretion, chiefly _____ move from _____ to ______ at any point after the Bowman's capsule. Often done by active transport.

Back 3

waste products or foreign materials
blood into tubule

Front 4

Proximal convoluted tubule is where _____ ______ are reabsorbed including _____% of________. Also, when ____ ion is reabsorbed, either ____ ion or ______ is reabsorbed with it to maintain ______ _______. Some secretion also occurs here.

Back 4

most substances
100% of nutrients
Cl- or HCO3- is reabsorbed
maintain electrical balance.

Front 5

The upper portion of the loop of _____ actively reabsorbs ____ and ____ ions

Back 5

Cl-
Na+

Front 6

The distal convoluted tubule secretion and reabsorption is influenced by what chemical

Back 6

aldosterone

Front 7

Aldosterone works in the _________ part of the kidney. What Ions does it influence, and how?

Back 7

Distal convoluted tubule
When aldosterone is present, Na+ is reabsorbed, while either K+ or H+ is secreted.

Front 8

Why would K+ depletion cause systemic alkalosis?

Back 8

-

Front 9

The collecting tubule is under the control of what chemical.

Back 9

Antidiuretic hormone [ADH]

Front 10

When blood is too diluted (thin/watery), is more less ADH released

Back 10

Less ADH is released

Front 11

What is SIADH (syndrome of inappropriate ADH) and what causes it

Back 11

Occurs when excessive levels of ADH are produced. It causes the body to retain water and certain electrolytes in the blood may fall.
Some causes: meningitis, encephalitis, brain tumors, lung diseases, some medications, hypothalamus or pituitary gland damage.

Front 12

The two systems involved in acid-base balance are ______ and _______

Back 12

Respiratory system
Kidney

Front 13

Bicarbonate Buffer System

CO2 +_____ <---> ______ <----> __ + ______ + _____

Back 13

CO2 + H2O <--> Carbonic Acid H2CO3 <--> Bicarbonate ion [H+] + [HCO3-] + [Na+]

Front 14

The respiratory system can correct for alkalosis by ________ respiratory rate which will retain ______ gas.

Back 14

Decreases respiratory rate
Retains CO2 gas

Front 15

The kidney corrects for alkalosis by eliminating excess ______ by reabsorbing less ______ and more _____.

Back 15

excess bicarbonate
bicarbonate
more chloride

Front 16

The respiratory system corrects for acidosis by

Back 16

Increases respiratory rate, removes CO2, and therefore carbonic acid
**Note: effectiveness depends on the amount of bicarbonate already in the system because carbonic acid in turn comes from bicarbonate ion combining with excess hydrogen ion in the body fluids

Front 17

The kidney corrects for acidosis by ________ more bicarbonate ion (instead of ______ ion) in the ________ tubule.
Kidney actively secretes more ____ instead of ___ in the distal tubule

Back 17

reabsorbing more bicarbonate
(instead of Cl- ion) in the proximal tubule
more H+ instead of K+

Front 18

The kidney may cause acid-base imbalances if it malfunctions or a _______ is given

Back 18

a diuretic is given

Front 19

Define Edema

Back 19

It is the accumulation of fluid in bodily tissues or a body cavity

Front 20

Causes of edema include


Hint, ce, ape, ld, rd, p

Back 20

Cardiac edema (congestive heart failure)
Acute Pulmonary Edema
Liver Disease
Renal Disease (Kidney)
Pregnancy (caution: some diuretics may be teratogenic)

Front 21

Caution of using a diuretics include women that are _______. Also ______ depletion, especially if patients is on digitalis.

Back 21

Pregnant
Potassium depletion

Front 22

Diuretics increase the rate of urine flow, but also alter the ___ and the ____ _________ of both the urine and the blood.

Back 22

pH
Ionic composition

Front 23

3 ways diuretics work include

Back 23

1. Osmotically hold water (agents like Mannitol)
2. Increase glomerular filtration rate (vasodilation) * Not a primary MOA - caused by other drugs, like Xanthines
3.Direct or indirect inhibition of ion reabsorption (Na+, Cl-, or HCO3-)

Front 24

The primary mechanism of action of all diuretics is

Back 24

Direct or indirect inhibition of ion reabsorption (Na+, Cl-, or HCO3-)

Front 25

The proximal tubule inhibits reabsorption of _______. Name 2 agents that affect the proximal tubule.

Back 25

HCO3-
Carbonic anhydrase inhibitors
Thiazides

Front 26

extra Na+ entering the distal tubule may cause ____ ion depletion

Back 26

K+ depletion

Front 27

Potassium sparing diuretics affect the _______ convoluted tubule.
Name 2 ways to do this

Back 27

Distal convoluted tubule
Spironolactone
Direct action on the tubule

Front 28

spironolactone is a/an ________ antagonist. It causes _____ ion diuresis and _____ ion retention

Back 28

Aldosterone antagonist
Causes Na+ diuresis and K+ retention

Front 29

Thiazides are most commonly used because (3)

Back 29

Oral use is convenient
Effective over extended periods of time
Relatively low toxicity

Front 30

Thiazides MOA inhibits _____ reabsorption from the ___ tubule and ____ ion from the ____ portion of the loop of Henle.
It also relaxes.......

Back 30

HCO3-
proximal tubule
Cl- ion
ascending
Relaxes blood vessel smooth muscles = higher filtration

Front 31

Thiazides are less likely to cause an acid-base imbalance because of ____ loss is balanced by ____ secretion and ___ loss.

Back 31

HCO3- loss
H+ secretion
Cl- loss

Front 32

Thiazides may a ____ ion or _____ ion depletion

Back 32

Potassium
Chloride

Front 33

Therapeutic uses of Thiazides include (4)

Back 33

Essential hypertension
Fluid retention
Acute pulmonary edema
Sometimes used in pregnancy (not teratogenic but *Cautions though)

Front 34

Thiazides and pregnancy use

Back 34

Not teratogenic, but can cause baby to have electrolyte problems, jaundice. , lower placental hormone production.
Mother may not go into labor as easily and increase chance of hyperglycemia

Front 35

Side effects of Thiazides (diuretic)

Back 35

K+ depletion
Weak
Nausea, cramps
Hyperglycemia intensified in diabetics
Uric acid in blood (aggravates gout)
Skin rashes

Front 36

Furosemide
Ethacrynic Acid,
Bumetanide
Torsemide
Are all examples of what type of diuretics

Back 36

Loop Diuretics

Front 37

Furosemide (Lasix) is a powerful thiazide that retains its effect on _____ _____. It is ____ to ____ times more powerful than other ______

Back 37

Blood vessels
8-10 times
Thiazides
*Can cause 4 liters of urine to be formed in a few hours

Front 38

Furosemide is also a powerful _________ of Cl- reabsorption from the _____ _____ area of the loop of Henle.

Back 38

Inhibitor
ascending limb

Front 39

Therapeutic uses of Furosemide (4)

Back 39

CHF - Congestive heart failure.
Acute pulmonary edema (vasodilator effect)
Hypertension (acute only - vasodilator effect)
Chronic renal failure (needed when kidney is 80% impaired)

Front 40

Special cautions for Furosemide include (3)

Back 40

Major electrolyte imbalance - especially K+ and alkalosis
Dehydration and hypotension may occur
Temporary or permanent deafness may occur

Front 41

Furosemide inhibits Cl- reabsorption in the ascending limb of loop of Henle, but Ethacrynic Acid, Bumetanide, and Torsemide inhibit Cl- and _____ion reabsorption from __________. Plus, inhibits ____ ion reabsorption from the _____ tubule

Back 41

Na+
ascending limb of loop of Henle (same)
Inhibits NA+ ion resorption from the proximal tubule

Front 42

Spironolactone, Triamterene, and amiloride are _______ _____ diuretics

Back 42

Potassium sparing diuretics

Front 43

Spironolactone requires what to work

Back 43

Requires aldosterone

Front 44

Spironolactone is a/an _______ antagonist

Back 44

aldosterone antagonist (inhibits aldosterone)

Front 45

How potent are postasium sparing diuretics

Back 45

Not very potent diuretics

Front 46

Matching: Triamterene, Amiloride, Spironolactone

Which of the above work independent of the amount of aldosterone in the system as a potassium sparing diuretic.

Back 46

Amiloride
Spironolactone

Front 47

Uses for osmotic diuretics like mannitol or urea include....

Back 47

Withdraw water from overhydrated cell, especially the brain or eye)
Maintain high volume of urine to prevent renal failure after hemolytic reaction, shock, hemorrhage, hemorrhage, or surgery. Also drug O.D.'s

Front 48

Osmotic diuretics such as mannitol and urea are not used for edema because....

Back 48

Does not extract abnormal amounts of fluid from the body. It does not eliminate sodium ion.

Front 49

Spironolactone, Triamterene, and amiloride cause potassium retention or depletion?

Back 49

Potassium Retention (hyperkalemia)

* all others cause hypokalemia