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24 Cards in this Set
- Front
- Back
various part of tubule
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proximal - 65% solultes reabosrbed
loop of henle thin D perm to water thick/thin A - imperm to h20 and urea Thick ascending limb - Na/k/2cl absorber macula densa TAL makes contact...senses Na+ concentration if high na+ - constrct Affecent...decrease GFR if low - renin produced...increases syn of Angiotenion II...constricts efferent increses GFR distal tubule - Na/Cl absorbed...IMPERM to water late distal + collecting duct...depends on ADH...(more ADH more water resorbed) |
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carbonic anydrase inhibitors
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proximal tubule
acetazolamide dozolamide (topical) |
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thiazides & congeners
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EDT
hydrochlorothiazide indapamide |
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loop diuretics
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TAL
furosemide ethacrynic acid |
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K+ sparing diuretics
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LDT & CCT
triamterene amiloride spironolactone |
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osmotic diuertics
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Thin D L
mannitol |
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ADH antagonists
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lithium
demeclocycline |
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Carbonic anhydrase inhibitors
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Inhibit NaHCO3 reabsorption blocks CA
excretion of Na, K, HCO3, H2po4 decreased excretion of Nh4, H+ (leads to acidosis) --hyper Cl...bc exits cells when H+ is high - hypokalemia too with ncreases the lumen negative potential which favors K+ excretion |
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Carbonic anhydrase inhibitors
- uses |
removes 5% of Na+..
- fast tolerance 2-3 days - good for aqueous humor stop (glacoma) - decrease CSF ACUTE MTN sickness - epilipsey (inhibit na+ into cells) |
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Carbonic anhydrase inhibitors - adverse
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paresthsias
nephrolithasis (ppt of ca+2 salts) sulfa-alergies CONTRADICTIONS hepatic cirrhosis COPD |
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Thiazides
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sulfonamides
MOA: blocks Na/Cl in EDCT Renal: Increased renal excretion of: Na+, K+, H+, Mg++, Cl-, HCO3-, H2PO4-. - Decreased renal excretion of: Ca++, NH4+, urates. - Urine pH: alkaline (due to inhibition of carbonic anhydrase). - Acid-base balance: metabolic alkalosis. 5-10% NA....stops if GFR is less then 30 mL Vasular - arterioialr vasodilation |
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Thiazides - Adverse
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hypokalemia
hypochloeria hypercalecmia meetablisc alkalosis (H+ loss) Sexual dysfunction contraindicatiosn Digitalized patients |
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thiazides - USE
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Hypertenteion (first choice)
- ememda (heart,liver, kidney) |
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Loop diuretics
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Etharcynic A = not sulfonamidel..rest are
MOA: block Na/k/2cl in TAL blocks Macula Densa sensitivity - inhibits tuboglom feedback - stimulates renin release 20-25% Na+ ....works with poor GFR too vasodialtion in VENOUS beds due to PG syn Metabolic Alkalosis...diluting capacity of kidney is decreased |
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Loop Diuretics - adverse
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hypokalemia
hypocholemia hypovolemia GI bleeding Tinnitus Allergry - sulfas |
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Loop - uses
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acute pulm edema
HF Ascities (RSHF...decreas preload..w/ venous dialtion) hypertension hypercalcemia |
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POTASSIUM-SPARING DIURETICS
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spironolactone - blocks aldosterone receptors in LDT & CCT...synthsis of Na/K + Na+ channels impaired)
Triameterne + amiloride = block Na+ channels urine pH = alkaline ...maybe slight acidocis low efficacy 2% Na+ |
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POTASSIUM-SPARING DIURETICS- adverse
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hyperkalemia - paraeshtisa, diarrhea, bradycard, AV block
Spiron - sexual dysfunction, gynecosamastia, prost hyper Contra Severe hepatic disease (drug-induced fluctuations in serum electrolyte concentration can occur rapidly and precipitate coma). - Patient treated with drugs that blunt the renin angiotensin system (beta-blockers, ACE inhibitors). - Patients receiving high doses of NSAIDs (these drugs can cause hyperkalemia). |
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POTASSIUM-SPARING DIURETICS - uses
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Spironolactone - primary hyperaldos - adrenal adenoma
secondary hyperald - hepatic cirrhosis, CHF, nepthoitic, renal stenosis amiloride - lithium-induced DI all treat: hypokalemic states |
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Osmotic diuretics
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limit h20 reabsorption
DTL + Prox tub Vascular - initial extracelluar expansion...later reductiotion - reduces intraocular/intracranial |
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osmo - adverse
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extra - contraction
hypovoluemia, dehydration, hypernatermia extra - expansion (cardiac + renal disease) oposite |
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osmo - uses
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reduce cerebral edema b4 & after neurosurg
acute angle-closs glaucoma CONTRA - severe renal failure, HF, pulm edema, hypovol |
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hypokalemia
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less then 3.5
Skeletal muscle weakness, flaccid muscle paralysis, rhabdomyolysis, respiratory failure. - Disturbances in cardiac repolarization (which may precipitate serious arrhythmias in patients receiving digitalis). - Constipation, paralytic ileus. - Polyuria, polydipsia. |
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hyperkal
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more then 5.3
Disturbances in cardiac excitability and conduction (which may lead to accelerate repolarization, slowing of A-V conduction, A-V Block, and cardiac standstill) - Flaccid paralysis (in case of severe hyperkalemia) |