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18 Cards in this Set

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Therapeutic Use of:
Manitol
1: Acute renal failure
2: Reductions in intracranial or IOP before or after surgery
Mechanism:
Mannitol
Osmotically active
Increases renal blood flow, decreasing osmotic gradient.
Mechanism:
Acetazolamide
Inhibits carbonic anhydrase in lumen and epithelial cells.
Decreases H+ secretion.
Mechanism:
Furosemide
Inhibits Na+/K+/2Cl- symporter.
Positive potential in lumen is reduced.
Mg+ and Ca+ reab also decreased.
Impairs ability to excrete dilute urine.
Prostaglandins decrease renal vascular resistance and increases renal blood flow.
Also a weak anhydrase inhibitor.
Dilates large veins, decreasing venous return, when given i.v.
Mechanism:
Hydrochlorothiazide
Inhibits electroneutral Na+, Cl- cotransporter.
Increases Na in lumen depolarizing luminal membrane, increasing K loss.

*Combined with Amiloride which blocks Na channel, reducing K loss.
Mechanism:
Spironolactone
Canrenone forms inactive receptor complex, blocking the action of aldosterone.
If no circulating aldosterone, spironolactone has no effect.
Mechanism:
Amiloride
Blocks Na+ channels, decreasing Na+/K+ exchange.
Blocks Na channel and reduces K channel loss.

*Effect is independent of aldosterone's presence (unlike Spironolactone)

*Combined with Hydrochlorothiazide
Urine volume and osmolarity is changed by:
Manitol
Increases urine volume.
Fall in urine osmolarity because cortico-medulary osmotic gradient is decreased by increase in renal blood flow.
Less water is reabsorbed.
Lowered Na+ concentration.
Increased tubular flow rate.
Excretion of what ions occur, making the urine acidic or alkalemic:
Acetazolamide
Carbonic Anhydrase
Increased excretion of HCO3-, Na+, K+.
Alkaline urine.
Excretion of what ions occur:
Furosemide
Loop diuretic
Na, Cl, K, Mg, Ca, HCO3-
**patient may get hypochloremic hypokalemic alkalosis!
Excretion of what ions in the urine causes hyperosmolar urine:
Hydrochlorothiazide
Thiazide diuretic
Increases excretion of Na, Cl, K. (Na/Cl cotransporter is blocked)
Decreases excretion of Ca.
Urine is hyperosmolar.
Excretion of what ion or ions in the urine is/are increased or decreased:
Spironolactone
K+ Sparing
Excretion of Na, Cl and water increased.
Excretion of K+ decreased.
Excretion of what ion or ions in the urine is/are increased or decreased:
Amiloride
K+ Sparing
Excretion of K+ decreased.
Plasma changes due to:
Mannitol
Initially hyponatremia
Water diuresis is greater than the increase in sodium loss, leading to HYPERNATREMIA
Plasma changes due to:
Acetazolamide
Hyperchloremic metabolic acidosis.
- charge in lumen causes more reabsorption of Cl- in collecting duct.
Plasma changes due to:
Furosemide
Loop diuretics can lead to:
hypochloremic alkalosis
hypokalemia.
**a weak carbonic anhydrase!
Plasma changes due to:
Hydrochlorothiazide
Thiazides may lead to:
hypokalemia
hypochloremic alkalosis
Plasma changes due to:
Spironolactone
This K+ Sparing drug may cause:
Hyperkalemia