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37 Cards in this Set

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alleviate

cause
1. Kidney may _________ acid-base balance if the cause is from another source.

Ex. alkalosis: hyperventilation, vomiting
acidosis: respiratory insufficiency, diarrhea, excess lactic acid

2. Kidney may ________ acid-base imbalance if malfunction or diuretic given.
sodium bicarbonate
What is the potential drug therapy for treating acidosis?
ammonium chloride or weak acid
What is the potential drug therapy for treating alkalosis?
Cardiac edema (congestive heart failure

Acute pulmonary edema

Liver disease (cirrhosis or other portal obstruction can cause ascites; made worse by lack of plasma proteins.

Renal disease (as long as kidney still capable of functioning)

Pregnancy (caution: some diuretics may be teratogenic)

Special caution: Potassium depletion - especially if on digitalis
What are the CAUSES of edema?
What are the CAUSES of edema?
Cardiac edema (congestive heart failure

Acute pulmonary edema

Liver disease (cirrhosis or other portal obstruction can cause ascites; made worse by lack of plasma proteins.

Renal disease (as long as kidney still capable of functioning)

Pregnancy (caution: some diuretics may be teratogenic)

Special caution: Potassium depletion - especially if on digitalis
1. Osmotically hold water and increase urine volume.
2. Increase glomerular filtration rate (vasodilation)
3. Direct or indirect inhibition of ion reabsorption ** (Na+, H20, CI-, HCO3-)
How do the diuretics work in the body?
diuretics mech of action
1. Osmotically hold water and increase urine volume.
2. Increase glomerular filtration rate (vasodilation)
3. Direct or indirect inhibition of ion reabsorption ** (Na+, H20, CI-, HCO3-)
Direct or indirect inhibition of ion reabsorption ** (Na+, H20, CI-, HCO3-)
What is the MAIN mechanism of action for all diuretics?
Main mech of action for all diuretics.
Direct or indirect inhibition of ion reabsorption ** (Na+, H20, CI-, HCO3-)
carbonic anhydrase inhibitors
thiazides
What are the drugs that act at the proximal convoluted tubule?
Thiazide
Furosemide
Ethacrynic acid
Bumetanide
Torsemide
What are the drugs that act at the ascending loop of Henle?
proximal tubule
inhibits reabsorption of HCO3-

where do these drugs act?
carbonic anhydrase inhibitors
thiazides
Na+ accompanies HCO3-

Extra Na+ entering distal tubule may cause K+ depletion

Not as much acid base upset as one might expect.

HCO3- loss may be balanced by tendency toward systemic alkalosis at the distal tubule.
Thiazide
Furosemide
Ethacrynic acid
Bumetanide
Torsemide
These drugs mechanism of action is to inhibit the reabsorption of Na+ and CI-. Very powerful. They work at the loop of henle. WHat are they?
Thiazide
Furosemide
Ethacrynic acid
Bumetanide
Torsemide
Na+ accompanies CI-

Extra Na+ at distal tubule may cause K+ depletion, H+ secretion may now be a problem.

WHat drugs?
Spironolactone
Triamterene
Amiloride
What are the drugs that act on the DCT?
DCT
potassium sparing diuretic drugs act here.

frequently cause hyperkalemia.
Spironolactone
need aldosterone to work

an aldosterone antagonist (only works well if aldosterone is high)

causes Na+ diuresis and K+ retention.
Triamterene and amiloride
Direct action on tubule

inhibits reabsorption of Na+

mimics effects of aldosterone antagonist, however, effectiveness DOES NOT depend upon aldosterone levels but still causes Na+ diuresis and K+ retention.

Which drugs?
Thiazide
most commonly used diuretics

inhibits HCO3- (and Na+)reabsorption from proximal tubule and CI- (and Na+) reabsorption from ascending limb of the loop of henle.

What drug?
Thiazide
Therapeutic uses

1. essential hypertension
2. fluid retention
3. acute pulmonary edema
4. sometimes used in pregnancy

What drug?
Thiazides
Side effects

potassium depletion

hyperglycemia

uric acid in blood (aggrevate gout)
Furosemide
A very powerful thiazide that retains it effect on blood vessels (vasodilation). Also, powerful inhibitor of Cl- reabsorption from ascending limb of loop of henle
Furosemide
8-10 times more powerful than thiazides

It can cause up to 4 liters of urine to be formed within the first few hours of administration.
Furosemide
Therapeutic uses

dangerous

emergency drug when rapid, effective diuretic needed

Congestive heart failure; often results in pulmonary edema
Acute pulmonary edema (works because of vasodilator effect)
Hypertension (not long term though, so use thiazide)
Chronic renal failure (very powerful)

**short duration of action (only 4 hours)
Furosemide
Cautions
serious electrolyte imbalance commonly occurs - especially K+ and H+ depletion and alkalosis

temporary or permanent deafness may occur
ethacrynic acid
bumetanide
torsemide
What are the other loop diuretics?
ethacrynic acid
bumetanide
torsemide
Inhibit Na+ reabsorption from proximal tubule

Inhibit CI- reabsorption from ascendinig limb of loop of henle

What drugs?
ethacrynic acid
bumetanide
torsemide
Hypokalemia and alkalosis

Deafness
Rapid onset (max effect in 2 hours, and can last 6-8 hours.)
Rare cases of myalgia reported.

What drugs?
Carbonic anhydrase inhibitors
No longer used as diuretics

we studied with glaucoma
Aldosterone antagonist or spironolactone
What is the drug that actually inhibits aldosterone, but you need aldosterone to be present to work?
Aldosterone antagonist or spironolactone
Used either:
1. in combo with thiazides or
2. when other diuretics are toxic or ineffective.
potassium retention

males develop gynecomastia (enlarged breasts)
What are the cautions with aldosterone antagonists or spironolactones?
osmotic diuretics
osmotically attracts water
osmotic diuretics
Therapeutic uses of what drug?

1. withdraw water from overhydrated cells (esp. brain and eye)

maintain high volume of urine
1. prevent renal failure after hemolytic reaction, shock, hemorrhage, or surgery
2. helps eliminate drug overdose such as barbiturates, salicylates, etc.
Does not extract abnormal amounts of fluid from body, ***NOT for EDEMA because doesn't eliminate Na+ ions.
Triamterene and amiloride
don't need aldosterone to work

works independently of amount in system
osmotic diuretics
***NOT for EDEMA because doesn't eliminate Na+ ions.