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31 Cards in this Set

  • Front
  • Back
At what locations and at what percentrages is sodium and water reabsorbed along the Nephron?
1. proximal conv tub - 60-70% of Na actively reabsorbed exchanged for H
- followed passively by water, CL, K
2. ascending loop of Henle - 25% of CL actively reabsorbed
- followed by Na, water
3. distal convoluted tubule - 5-10% of Na/K exchange
- followed by water, Cl
Where does aldosterone and ADH act on the nephrone?
aldosterone - distal convoluted tubule, where Na/K exchange occures

ADH - collecting duct
What is the funciton of carbonic anhydrase?
provides H ions for exchange for sodium in proximal convoluted tubule, allowing for reabsorption of water and electrolytes
What is the mechanism of carbonic anydrase inhibitors? (CAI)
prevents production of H ions for exchange in proximal convulted tubule, preventing reabsorption
adverse effects of CAI?
most commonly - meabolic acidosis, hypokalemia

also, drowsiness, anorexia, paresthesia, photosensitvity
Drug ineractions with CAI?
causes hypokalemia --> inc risk for digoxin
What electrolyte do loop diurteics act on? Where?
Cl, indirectly Na

thick part of ascending loop of Henle
Pt. creatinine clearance is <25mL/min. What dirutic can be used?
loop diuretics can be used with impaired renal function (<25mL/min creatinine clearance)
What is the effect of renal prostaglandins?
relaxing hormone

vasodilation in kidneys, lungs, systemically
What diuretic would be used when rapid diuresis is needed?
loop diuretics

rapid onset

lasts at least 2 hours

also operates with poor renal function
What mechanisms of action do loop diuretics have?
- block Cl, Na, Water -> profound diureses
- activate renal prostaglandins -> vasodilation
- reduce preload and CVP
- excrete Ca
What are indications for loop diuretics?
edema --> HF
HTN ---> renal or hepatic disease
renal excretion of Ca --> hypercalcemia
Can loop diuretics be used during pregnancy?
only if absolutely necessary
Adverse effects of loop diuretics
obvi - hypotension, hyponat, hypokalem, dehydration, hypochloremia,

also

ototoxicity (when combined with other ototoxic drugs)
digoxin toxicity risk
hypokalemia sets the stage for what drug toxicity?
digoxin
This drug blunts the diuretic effects of loop diuretics
aspirin and NSAIDs
What is the most frequently prescribed Loop diuretic?
furosemide (lasix)
T or F. Thiazides can only work when kidney functioning (creatinine clearance) is above 30-50 ml/min.
both T and F.

T - all thiaides should not be used with impaired renal funcn

EXCEPT

F - metolazone - only thiazide that can work as low as 10ml/min
WHat is the mechanism of action for thiazides?
operate on the early distal conv tubule
What are the effects and indications of thiazides
effect: areteriole relaxation

--> dec afterload and preload, --> HTN and HF

also edema, diabetes insipidus
What drug should be prescribed for a hypertensive patient takin ototoxic drugs?
thiazide. loops cause ototoxicicty.
What drugs are usually used in concert with K - sparing diuretics?
loop or Thiazides given with K-sparing to compensate hypokalemia
What is the mechanism of action of Spinolactone?
(Ksparing) spinolactone - aldosterone antagonist - blocks aldosterone
What is mechansim of triamterine?
(Ksparing) triamterine - non aldosterone antag - blocks Na/K exchange
What is mechansim of amiloride?
(Ksparing) amiloride- non aldosterone antag - blocks Na/K exchange
Adverse effect of Ksparing?
hyperkalemia. duh
NEver combine K sparing with..?
K supplement
salt substit (contains K)
ACE inhibitor
other Ksparing

all cause hyperK
What does restricing sodium do to K levels?
inc K levels

less sodium, less Na/K exchange, inc K levels
What is the problem with decreased renal functioning and diuretics?
diuretics need to reach the kidneys in order to act on nephron

in dec renal, low kidney perfusion, dec drug reaching action site
What is mechanism of action of osmotic diuretic?
osmotic diuretic, ie mannitol, cannot be reabsorbed back into circulation.

this creates osmotic force, pulling water into nephron, with minimal electrolyte losses
indication for osmotic diuretic?
prophylaxis of renal failure
reduce intracranial and intraocular pressure