Renal 2- Johnson- Vasopressin

Front 1

Vasopressin Antagonist

Back 1

Conivaptan (Vaprisol®)

Front 2

Vasopressin Agonists

Back 2

Desmopressin (Stimate ®)

Front 3

Vasopressin (ADH-antidiuretic hormone)
2 types

Back 3

Lysine
vs
Arginine

Front 4

Vasopressin Receptors

Back 4

V1a – peripheral smooth muscle. Promotes contraction. Coronary vasospasms.
V1b – Central nervous system. Function unclear.
V2 – Located in cortical collecting ducts. Promote synthesis of water channels.

Front 5

Desmopressin (Stimate®) TX

Back 5

central diabetes insipidus
bedwetting
sleep apnea (tablet, NOT NASEL SPRAY)
promote release of VonWillebrand factor for some anemias
diagnostic workups to distinguish central and nephrogenic diabetes insipidus

Front 6

Desmopressin (Stimate®) general

Back 6

Synthetic vasopressin replacement (modified vasopressin)
Stimulates V2 receptors to promote urine retention
Administered nasally, intravenously, or as a tablet.

Front 7

Conivaptan (Vaprisol®) general

Back 7

vasopressin receptor antagonist
non-peptide
inhibits V1a and V2 subtypes
approved for treating hyponatremia from syndrome of inappropriate antidiuretic hormone (SIADH)
Causes iatrogenic nephrogenic diabetes insipidus.

Front 8

Adverse Effects: Conivaptan (Vaprisol®)

Back 8

Blocks vasopressin receptors in the cortical collecting ducts.
Interferes with insertion of aquaporin channels, that normally promote water reabsorption from the cortical collecting duct.
Blockade results in WATER loss.
Promotes formation of copius amounts of dilute urine (like the astronauts, deep sea divers).

Front 9

Vasopressin Disorders

Back 9

Central Diabetes Insipidus
Nephrogenic Diabetes Insipidus
Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)

Front 10

Central Diabetes Insipidus
causes/Tx/condition

Back 10

Condition: reduced pituitary vasopressin production/release
Causes: head trauma, drugs, alcohol, genetic
Treatments:
Desmopressin (Stimate®)
Chlorpropamide (Insulase®)- a sulphonylurea used to treat diabetes mellitus
Thiazide diuretics – in diabetes insipidus, sodium excretion seems to trigger water retention. Mechanism unknown.
Carbamazepine (tricyclic antidepressant)

Front 11

Nephrogenic Diabetes Insipidus
causes/Tx/condition

Back 11

Condition: reduced renal responsiveness to vasopressin
Causes: metabolic, drugs (ie lithium), genetic
Treatments:
Adequate water intake (replacement)
thiazide diuretics – in nephrogenic diabetes insipidus, sodium excretion seems to trigger water retention. Mechanism unknown.
Amiloride (Midamor®) (potassium sparing) – Off Label: blocks lithium reabsorption from the cortical collecting tubule to control lithium-induced diabetes insipidus

Front 12

Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)
condition/cause/TX

Back 12

Hormone (SIADH)

Condition: Impaired excretion of water, hyponatremia and hypo-osmolality due to inappropriate elevations in vasopressin.
Causes: unclear
Treatments:
Managed restrictions on water intake
Conivaptan (Vaprisol®) to blockV1a and V2 receptors. Available only for parenteral preperation.
Lithium – consider if unresponsive to other therapies. DANGER of renal damage after long-term therapy.
Demeclocycline (Declomycin®) – Off Label - tetracycline antibiotic that also inhibits V2 receptors.
Tolvaptan (Samsca) NOT FDA approved, orally administered vasopressin antagonist.

Front 13

Arginine Vasopressin
from

Back 13

Humans, horses, squirrels

Front 14

Lysine Vasopressin
from

Back 14

Hippopotamuses, pigs, Syrian hamsters…

Front 15

Vasopressin (ADH-antidiuretic hormone
source

Back 15

posterior pituatary

Front 16

Stimulus of ADH

Back 16

-increased plasma osmolarity
-hypothalamic input
-“volume receptors” (suppress)

Front 17

Effect of ADH

Back 17

-vasoconstriction via V1 receptors
-circulates to kidney cortical collecting duct
-stimulates renal synthesis of aquaporin (V2 receptors)
-permits renal H2O reabsorption
-restores plasma osmolarity

Front 18

Vasopressin stimulates “V? receptors” in the cortical collecting tubules.

Back 18

V2

Front 19

V2 receptors drive synthesis of _____ that increase water permeability in the duct.

Back 19

aquaporins in CCD

Front 20

What? Creates the path for water passage through the collecting tubule.

Back 20

aquaporins in CCD

Front 21

V1a

Back 21

peripheral smooth muscle. Promotes contraction. Coronary vasospasms.

Front 22

What receptor?
peripheral smooth muscle. Promotes contraction. Coronary vasospasms.

Back 22

V1a

Front 23

V1b

Back 23

Central nervous system. Function unclear.

Front 24

What receptor?
Central nervous system. Function unclear.

Back 24

V1b

Front 25

V2

Back 25

Located in cortical collecting ducts. Promote synthesis of water channels.

Front 26

What receptor?
Located in cortical collecting ducts. Promote synthesis of water channels.

Back 26

V2

Front 27

What Osmolraity?
Low ADH

Back 27

LOW

Front 28

What Osmolraity?
HIgh ADH

Back 28

high

Front 29

Vasopressin Agonist

Back 29

Desmopressin (Stimate®)

Front 30

Vasopressin Antagonist

Back 30

Conivaptan (Vaprisol®)

Front 31

What drug?
Stimulates V2 receptors to promote urine retention

Back 31

Desmopressin (Stimate®)

Front 32

What drug?
Administered nasally, intravenously, or as a tablet.

Back 32

Desmopressin (Stimate®)

Front 33

non-peptide******

Back 33

Conivaptan (Vaprisol®)

Front 34

inhibits V1a and V2 subtypes

Back 34

Conivaptan (Vaprisol®)

Front 35

Causes iatrogenic nephrogenic diabetes insipidus.

Back 35

Conivaptan (Vaprisol®)

Front 36

Promotes formation of copius amounts of dilute urine (like the astronauts, deep sea divers).******

Back 36

Conivaptan (Vaprisol®)

Front 37

Conivaptan (Vaprisol®)
Adverse effect:*****

Back 37

Hyporvolemia and increased blood osmolarity.

Front 38

sodium excretion seems to trigger water retention. Mechanism unknown.*****

Back 38

Thiazide diuretics – in diabetes insipidus,and Nephrogenic Diabetes Insipidus

Front 39

reduced renal responsiveness to vasopressin

Back 39

Nephrogenic Diabetes Insipidus

Causes: metabolic, drugs (ie lithium), genetic
Treatments:
Adequate water intake (replacement)
thiazide diuretics – in nephrogenic diabetes insipidus, sodium excretion seems to trigger water retention. Mechanism unknown.
Amiloride (Midamor®) (potassium sparing) – Off Label: blocks lithium reabsorption from the cortical collecting tubule to control lithium-induced diabetes insipidus

Front 40

: reduced pituitary vasopressin production/release

Back 40

Central Diabetes Insipidus

Causes: head trauma, drugs, alcohol, genetic
Treatments:
Desmopressin (Stimate®)
Chlorpropamide (Insulase®)- a sulphonylurea used to treat diabetes mellitus
Thiazide diuretics – in diabetes insipidus, sodium excretion seems to trigger water retention. Mechanism unknown.
Carbamazepine (tricyclic antidepressant)