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34 Cards in this Set
- Front
- Back
What do diuretics increase?
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-rate of urine flow
-sodium and chloride excretion -may also potassium excretion |
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Diuretics are most commonly given for
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-hypertension and heart failure
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What is the equation for the single nephron glomerular filtration rate
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SNGFR = Kf(delta P - pi)
k = filtration coefficient delta P = press diff b/t arteries and proximal tubule pi = osmotic press diff b/t capillaries and proximal tubule |
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Where does the filtrate come from
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the glomerulus
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What is the filtration rate of both kidneys combined and what is the urine making rate
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120 ml/min filtered, 1 ml/min urine
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What and how much is reabsorbed from the proximal convoluted tubule
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-65% of water
-most K -65% of Na, Cl, and bicarbonate |
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What/amount is resorbed from descending thin loop
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-25% of H2O
-impermeable to water and urea |
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Why is the ascending thick limb and DCT known as the "diluting" part of the system
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-b/c no water can get out, only NaCl
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What does the macula sense?
-what does it signal |
-osmolality of urine
-signals afferent arteriole to cut down on flow --> tubuloglomerular feedback |
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What leaves the distal convoluted tubule
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-NaCl is actively transported out
-NO water |
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T/F - water is always taken out at the collecting tubules
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-false, only if ADH is present
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Where is carbonic anhydrase found
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-lumen of proximal tubule
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What is the net result of carbonic anhydrase & what happens when inhibitors are present
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-drive sodium bicarbonate out of the urine
-inhibitors leave sodium bicarbonate in the urine |
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Where do carbonic anhydrase inhibitors act
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primarily = proximal tubules
secondary = distal collecting duct (inhibit acid secretion) |
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How do carbonic anhydrase inhibitors affect urine and blood pH
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increase urine pH, decrease blood pH
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acetazolamide, methazolamide, dichlorphenamide are all?
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-carbonic anhydrase inhibitors
|
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carbonic anyhydrase inhibitors:
-potassium affect? -indications |
-potassium wasting
-glaucoma, altitude sickness, counteract metabolic acidosis |
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What is a major reaction to carbonic anhydrase inhibitors?
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-sulfa allergies
-metabolic acidosis |
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Osmotic diuretics:
-what they do -site of action -effect on K+ |
-increase renal blood flow and wash out salt gradient
-primarily = loop of henle, secondary = proximal convoluted tubule -potassium wasting |
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glycerine and mannitol are
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-osmotic diuretics
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osmotic diuretics:
-indications -adverse reactions |
-acute renal failure, tubular necrosis, reduce brain swelling
-convert pulmonary congestion to edema, hyponatremia |
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Loop diuretics:
-how they work -K+ effect |
-inhibit Na/K/Cl symporter in ascending thick LOH
-K+ wasting |
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Lasix is a?
-how is it useful in heart failure -useful for ascites |
-loop diuretic and a weak carbonic anhydrase inhibitor
-increases venous capacitance -glucuronidated in kidney, not liver |
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Loop diuretics:
-half life -low/high ceiling |
-short
-high ceiling = lots of diuresis |
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What are thiazide diuretics
-how they work -where they act |
-sulfonamide analogs but NOT carbonic anhydrase inhibitors
-blcok NaCl symport, not K -distal collecting tubule |
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thiazide diuretics:
-K+ effect -efficacy |
-potassium wasting
-moderately b/c 90% of Na has already been resorbed before the DCT |
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Why do you not get dehydration with thiazides?
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-because the medullary concentration is NOT affected
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Which thiazide would you give for acute diuresis
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-hydrochlorothiazide
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Which thiazide would you give for hypertension
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-hydroflumethiazide, polythiazide
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What reaction do thiazides have with anesthetics, NSAIDs, corticosteroids
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-increase the effects of anesthetics
-decrease effectiveness -increase risk of clinically significant hypokalemia |
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Inhibitors of renal Na channels:
-prototype drug -used for -act where -K+ effects |
-amiloride
-ability to block K+ excretion in combo w/other diuretics -DCT and CD -potassium sparing |
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How do amiloride and triamterine differ in elimination and potency
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a = kidney
t = liver a >> t |
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Minceralocorticoid antagonists:
-sites of receptors -K+ |
-DCT and CD
-potassium sparing |
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spironolactone and eplerenone
-what are they -how they work |
-mineralcorticoid antagonists
-competitively bind receptor and block function |