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34 Cards in this Set

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