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37 Cards in this Set
- Front
- Back
Diseases causing high levels of kidney reabsorption of NaCl lead to...
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water retention
Inc blood volume edema in tissues |
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Body response to heart failure causes...
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Kidney responds as if there were a decrease in blood volume
Kidney retains more salt and water to raise blood volume Diseased heart cannot increase output which results in edema |
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Body response to hepatic ascites...
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Complication of cirrhosis
Caused by obstruction of blood flow in the portal system-->inc portal BP Colloidal osmotic pressure of blood decreased due to impaired synthesis of plasma protins by diseased liver Fluid escapes and collects in abdomen |
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Body response to nephrotic system..
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Loss of protein from plasma reduces colloidal osmotic pressure--> edema
Low plasma volume stimulates aldosterone secretion Leads to retention of Na and fluid--> more edema |
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Body response to premenstural edema...
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excess of estrogen facilitates loss of fluid into extracellular space
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Nonedematous states that you would use diuretics for..
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HTN--> reduce Blood volume and dilate arteroiles
Hypercalcemia--> loop diuretics promot calcium excretion Diabetes insipidus--> polyuria/polydypsia--> reduces plasma volume, causing drop in glomerular filtration and reabsorption of Na and water |
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Increasing the dose above normal does not promot further diuretic response
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Celing diuretics
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First modern diuretic that was active orally
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Chlorothiazide
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Newer deriviatives of thiazide diuretics
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hydrochlorothiazide
chlorthalidone |
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Thiazide like diuretics--> not true thiazides
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chlorthalidone, indapamide, metolazone
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Thiazide Mechanism of Action
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Act in distal tubules to decrease reabsportion of Na by inhibition of Na/Cl cotransporter in the distal tubule
Must have good renal function |
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Therapeutic uses for thiazides
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HTN- mainstay of antihypertensive meds
(inexpensive and well tolerated) Heart failure- reducing extracellular volume in mild-moderate heart failure (if thiazides fail use loop diuretic) Hypercalciuria- calcium oxalate stones in urinary tract DI- produce hyperosmolar urine--> sub for anti-diuretic hormone in tx of nephrotic DI |
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most frequent adverse effect of thiazide diuretics
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K+ depletion
Suppliment with diet (citrus fruits, bananas, prunes) Overcome by Spironolactone- interferes with aldosterone action or Triameterene- retains K+ |
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Adverse events of thiazise diuretics
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Hyperuricemia- inc serum uric acid
Volume depletion- orthostatic HTN Hypercalcemia- inhibit Ca secretion Hyperglycemia- impaired release of insulin Hyperlipidemia- inc in serum cholesterol and serum LDL Hypersensitivity- dermatits, interstitial nephritis |
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Thiazide like analog with a very long duration of action
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Chlorthalidone
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Thiazide like analog that causes Na excretion in advnaced renal failure
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Metolazone
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Thiazide like analog that has significant anti-HTN action with minimal diuretic effects
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Indapamide
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What part of the kidney do loop/high celing diuretics work on?
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The ascending limb of the loop of Henle
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Most commonly used loop diuretics
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furosemide
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Much more potent loop diuretics
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bumetanide
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Loop Diuretics
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Highest efficacy in mobilizing Na and Cl
Produces copious amounts of urine |
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Mechanism of action for Loop Diuretics
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Inhibit cotransport of Na/K/2Cl- in ascending limb of loop of Henle
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Loop diuretic action on the body
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Acts promptly among pts with poor renal function
Increases Ca content of urine Hypomagnesia Decreased renal vascular resistance Increased renal blood flow |
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Therapeutic uses of Loop diuretics
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Hypercalcemia
Hyperkalemia Reduces pulmonary edema of heart failure |
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Adverse effects of Loop diuretics
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Ototoxicity- ethacrynic acid
Hyperuricemia- blocks secretion--> gouty attacks Hypovolemia K+ depletion--> hypokalemic alkalosis |
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Major use of K+ Sparing Diuretics
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HTN tx in conjunction with thiazide
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Where in the kidneys do K+ sparing durietics act?
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collectinv tubules to inhibit Na reabsorption and k+ excretion
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K+ Sparing diuretics
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Triamterene
Amiloride Spironolactone |
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Mechanism of action for Spironolactone
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antagonism of aldosterone
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Action of spironolactone on the body
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High levels of aldosterone in edematous states
Antagonism of aldosterone results in retention of K and excretion of Na |
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Therapeutic uses of Spironolactone
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Diuretic--> low effacy in mobilizing Na
Useful in K+ retention Given with thiazide of loop to prevent K+ excretion Heart failure--> prevents remodeling for progressive heart failure |
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Diuretic that inhibits enzyme carbonic anhydrase in proximal tubular epitheilal cells
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Carbonic anhydrase inhibitor
Acetazolamide |
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Mechanism of action for Acetazolamide
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mild diuresis
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Treatment uses of Acetazolamide
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Treatment of glaucoma
-should not be used in acute attacks (pilocarpine) Mountain sickness (prophylaxis) |
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Osmotic diuretics
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used to maintain urine flow following acute toxic ingestion of substance capable of producing acute renal failure
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Osmotic diuretic mainstay of treatment for...
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increased intracranial pressure, acute renal failure due to shock, or drug toxicities
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Osmotic diuretic
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mannitol- IV
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