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Pharm Fall 2024 > Diuretics > Flashcards

Diuretics Flashcards

Test 3 (81 cards)

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1
Q

What do diuretics treat?

A

HTN
Edema

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2
Q

Diuretics and ______ are used interchangeably

A

Natriuretic

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3
Q

Diuretics increase _____ volume while Natriuretics increase __________ secretrion

A

Urine

Sodium ion (which increases water secretion)

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4
Q

Increasing urine output, decreases ______ and decreases blood pressure

A

blood volume

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5
Q

What is the functional unit of the kidney?

A

Nephron

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6
Q

Where does a nephron start?

A

The Glomerulus which is located in the cortex

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7
Q

What happens in the nephrons?

A
  • blood is filtered
  • water, ions, and glucose are reabsorbed
  • urine is produced & substances are from blood into urine
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8
Q

How many nephrons does each kidney contain?

A

800,000 to 1,000,000

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9
Q

What is one of the main substances that is secreted by the kidneys and not reabsorbed back into the blood? why?

A

NH3 – Ammonia

This is a waste product that is filtered by the kidneys. build up can cause coma/death. Therefore its converted to urea (made in the liver) and excreted by the kidneys.

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10
Q

T/F: The medulla is the outer part of the kidney and the cortex is the inner part

A

F

Switched

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11
Q

Describe the hilus

A

“hilum”

Center/medial side of the kidney where the renal artery, renal vein, and ureter are located

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12
Q

What structures exit the ureter?

A

hilum -> ureter -> urinary bladder -> urethra -> exits body

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13
Q

What type of structure is the glomerulus?

A

capillary

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14
Q

What is “the loop”

A

The very bottom of the loop of Henle

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15
Q

T/F: The glomerulus is located in the medulla

A

F

cortex

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16
Q

F/T: The cortex and medulla have different osmolality

A

T

It effects how much water is reabsorbed back into the urine vs blood

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17
Q

Where is the Loop of Henle?

A

The medulla

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18
Q

What parts make up the Loop of Henle?

A

Thick descending -> thin descending -> the loop -> ascending thin -> ascending thick

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19
Q

Describe the renal corpuscle

A

Bowman’s capsule
Glomerulus

Where the blood is filtered

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20
Q

T/F: the collecting tubule and ducts are part of the nephron

A

F

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21
Q

What is the bowman’s capsule?

A

Epithelial and connective tissues that surrounds the glomerulus capillary structure .

Catches secretions and is the beginning of the nephron

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22
Q

What type of cell provides the filtration in the renal corpuscle?

A

podocytes

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23
Q

What does protein in the urine mean?

A

Proteinuria

Podocytes are not permeable to large protein molecules. This indicated problem with the kidneys.

(small proteins can cross)

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24
Q

Where are the Macula Densa Cells located?

A

Juxtaglomeruler apparatus in the distal tubule; which end up being very close to the glomerulus and the afferent glomerulus artery

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25
What do the Macula Densa Cells do?
Sense Na+ and fluid pressure in the distal tubule Active the RAA system and regulate blood flow directly into the glomerulus by increasing or decreasing release of NO to juxtaglomerular cells to increase or decrease the size of the afferent artery . **Negative feedback system**
26
_____ artery takes blood into the glomerulus and the ________ takes blood out
afferent efferent
27
T/F: Glomerulus is located in the medulla
F cortex
28
What capillaries are only found in the cortex in the kidneys? what are they responsible for?
Peritubular capillaries Filtation & water reabsorption
29
What capillaries are only found in the medulla in the kidneys?
vasa recta omsolality changes -> ion reabsorption
30
What 2 items do we specifically want to be filtered and reabsorbed?
bicarb and glucose
31
Where does a majority of your reabsorption happen?
Proximal convoluted tubule
32
How much urine is produced from the filtrate?
1%
33
What does the juxtaglomerular appartaus consist of?
macula densa Juxtaglomerular cells extraglomerular mesanginal cells
34
What is osmolality?
dissolved substances in a solution
35
What is the juxtaglomerular cells? where is it located?
-modified epithelial cells that act like smooth muscle -Communicate with macula dense cells -contract and dilate to effect blood flow to the glomerulus Afferent artery
36
What 3 systems regulate how blood gets into the glomerulus?
Direct renal autoregulation (Juxtaglomerular apparatus) neural regulation (Activation of SNS and release of Epi and NE) hormonal regulation (Activation of RAA)
37
What happens at the proximal tubule?
80% of water and ions are reabsorbed back into blood -NaHCO3, NaCl, glucose, amino acids, organic solutes, K+, water are reabsorbed
38
Where do Carbonic anhydrase inhibitors work? What do they do?
Proximal tubule Inhibit CA enzyme that allows carbonic acid to be converted to water an CO2 in the lumen-urine block bicarb reabsorption
39
Drugs: Caffeine
Diuretic MOA: blocks adenosine-R in PCT
40
Describe the function of NHE3 and carbonic anhydrase in sodium and bicarb reabsorption.
Located in the PCT NHE3: Na+ in the nephron in exchange for H+ in the lumen-urine (water follows Na+) Carbonic anhydrase: Converts Carbonic acid to water and CO2 to be reabsorbed into the nephron and Carbonic anhydrase converts it to bicarb
41
Drugs: Acetazolamide
Class: Carbonic Anhydrase inhibitor MOA: inhibits Carbonic Anhydrase -> blocks sodium bicarb reabsorption -> slows down NHE3 counter-transporter Uses: Acute mountain sickness, glaucoma, alkalinization of urine SE: decreased K+, Na+, pH (below 7.35), kidney stones
42
Where does Acetazolamide work?
Carbonic Anhydrase inhibitor PCT
43
What is the osmolality in the cortex?
300
44
What is the osmolality in the medulla? Why?
400-1200 increased solutes helps with water reabsorption
45
What type of diuertic is mannitol?
osmotic diuretic
46
List 5 major types of diuretics and relate them to their sites of action, urinary electrolytes, and main side effects.
Carbonic Anhydrase inhibitors: CA in PCT; bicarb/K+ loss; decreased pH Loop diuretics: NKCC2 in TAL; Na+/K+/Cl-/Mg++/Ca++ loss; slight alkalosis Thiazide: NCC (NaCl) in DCT; Na+/Cl- loss; slight alkalosis omsotic: Mostly PCT but anywhere where water is permeable Potassium-sparing: inhibit aldolsterone-R in CT;
47
T/F: Mannitol is reabsorbed into bloodstream
F impermeable solute stays in nephron
48
Mannitol increase _________
osmolality
49
What area of nephron doesnt have an effect on diuretics?
S2 - straight segment
50
What is the S2 - straight segment?
Area where some diuretics dont work area where larger substances can be secreted: - uric acid - NSAIDs - Abx -Diuretics
51
Where does water reabsorption happen in the loop of Henle?
Descending
52
Where is water impermeable in the loop of Henle?
Ascending
53
What are NKCC2? Where are they?
cotransporter that takes 1Na+, 1K+, 2Cl- into nephron Ascending Loop of Henle
54
Describe positive potential
potential in the lumen-urine thats affected by increasing positive charges (increased K+ in the nephron which increases K+ in the lumen-urine) in the lumen urine which drive Mg++ and Ca++ into the blood.
55
What happens in the ascening loop of Henle?
Na+ moves only. Impermeable to water
56
What are the strongest diuretics?
Loop diuretics
57
What are sulfamide diuretics?
Loop diuretics Thiazide
58
How do loop diuretics work?
inhibit NKCC2 cotransporter prevents reabsorption of Na+/K+/Cl-
59
What loop diuretic is NOT a sulfamide?
Ethacrynic acid
60
What are my K-wasting diuretics?
Carbonic anhydrase inhibitors loop diuretics thiazide
61
Drug: Furosemide
Loop Diuretic Inhibits NKCC2 in TAL **Sulfa allergies** Secrete: Na, K, Cl, Mg, Ca Causes slight alkalosis
62
Drug: Ethacrynic acid
Loop Diuretic Inhibits NKCC2 in TAL **Not a Sulfa Drug!!!** Secrete: Na, K, Cl, Mg, Ca Causes slight alkalosis
63
What do Thiazide drugs work?
inhibit the NCC (NaCl- cotransporter) in the Distal Convoluted tubule **Also inhibit Ca++ activity**
64
Is the thiazide prototype?
Hydrochlorothiazide
65
What is the final site for sodium reabsorption in water reabsorption?
Collecting tubule
66
What happens at the collecting tubule?
-Final site for sodium reabsorption -Important site for potassium secretion -Site for influence of aldosterone
67
Where are the principal and intercalated cells?
Collecting tubules
68
What is aldosterone's role in the nephron at the collecting tubule?
diffuses into nephron at CT binds with its receptor increases ENaC (Na+ ion channel) activity increases Na+ reabsorption increases blood volume **this contributes to (-) lumen charge**
69
Drugs: Spironolactone
Potassium-sparing diuretic inhibit aldosterone-R in CT
70
Drugs: Amiloride
Potassium-sparing diuretic inhibit ENaC (Na+ ion) channels
71
Define “potassium wasting”.
increased excretion of potassium in the urine, which can occur with certain diuretics
72
Explain the mechanism of potassium and bicarb wasting in the collecting tubule following specific diuretic administration
Carbonic anhydrase inhibitors block the enzyme responsible for converting carbonic acid to water and CO2. This can cause potassium and bicarbonate wasting in the collecting tubule by blocking sodium-bicarbonate reabsorption in the proximal tubule, leading to increased delivery of sodium and bicarbonate to the collecting tubule, which then promotes potassium and bicarbonate excretion.
73
What are the 2 drugs that reduce potassium loss during sodium diuresis
Spirolactone Amiloride
74
What do potassium sparing diuretics help with?
Spirolactone only. **Adrenal cortex overproducing alderosterone** -Conn's syndrome -Ectopic ACTH production CHF Nephrotic syndrome use of K-wasting diuretics
75
T/F: You want to use Potassium-sparing diuretics in combo with a K-wasting diuretic
T
76
Drug: ADH/Vasopressin
Works in the Collecting Duct Adds more Aquaporin channels to increase water reabsorption **increases blood volume (Increases BP) and concentrates urine**
77
Drug: Conivaptan
Potassium-sparing diuretic Works in the collecting duct **ADH Antagonist**
78
Drug: Mannitol
Osmotic diuretic Increases osmolality in nephron Works in PCT and descending loop Uses: , increase UO, decrease ICP; removal of renal toxin (rhabdo), after contrast, induce diarrhea (PO) **slight edema and increased Na+ when 1st administered** **USE FILTER WHEN CONCENTRATION ABOVE 20%**
79
Discuss the use of diuretics in patients with diabetes insipidus.
DI is the dumping of dilute urine. ADH/Vasopressin and thiazides diuretics treat this
80
Where does the distal tubules dump?
Collecting ducts
81
The proximal and distal _______ tubules are in the _______
convoluted cortex

Pharm Fall 2024 (30 decks)

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