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Pharm 2 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Diuretics that work on Proximal Tubule

A

Carbonic Anhydrase inhibitors, Osmotics

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2
Q

25% of plasma that arrives here passes through the filtration barrier to become filtrate

A

Glomerulus w/ Bowman’s capsule

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3
Q

Concentrates urine

A

loop of Henle

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4
Q

Descending Loop

A

NaCl diffuses in, water reabsorbed

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5
Q

Ascending Loop

A

NaCl actively reabsorbed, water stays in

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6
Q

Distal Tubule diuretics

A

Thiazides

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7
Q

Collecting duct diuretics

A

Potassium sparing and aldosterones

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8
Q

Collecting Duct
Reabsorption:

A

Water

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9
Q

CKD

A

Kidney damage for > 3 months

GFR < 60 mL/min for > 3 months

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10
Q

Pre-renal AKD

A

likely dehydration

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11
Q

Intrinsic AKD

A

damage along nephron, med induced, toxin induced

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12
Q

Post-renal AKD

A

outflow obstruction, kidney stones, tumors

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13
Q

Bicarb and sodium are blocked from reabsorption. Effect is short lived due to compensation at loop of Henle.

A

Carbonic Anhydrase Inhibitors

Acetazolamide (Diamox)

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14
Q

Diamox off-label use

A

metabolic alkalosis (commonly happens when “over-diuresing” CHF patients)

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15
Q

-Loss of Sodium Bicarb
-Hypokalemic metabolic acidosis
-tolerance develops after 2-3 days

A

Carbonic Anhydrase Inhibitors

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16
Q

CAIs side effects

A

acts on CNS

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17
Q

-loss of water
-reduce intracellular volume
-Hypernatremia risk

A

MANNITOL

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18
Q

Urinary pH is _______ altered by mannitol-induced osmotic diuresis.

A

NOT

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19
Q

IV Mannitol _______ plasma osmolarity and draws fluid from _______ spaces to ________ spaces.

A

-increases
-intercellular to extracellular

Acutely expands the intravascular fluid volume

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20
Q

Clinical uses of Mannitol

A

-Prophylaxis against acute renal failure (ARF)
-Differential diagnosis of acute oliguria
-Treatment of increased intracranial pressure (ICP)
-Decreasing intraocular pressure (IOP)

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21
Q

is there evidence that mannitol is nephroprotective?

A

NO

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22
Q

If glomerular or renal tubular function is severely compromised then……

A

mannitol will NOT increase UO

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23
Q

Mannitol for increased ICP

A

Requires intact BBB ——> cerebral edema

24
Q

Mannitol side effects

A

-Precipitate pulmonary edema

-Hypovolemia, electrolyte disturbances, plasma hyperosmolarity d/t water and NaCl secretion

25
Q

Increased B.U.N. after administration of UREA should _______ be confused with acute renal failure

A

NOT

26
Q

Loop Diuretics MOA

A

Inhibits Na and Cl reabsorption in the Ascending loop and to a lesser extent in the proximal tubule

27
Q

Loop Diuretics main points

A

-loss of Na and Water
-HYPOkalemic metabolic ALKOLOSIS
-increased Ca++ loss

28
Q

Loop diuretics will make you lose which electrolytes

A

Na+, K+, Cl-, Ca++, Mg++

29
Q

Most Agressive Diuretics?

A

LOOP Diuretics

30
Q

Furosemide-induced increases in RBF are inhibited by _______ and ________.

A

NSAIDs AND ASA

INCREASE loop diuretic induced kidney failure

31
Q

LOOPS: clinical uses

A

Mobilization of edema fluid due to renal, hepatic, or cardiac dysfunction

Treatment of increased ICP

Treatment of hypercalcemia

Differential diagnosis of acute oliguria

32
Q

ICP decreased by what with loop diuretics.

A

Systemic diuresis
Decreasing CSF production by interfering with Na transport in glial tissue
Resolving cerebral edema by improving cellular water transport

33
Q

Compared to Mannitol, Furosemide:

A

-Not as effective in decreasing ICP

-Immediate or subsequent effects of furosemide on ICP not affected by alterations in BBB

34
Q

Loop Diuretics fluid and electrolyte abnormalities

A

Hypokalemia
Hypochloremia
Hyponatremia
Hypomagnesemia
Metabolic alkalosis

35
Q

If electrolytes not replaced, will lose electrolyte induced water gradient

A

Acute Tolerance (Braking Phenomenon)

36
Q

Loop Diuretics: Side Effects

A

-Deafness
-Cross-sensitivity (SULFAS!!!!)

Higher risk with bolus doses – dose related
Ethacrynic acid does not have sulfa component

37
Q

Thiazide Diuretics MOA:

A

MOA: Compete for the Na-Cl cotransporter in the distal tubule to inhibit reabsorption. Inhibit only urinary diluting capacity, not concentrating capacity.

38
Q

Thiazides Main Points:

A

-Loss of Na & Water
-HYPOkalemic metabolic ALKOLOSIS
-INCREASED Ca++ Reabsorption

-HYPERCALCEMIA!

39
Q

Clinical uses for Thiazides

A

Hypertension

Mobilization of edema

40
Q

Thiazides: Metabolic and Electrolyte Side Effects

A

Hypokalemia, hypochloremia, hypercalcemia, metabolic alkalosis with chronic administration
Na and Mg depletion may accompany kaliuresis

41
Q

Thiazides: Side Effects

A

-Decreased intravascular volume
-Hyperglycemia
-Hyperuricemia (GOUT)
-Decreased renal or hepatic function

42
Q

Aldosterone Antagonists (K+ Sparing) Main Points:

A

-Loss of Na+ and Water
-HYPERkalemia
-Some risk for acidosis

43
Q

K Sparing Diuretics clinical uses

A

Less effective diuresis so used in combo

-Teatment of refractory edematous states due to:
CHF Cirrhosis of the liver

44
Q

K Sparing: Increased risk of hyperkalemia in patients also taking other drugs associated with increased plasma K concentrations

A

NSAIDs
Ace inhibitors (i.e. lisinopril)
Beta blockers

45
Q

Side Effects Comparison Chart

A
46
Q

Hyperkalemia:

A

Renal failure, hypoaldosteronism, K supplements, ACEi/ARB, Heparin, NSAIDs, K sparing diuretics, Digoxin

47
Q

Hypokalemia:

A

Loop diuretics, thiazide diuretics, osmotic diuretics, hyperaldosteronism, mineralocorticoids, fluid loss (vomit/diarrhea

48
Q

HYPERkalemia Tx

A

-IV Calcium
lowers the threshold potential of the myocardium

Insulin and Dextrose 50%

Inhaled Beta2 agonists

Dialysis:
Treatment of last resort

49
Q

“See” BIG K Drop

A

C = Calcium (cardiac stabilizer)
B = beta agonists (intracellular shift)
I = Insulin (followed by..)
G = Glucose (given with insulin)
K = Kayexalate (mainly chronic RF)
D = Diuretics (renal elimination)
ROP = Renal unit for dialysis Of Patient

50
Q

VAPTANS

A

For euvolemic and hypervolemic hyponatremia

51
Q

Hypercalcemia:

A

Hyperparathyroidism, cancer, thiazides

Ca:Normal range: 8.5-10.5 mg/dL
Dependent upon albumin

52
Q

Hypocalcemia:

A

Hypoparathyroidism, renal disease, loop diuretics

Check albumin before replacing!

53
Q

Hypercalcemia Picture

A
54
Q

Only use these diuretics for hypercalcemia

A

LOOP

55
Q
A

Pharm 2 (5 decks)

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