Pathology, Diuretics, & Anesthesia - Final Wrap Up

Question 1

What do Natriuretic Peptides do ?

Answer 1

Long-Term Sodium-Water, Blood Volume, and Arterial Pressure Regulation by Vasodilation and Renal Natriuresis & Diuresis.

Question 2

How do Natriuretic Peptides affect the CV System?

Answer 2

↑Venous Compliance

↓Preload & ↓CVP

↓CO

↓SVR

↓PCWP

Question 3

How do Natriuretic Peptides affect the Kidneys?

Answer 3

↑GFR

Inhibits Renin Release

Inhibits Aldosterone Secretion

Inhibits ADH Secretion

↓Angiotensin II

Question 4

What stimulates Atrial Natriuretic Peptide release?

Answer 4

Atrial Stretch or ↑ECF

Question 5

Where in the Kidney does ANP act to Decrease Sodium Reabsorption?

Answer 5

Collecting Duct

Question 6

Where is Brain Natriuretic Peptide synthesized?

Answer 6

Heart Ventricles

Question 7

What happens w/ the Chronic use of Diuretics?

Answer 7

Decreased Effects

Question 8

Where in the Kidneys do Loop Diuretics, like Bumex & Lasix work?

Answer 8

Thick Ascending Limb of Loop of Henle

Question 9

Where in the Kidney do Thiazides work?

Answer 9

Distal Convoluted Tubule

Question 10

Where do Potassium-Sparing Diuretics work?

Answer 10

Distal Tubule & Collecting Duct

Question 11

Where in the Kidney does Mannitol & Diamox work?

Answer 11

Proximal Tubule

Question 12

How do Osmotic Diuretics like Mannitol & Urea work?

Answer 12

Gets filtered & stuck in the Tubules and draws in fluid with them

Question 13

How do Loop Diuretics like Lasix, Bumex, and Ethacrynic Acid work?

Answer 13

Inhibits the Na-2Cl-K pump in the TAL and stops the Countercurrent System

Question 14

Thiazides are most commonly used & stops Sodium Reabsorption in the DCT. How do they affect Potassium Levels?

Answer 14

Can cause Hypokalemia & Alkalosis b/c increased Sodium in the DCT stimulates Aldosterone sodium pump to exchange Potassium & H⁺ for Sodium

Question 15

How do Carbonic Anhydrase Inhbitors, like Diamox, work?

Answer 15

↓Na Reabsorption in PCT by decreasing the Bicarb Reabsorption that is coupled to the Sodium, which can cause Acidosis

Question 16

What is the main use for Diamox?

Answer 16

Treats Glaucoma

Question 17

How do Aldosterone Antagonist like Spironolactone work?

Answer 17

Spares Potassium via a decrease in Na Reabsorption & K+ Secretion by competing for aldosterone binding sites in the DCT.

Question 18

Which class of Diuretics are Amiloride & Triamterene?

Answer 18

Sodium Channel Blockers

Question 19

How do Na Channel Blockers work?

Answer 19

Decrease Na Reabsorption by decreasing Na/K-ATPase in the Collecting Tubule, which also spares Potassium

Question 20

What is the difference b/t Acute Kidney Injury vs. Chronic Kidney Disease?

Answer 20

AKI: Acute decline or complete loss of kidney function that eventually recovers back to normal

CKD: Irreversible decrease in Functional Nephrons

Question 21

What are the leading causes of ESRD?

Answer 21

1 - Diabetes

Question 22

When would you start to see symptoms of CKD?

Answer 22

When there are < 70% of Functional Nephrons

Question 23

How is Chronic Kidney Disease defined?

Answer 23

Kidney Damage or Decreased Kidney Function lasting 3 months or more

Question 24

How much of a decrease in functioning nephrons would result in abnormal electrolytes & body fluid volumes?

Answer 24

A decrease below 20-25% of normal

Question 25

What causes CKD?

Answer 25

Renal Vasculature Injury Glomerulonephritis Infection Nephrotic Syndrome

Question 26

What are some causes of Renal Vasculature Injury?

Answer 26

Atherosclerosis Fibromuscular Dysplasia Nephrosclerosis

Question 27

What are some causes of Glomerulonephritis?

Answer 27

Antigen-Antibody Complexes Strep Infection Lupus

Question 28

What is Nephrotic Syndrome?

Answer 28

Loss of Negative Charge in Basement Membrane from Proteinuria

Question 29

What is Pyelonephritis?

Answer 29

E. Coli Infection, affecting the Renal Medulla & Impairs Ability to concentrate Urine

Question 30

What are the effects of Uremia?

Answer 30

Edema Anemia Acidosis ↑Nitrogenous Waste ↑K, Phosphates & Phenol ↑CO for more O₂ Carrying Capacity

Question 31

What are the signs of Uremic Syndrome?

Answer 31

Anorexia N/V Pruritis Anemia Fatigue Coagulaopathy

Question 32

What is the biggest risk factor for ESRD?

Answer 32

Obesity b/c it causes DM & HTN

Question 33

How does Renal Failure affect Minute Ventilation

Answer 33

Increase Minute Ventilation to compensate for Acidosis

Question 34

How does Renal Failure cause Osteomalacia?

Answer 34

Vitamin D is converted by Liver & Kidneys. Inablity to do this causes Secondary Hyperparathyroidism to get calcium from bones

Question 35

How does Renal Failure affect the GI?

Answer 35

Gastroparesis & Gastric Acid Hypersecretion --\> Ulcers

Question 36

What happens to the other Kidney if one of them gets damaged?

Answer 36

Renin & Angiotensin II from the damaged kidney affects the good kidney

Question 37

During Dialysis, what does the Rate of Solute Movement depend on?

Answer 37

Concentration Gradient Membrane Permeability & Surface Area Length of Time

Question 38

How much blood is there in the Dialysis Machine at any given time?

Answer 38

500 cc

Question 39

What does Dialyzing Fluid NOT have in it?

Answer 39

Phosphate Urea Urate Sulfate Creatinine

Question 40

When is Hemodialysis indicated?

Answer 40

Metabolic Encephalopthy Coagulopathy Pericarditis Refractory GI Problems HyperKalemia Fluid Overload Acidosis Drug Toxicity

Question 41

What can cause an Increased BUN?

Answer 41

↓GFR ↑Protein Breakdown Sepsis GI Bleed

Question 42

What is the Normal BUN & Creatinine?

Answer 42

**BUN**: 10-20 mg/dL **Creatinine**: 0.8 - 1.3 mg/dL

Question 43

Creatinine Concentration is ______ related to Muscle Mass & _______ related to GFR

Answer 43

Creatinine Concentration is **DIRECTLY** related to Muscle Mass & **INVERSELY** related to GFR

Question 44

How is the GFR affected by age?

Answer 44

5% decrease per decade after 20

Question 45

With Renal Tubular Acidosis, what would you exepct the Urinary pH to be?

Answer 45

Urinary pH \> 7.0

Question 46

How would impaired Renal Function affect Barbiturates?

Answer 46

More Senstive d/t ↓Protein Binding

Question 47

How does impaired Renal Function affect Propofol, Ketamine, & Etomidate?

Answer 47

No Difference

Question 48

How are Benzos affected by impaired Renal Function?

Answer 48

↑Duration

Question 49

How does impaired Renal Function affect Precedex?

Answer 49

↑Duration

Question 50

Which Opioids are safe to use with impaired Renal Function?

Answer 50

Fentanyl Other opioids may accumlate d/t metabolites

Question 51

How are Reglan & Anticholinergics affected by Impaired Renal Function?

Answer 51

Ok for 1 time dose, but can accumulate if more

Question 52

What can happen when using Sevoflurane in the setting of Impaired Renal Function?

Answer 52

Flouride Accumulation

Question 53

Which NMBs should be avoided in pts. w/ impaired renal function?

Answer 53

Pancuronium Pipercuronium Doxacurium Alcuronium

Question 54

What are the NMBs of choice w/ Impaired Renal Function?

Answer 54

Cis-Atracurium d/t Hoffman Elimination

Question 55

How is Suggamadex viewed in the setting of ESRD?

Answer 55

Should be avoided, but not much data

Question 56

What is the main cause of Peri-Op Renal Failure?

Answer 56

Hypovolemia

Question 57

What are the main symptoms of Kidney Stones?

Answer 57

Pain & Hematuria

Question 58

Calcium Oxalate is the most common type of Kidney Stone. What caues this buildup?

Answer 58

Not enough Dietary Calcium

Question 59

What size Kidney Stones can usually pass on their own?

Answer 59

\< 4mm

Question 60

What drugs can help pass the stone by decreasing Ureter Tone?

Answer 60

Alpha Blockers - Terazosin

Question 61

What procedures are used to treat Kidney Stones?

Answer 61

ESWL Ureteroscopic Fragmentation Perc. Nephrolithotomy Double J Stents

Question 62

What are contraindications to ESWLs?

Answer 62

Can't Position Pregnancy Infection Obstruction Below Stones Prosthesis Near Stones

Question 63

How are kidney stones prevented?

Answer 63

Hydration Avoid Soda Limit Dietary Protein, Nitrogen, & Sodium

Question 64

What kind of diet may cause Gout?

Answer 64

Diet rich in Protein, Fat, & Alcohol

Question 65

How is Gout Treated?

Answer 65

NSAIDs Steroids Acetazolamide Colchincine

Question 66

What drugs can prevent Gout?

Answer 66

Allopurinal Uricocurics Caffeine CPAP (since gout associated w/ Sleep Apnea)