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MQW U4 > Pharm --Renal/Diuretic > Flashcards

Pharm --Renal/Diuretic Flashcards

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1
Q

___ contracts from 1/2 of Total body fluid (TBF) to 1/3 of TBF in adults

A

ECF

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2
Q

What is solute concentation/osmolarity of ICF and ECF

A

approx. 300mOsm/L

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3
Q

ICF is __% of body weight
ECF is __% of body weight
Blood volume is __% of body weight

A

ICF = 40%
ECF = 20%
Blood volume = 7%

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4
Q

K is high ___ the cell

Na is high ___ the cell

A 
K = high inside
Na = high outside

–b/c Na/K pump sends K inside and Na out; K can leak out, Na can’t come in

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5
Q

Daily urine output is ___L which is ___% of GFR

A

1-2L

0.5-1% of GFR

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6
Q

___ is the major solute determining ECF osmolarity

A

Sodium

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7
Q

Low Na in ECF causes what compensatory change in ECF volume?

A

Decreases to maintain osmolarity

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8
Q

Can sodium be:

  • -filtered?
  • -secreted?
  • -reabsorbed?
  • -excreted?
A
  • -Duh
  • -NO!
  • -yes
  • -yes
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9
Q

What is normal GFR (mL/min)

A

125ml/min

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10
Q

Normal plasma Na concentration:

A

140mM

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11
Q

Normal plasma bicarbonate concentration:

A

24mM

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12
Q

% of Sodium reabsorbed at:

  • -Proximal tubule
  • -TAL of Loop
  • -Distal tubule
A
  • -66%
  • -25%
  • -6-8%
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13
Q

Nephrotic syndrome is excess filtration and excretion of ___

A

Albumin

–leads to decreased plasma oncotic pressure

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14
Q

Most filtered bicarbonate is reabsorbed here

A

Proximal tubule

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15
Q

This portion of the nephron has “leaky” epithelium and is unable to maintain an osmotic gradient.

A

Proximal tubule

–66% of tubular filtrate is reabsorbed

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16
Q

Loop of Henle: thin descending, thin ascending, TAL

Which is/are impermeable to water?

A

thin ascending, TAL are impermeable to water (even in presence of ADH)

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17
Q

What portion of the nephron is the physiological origin of positive free water clearance?

A

Ascending limb of Loop

–no water reabsorption –> hypoosmotic tubular fluid

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18
Q

Circulating Aldosterone hormonally regulate this mechanism at this portion of the nephron.

A

Sodium reabsorption in the late distal tubule

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19
Q

Early vs. late distal tubule:

Which portion is permeable to water?

A

Late distal tubule = permeable when induced by interaction with antidiuretic hormone (ADH) –> concentrates urine by reabsorbing water

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20
Q

What is normal filtration fraction?

A

FF = GFR/RPF = 0.2

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21
Q

What is used to measure GFR? Why?

A

Inulin clearance

–It is not reabsorbed or secreted, so filtered = excreted

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22
Q

Excretion = Filtration + Secretion - Reabsorption
How is renal handling of Potassium (K) different in low K vs. high K diets?
In what portion of the nephron does this regulation occur?

A

Low K = no secretion, more reabsorption
High K = high secretion, less reabsorption

Distal tubule and cortical collecting duct

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23
Q

How do alkalosis and acidosis affect potassium (K) secretion?

Study These Flashcards
A

Alkalosis –> increased K secretion

Acidosis –> decreased K secretion

24
Q

How do diuretics (except K sparing) cause hypokalemia?

Study These Flashcards
A

Block of Na reabsorption upstream (TAL for loop and early DT for thiazide) causes increased Na secretion at late DT which induces K secretion

25
What is negative free water clearance? | What hormone affects it?
Water in tubule reabsorbed back into circulation - -induced by ADH - -generates hypertonic urine
26
How does volume expansion affect Aldosterone levels?
Volume expansion --> low aldosterone --> less Na reabsorption --> less water reabsorption --> dilute urine
27
What is the mechanism of aquaretics?
Decrease ability of ADH to increase water permeability in late distal tubule and collecting duct --> dilute urine
28
What are 4 osmotic diuretics?
Mannitol Excess glucose Urea Isosorbide
29
How do loop diuretics affect positive and negative free water clearance?
--Decrease positive free water clearance (directly, by increasing osmotic clearance in TAL) --Decrease negative free water clearance (indirectly, by reducing ADH sensitivity (ability to concentrate urine) in the medullary CD from reduced medullary gradient)
30
How do thiazide diuretics affect positive and negative free water clearance?
Only affects positive free water clearance (prevent salt reabsorption --> increased tubular concentration --> increased water clearance) --Does not affect negative free water clearance (concentrating urine)
31
Relative maximal fractional excretion of Na in: - -PT - -TAL - -DT - -CD
``` TAL = 25% --loop DT = 8% --thiazide PT = 5% --CA inhibitor, osmotics CD = 2% --K+ sparing diuretics ```
32
Carbonic anhydrase inhibitors [increase/decrease]: - -tubular H+ - -tubular pH - -Na/H exchanger rate - -Intracellular carbonic acid formation
- -tubular H+ = decrease - -tubular pH = increase --> alkaline urine - -Na/H exchanger rate = decrease - -Intracellular carbonic acid formation = decrease
33
Carbonic anhydrase can induce - -[hyper/hypo] kalemia - -metabolic [acidosis/alkalosis]
- -Hypokalemia | - -Metabolic acidosis -- excess bicarb excretion
34
Why are osmotic diuretics used in shock and surgery?
Prevent acute renal failure -- maintain urine flow
35
What is the molecular mechanism of loop diuretics?
--Compete w/ chloride for occupancy in 1 of 2 Cl binding sites of Na-K-2Cl cotransporter in luminal membrane of TAL
36
How long does it take for loop diuretics to induce diuresis?
``` IV = within minutes Orally = within an hour ```
37
How do you prevent hyponatremia caused by chronic use of loop diuretics?
Limit water consumption -- prevent volume expansion b/c loop diuretics reduce positive free water clearance
38
When loop diuretics are used together with aminoglycoside antibiotics (gentamycin), there is a markedly increasked risk for what complication?
Ototoxicity -- hearing loss
39
What are loop diuretic effects on: - -Calcium - -Magnesium - -Potassium
- -Increase calcium excretion - -Increase magnesium excretion - -Increase potassium excretion
40
What is the molecular mechanism of thiazide diuretics?
Inhibit Na-Cl cotransporter in luminal membrane of early DT
41
A patient on [loop/thiazide] diuretic is more at risk for hyponatremia
Thiazide diuretic -- imbalance in renal volume regulation (since it only affects + (diluting urine ability) and not - (concentrating urine ability) free water clearance)
42
What is the only segment of the nephron that reabsorbs glucose?
Proximal tubule
43
Is mannitol reabsorbed and/or secreted?
Neither
44
Do loop diuretics increase or decrease the ability of the kidney to excrete water in excess of solutes?
Decrease -- lowers positive free water clearance = less ability to dilute urine
45
What are the 2 substituted benzothiazide drugs?
- -Chlorothiazide | - -Hydrochlorithiazide
46
What are the 4 thiazide-like drugs?
- -Chlorthalidone - -Metolazone - -Quinethazone - -Indapamide
47
The early distal tubule is [permeable/impermeable] to water
Impermeable -- even in the presence of ADH
48
Do thiazide diuretics affect the kidney's ability to correct for: - -increase in ECF? - -decrease in ECF?
--Increased ECF -- YES = reduces ability to excrete water in excess of solutes (dilute urine/ + free water clearance) after excess water consumption --Decreased ECF -- NO = doesn't affect ability to concentrate urine
49
How is calcium excretion affected by: - -Loop diuretics? - -Thiazide diuretics? - -Amiloride (K-sparing)?
- -Loop = increased excretion - -Thiazide = increased paracellular reabsorption --> decreased excretion - -Amiloride = decreased excretion
50
Assuming Na consumption is constant, loop and thiazide diuretics induce what compensatory mechanism?
--Compensatory increase in Na and water reabsorption in proximal tubule (upstream) --> maintain sodium balance, but not enough to maintain water --> diuresis w/o hyponatremia
51
Diuretics cause contraction alkalosis through what 2 mechanisms?
- -ECF volume contraction w/o increased bicarb elimination | - -ECF volume contraction induces increased PT reabsorption of bicarb (to increase water reabsorption?)
52
Which class of diuretics can be used to prevent kidney stone formation?
Thiazide -- reverese idiopathic hypercalciuria
53
How do thiazide diuretics affect GFR?
Decreases GFR
54
Thiazide drug intereractions with digitalis and quinidine increase the risk of what events?
- -Digitalis -- arrhytmia | - -Quinidine -- torsade des pointes
55
Compete with Aldostere for binding to an intracellular receptor --> decrease amount of Aldosterone-Receptor (AR) complex --> decrease proteins that maintain Na reabsorption and K secretion Also, indirectly inhibit Na/H exchanger This is the molecular mechanism of what drug(s)?
Spironolactone
56
Inhibit channel mediated Na reabsorption at the late DT --> decreased intracellular Na --> decreased Na/K ATPase --> decreased intracellular K --> decreased K secretion Also, directly inhibit Na/H exchanger This is the molecular mechanism of what drug(s)?
Amiloride | Triamterene
57
This diuretic is a competitive antagonist of androgen receptors which: - -in males, cause: gynecomastia, erectile dysfunction, loss of libido - -in females, cause: amenorrhea, oligomenorrhea, breast soreness What is it?
Spirinolactone

MQW U4 (9 decks)

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