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Pharm 2024 > PPT 15: Diuretics > Flashcards

PPT 15: Diuretics Flashcards

Exam 3 (54 cards)

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1
Q

What are the Proximal Tubule Targets?

A

NaCl and NaHCO3

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2
Q

Which drugs target Proximal Tubule Targets?

A

Carbonic anhydrase inhibitors (block NaHCO3 reabsorption)

Caffeine (weakly blocks adenosine receptors in PCT (Na+))

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3
Q

_______ is an example of a Carbonic anhydrase inhibitor

A

Acetazolamide

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4
Q

Body fluids are kept at a constant osmolality of _____ via a _________ mechanism in the ____

A

300 mOsm/kg
countercurrent
proximal tubule

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5
Q

The _____ is responsible for the secretion of larger substances (drugs) into luminal fluid

A

S2 - straight segment

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6
Q

______ is an impermeable solute that increases osmolality

A

mannitol

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7
Q

The _______ loop of henle is responsible for water reaborption

A

descending

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8
Q

The ______ loop of henle is impermeable to water

A

ascending

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9
Q

What is the pump that transports NaCl and K in the ascending loop of henle?

A

NKCC2 - sodium, potassium, 2 chloride
- all pumped from urine to thick ascending limb

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10
Q

The excess ____ in the urine of the ascending loop of henle drives ____ out of the urine and into the blood

A

K+ (charge gradient)
Mg++ and Ca++

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11
Q

What is the MOA of loop diuretics? What is an example?

A

Selectively inhibit NaCl reabsorption in the thick ascending limb (TAL)
- Reduction in NaCl absorption
- Diminish lumen positive potential - Increase secretion (loss) of Mg2+ and Ca2+ in urine

Lasix

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12
Q

What diruertics should be avoided in patients with sulfa alergies?

A

Loop diuretics (lasix) and thiazides (HCT)

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13
Q

What is reabsorbed in the distal convoluted tubule? By what?

A

Ca++, by PTH

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14
Q

What is the MOA of thiazides?

A
  • Inhibit NaCl transport in DCT
  • Some inhibition of CA activity
  • HCT
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15
Q

Carbonic anhydrase inhibitors ___ pH, while loop diuretics and thiazides ___ pH

A

Decrease, increase

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16
Q

______ is the final site for sodium reabsorption

A

collecting tubule

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17
Q

______ is the most important site for potassium secretion

A

collecting tubule

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18
Q

The collecting tubule contains what 2 cell types?

A

Principal and intercalated

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19
Q

What is the role of the principal cells in the collecting tubule?

A

Builds up (-) charge in lumen
- more Na+ in than K+ out
- drives Cl- out through paracellular route

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20
Q

_____ is the channel responsible for Na+ and water reuptake in the collecting tubule

A

ENaC - epithelial sodium channel

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21
Q

What is the role of the intercalated cells in the collecting tubule?

A

H+ removal into urine
Exchange bicarb for Cl- in blood

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22
Q

Differentiate between the 2 types of K+ wasting diuretics

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A

Some block NaCl
- Cl- leaves via paracellular route
Some block NaHCO3
- HCO3 can’t exit via paracellular route
- Drives increased K+ depletion

23
Q

Diuretics upstream result in excess ___ in CT

24
Q

Aldosterone is secreted by the ______

Study These Flashcards
A

adrenal cortex

25
What is the effect of aldosterone at the collecting tubule?
Increase Na+ and water reuptake (ENaC) - increasing BP and vol
26
K+ sparing diuretics work by what MOA?
1. Antagonize the effects of aldosterone - spironolactone 2. Inhibition of sodium flux through ion channels in luminal membrane - amiloride
27
K+ sparing diuretics are most useful in states of _____
mineralocorticoid excess - Conn’s syndrome, Ectopic ACTH production
28
ADH (vasopressin) effects at the collecting duct
- Increases water reabsorption - Adds preformed AQP2 to apical membrane - Increases blood volume - Makes more concentrated urine
29
ADH agonist vs antagonist
- Agonist: Vasopressin - Antagonist: **Conivaptan**
30
What parts of the nephron are freely permeable to water?
PCT and descending loop
31
_____ is used mainly to reduce intracranial pressure
mannitol - also for rhabdomyolysis and radiocontrast agents
32
Mannitol works by countering the _____
osmotic force - more urine ouput, less Na+ reabsorption
33
What is the etiology and treatment for DI?
Insufficient ADH Thiazide diuretics
34
The hypertonic medullary interstitium is in the _____
descending loop of henle
35
What are the uses for Carbonic Anhydrase Inhibitors?
Glaucoma Alkalinization of urine Metabolic alkalosis Acute Mountain Sickness
36
What is the loop diuretic that isn't a sulfanamide?
Ethacrynic acid
37
What are the 3 ways GFR is regulated?
1. Adjust blood flow 2. Alter capillary surface area 3. Control arteriole diameter
38
What are the steps that occur if GFR is increased?
GFR increased 1. Receptors - macula densa cells of JGA detect increased NaCl and water 2. Juxtoglomerular apparatus is the control center - decreased secretion of NO 3. Effectors - afferent arteriole decreases blood flow through the glomerulus 4. GFR decreased - back to homeostasis
39
What are the actions of the nephron?
1. Glomerular filtration 2. Tubular reabsorption 3. Tubular secretion
40
Rate of excretion =
Rate of excretion = filtration rate + secretion rate - reabsorption rate
41
Most of the filtrate is reabsorbed in the ____
PT
42
What are the components of the neprhon?
1. Glomerulus 2. PCT 3. Descending loop of henle 4. Ascending loop of henle 5. DCT 6. Collecting tubule 7. Collecting duct
43
______ is the hormone that acts at the collecting tubule, while _____ is the hormone that acts at the collecting duct
aldosterone ADH
44
What are the 4 main targets of diuretics?
1. Membrane transport proteins 2. Water permeable segments of nephron 3. Enzyme inhibition 4. Interference with hormone receptors
45
What are the classes of diuretics?
- Carbonic Anhydrase Inhibitors - Loop Diuretics - Thiazides - Potassium Sparing Diuretics - Osmotic diuretics
46
The renal corpuscle is made of what 2 parts?
1. glomerular capillaries (glomerulus) 2. glomerular (Bowman's) capsule
47
The _______ is the capillary system that surrounds the PCT and DCT, while the _____ surrounds the loop of henle
Peritubular capillaries vasa recta
48
Podocytes are only found in the ____
cortex - glomerular filtration
49
The juxtaglomerular apparatus includes what 3 parts?
macula densa, juxtaglomerular cells, and extraglomerular mesanginal cells
50
The juxtaglomerular apparatus is located where?
the vascular pole of the renal corpuscle.
51
How does the juxtaglomerular apparatus regulate BP?
Regulates blood pressure by activating the renin-angiotensin-aldosterone system
52
The _____ monitors osmolality and fluid volume in the distal tubule and transmits info to JG cells (NO)
macula densa
53
_________ are the modified SM cells in the afferent arteriole that synthesize renin
Juxtaglomerular Cells
54
The nephron filters ___ and produces _____
blood, urine

Pharm 2024 (32 decks)

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