Term
| describe the urine at the proximal part of the DCT |
|
Definition
|
|
Term
| How does the Medullary space draw out water in the descending limb? |
|
Definition
| high Na+ in the medullary space- draws water out (water is permeable here), concentrating the urine |
|
|
Term
| How is Conivaptan administered? |
|
Definition
|
|
Term
| How is Mannitol given? and why? |
|
Definition
| Only parenterally because if it were to be given orally, it would cause osmotic diarrhea |
|
|
Term
| how is the DCT specialized? |
|
Definition
| selective transporters and channels. which allows us to fine tune composition of urine |
|
|
Term
| how is the loop divided into specialized functions? |
|
Definition
| descending permeable to water, ascending permeable to salts |
|
|
Term
| How were thiazide diuretics developed? and what does this mean about their actions? |
|
Definition
| effort to develop better CA inhibitors. they have CA inhibition activity |
|
|
Term
| If Diabetes Insipidus is nephrogenic, what is indicated? |
|
Definition
|
|
Term
| In the thick ascending limb, what is disturbed when NKCC2 is inhibited? |
|
Definition
| K+ potential, which usually leads to paracellular uptake of Mg2+ and Ca2+. With a loop diuretic, this is disturbed, so Mg/Ca lost in urine |
|
|
Term
| In what patients is a CA inhibitor contraindicated? |
|
Definition
| Cirrhotics. Ammonium will be converted back to ammonia and cross BBB and lead to hepatic encephalopathy. |
|
|
Term
| what are 3 clinical uses of CA inhibitors? |
|
Definition
| Glaucoma**, Mountain Sickness, Edema with Alkalosis |
|
|
Term
| What are 4 clinical uses of Thiazides? |
|
Definition
| Hypertension, CHF, Nephrolithiasis (prevents Ca++in urine), Nephrogenic Diabetes Insipidus |
|
|
Term
| What are 4 toxicities of Thiazides? |
|
Definition
| Hypokalemic metabolic alkalosis, Hyperuricemia, Hyperglycemia, Hyponatremia |
|
|
Term
| What are 5 clinical uses of Loop Diuretics |
|
Definition
| Acute pulmonary edma, Acute Hypercalcemia, Hyperkalemia, Acute Renal failure, Anion overdose |
|
|
Term
| What are 5 toxicities of Loop Diuretics? |
|
Definition
| Hypokalemic Metabolic Alkalosis, Ototox, Hyperuricemia, Hypomagnesemia, Allergy to sulfonamides (except Edecrin-it is not a sulfonamide) |
|
|
Term
| What are CA inhibitors used for clinically? |
|
Definition
| not as diuretics, but for glaucoma to lower intraocular pressure |
|
|
Term
| What are clinical uses of Osmotic Diuretics? |
|
Definition
| Renal failure due to increased solute load (Rhabdomylolysis, chemotherapy), increased ICP, Glaucoma |
|
|
Term
| What are the 2 Aldosterone Antagonists? |
|
Definition
| Spironolactone, Eplerenone |
|
|
Term
| what are the 2 clinical uses of Aldosterone Receptor Antagonists? |
|
Definition
| Aldosteronism and PostMI-increases perfusion |
|
|
Term
| What are the 2 clinical uses of Na+channel inhibitors? |
|
Definition
| Lithium induced polyuria and Hypokalemia due to other diuretics |
|
|
Term
| What are the 2 important Loop Diuretics to know? |
|
Definition
| Furosemide and Ethacrynic Acid |
|
|
Term
| What are the 2 important Thiazides? |
|
Definition
| Hydrochlorothiazide and Chlorothiazide |
|
|
Term
| What are the 2 Na+ channel inhibitors? |
|
Definition
|
|
Term
| What are the 2 TYPES of K+ sparing Diuretics? |
|
Definition
| Aldosterone Antagonists and Na+ Channel inhibitors |
|
|
Term
| What are the 3 toxicities of CA inhibitors? |
|
Definition
| Metabolic acidosis (bicarb lost), Renal stones (alkaline urine precipitates Ca++ stones), Hyperammonemia in cirrhotics |
|
|
Term
| What are the 4 Loop DIuretics? |
|
Definition
| Furosemide-prototype, Bumetanide, Torsemide, Ethacrynic Acid |
|
|
Term
| What are the clinical uses of ADH antagonists? |
|
Definition
|
|
Term
| what is the specialized fxns of some afferent arteriole smooth muscle cells? |
|
Definition
| JG cells are specialized smooth muscle cells that are able to secrete renin |
|
|
Term
| What are the three CA inhibitors? |
|
Definition
| Acetazolamide, Brinzolamide, Dorzolamide (OLAMIDE) |
|
|
Term
| what are the two causes of Diabetes Insipidus? |
|
Definition
|
|
Term
| what does the anatomical proximity of Vasa recta and tubules result in? |
|
Definition
| countercurrent exchange and multiplication |
|
|
Term
| What drug interaction occurs with NSAIDS and Loop Diuretics? |
|
Definition
| The action of NSAIDs decreases COX2 activity, inhibiting the effects of the Loop diuretics |
|
|
Term
| What effect do loop diuretics have on Urine Ca++? What effect do thiazides have on urine Ca++? |
|
Definition
| increased, decreased ** important |
|
|
Term
| What enzyme is induced by loop diuretics and what does it lead to? |
|
Definition
| induce COX2, leading to PGE2 formation, which inhibits NaCl absorption |
|
|
Term
| What happens in the ascending limb of Henle's loop? |
|
Definition
|
|
Term
| what happens to osmolairty as you descend down the Loop of Henle? |
|
Definition
| increases, as the tubule is permeable to water, but not salt. |
|
|
Term
| What happens to osmolarity as you ascend the ascending portion of Henle's loop? |
|
Definition
| decreases, as water is retained and Na leaves the tubule. |
|
|
Term
| What is a side effect of ALL diuretics except Aldosterone antagonists? |
|
Definition
|
|
Term
| what is a side effect of CA inhibitors |
|
Definition
| prodcues metabolic acidosis because Bicarb is lost in the urine and not reabsorbed. |
|
|
Term
| What is a unique side effect of Spironolactone? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the action of CA inhibitors? |
|
Definition
| prevents the breakdown of H2CO3 into water and CO2 by CA. H2CO3 is not diffusable and remains in urine when CA is inhibited. **reduces reabsorption of bicarb** |
|
|
Term
| What is the action of Na channel inhibitors? |
|
Definition
| inhibit the ENaC channel directly. |
|
|
Term
| What is the clinical advantage of CA inhibitors? |
|
Definition
| reduces intraocular pressure |
|
|
Term
| What is the difference between Amiloride and Triamterene (the 2 Na+ channel inhibitors)? |
|
Definition
|
|
Term
| What is the Important ADH Antagonist? |
|
Definition
|
|
Term
| What is the main difference between Spironolactone and Eplerenone? |
|
Definition
| Eplerenone is more selective for the Aldosterone receptor. |
|
|
Term
| What is the main symptom of nephrotic syndrome? |
|
Definition
|
|
Term
| What is the main toxicity with K+sparing diuretics? |
|
Definition
| Hyperkalemia due to the K+sparing |
|
|
Term
| What is the MOA of ADH antagonists? |
|
Definition
| Block the binding of ADH to its Receptor (mainly the V2 receptor). No cAMP made, no Aquaporin 2 insertion. No water reabsorption. |
|
|
Term
|
Definition
| Binds its receptor apically (mainly V2 receptor), which induces cAMP with a final effect of Aquaporin 2 insertion into the luminal membrane. This allows for water reabsorption from the urine |
|
|
Term
| What is the MOA of Aldosterone receptor blockers? |
|
Definition
| When aldosterone binds its Receptror, signals the ENaC transporter to uptake Na+. This is blocked. |
|
|
Term
| What is the MOA of Loop diuretics? |
|
Definition
| Inhibits NKCC2 transproter, reducing reabsorption of Na CL |
|
|
Term
| What is the MOA of Mannitol? |
|
Definition
| It is excreted into the urine and stays there, preventing reabsorption of water |
|
|
Term
| what is the MOA of Thiazides? |
|
Definition
| inhibits NCC in the DCT- modes increase in NaCl excretion, increase K+ excretion. decreased urine Ca++ |
|
|
Term
| What is the only IV thiazide? |
|
Definition
|
|
Term
| What is the only side effect of ADH antagonists? |
|
Definition
| No real toxicity. Infusion site reaction only |
|
|
Term
| what is the osmolarity of plasma? |
|
Definition
| 300; same for primary filtrate |
|
|
Term
| What is the prototype CA inhibitor? |
|
Definition
|
|
Term
| What is the prototype Osmotic diuretic? |
|
Definition
|
|
Term
| what is the toxicity of OSmotic Diuretics? |
|
Definition
| General- nausea, vomiting, headache. General because the drug is very non-specific |
|
|
Term
| What separates Acetazolamide from the other 2 CA inhibitors based on administration? |
|
Definition
| it is the only one used parenterally. other 2 are topical |
|
|
Term
| Where do Osmotic diuretics work? |
|
Definition
| mainly in the PCT, but throughout the tubules really |
|
|
Term
| where is the highest osmolarity? |
|
Definition
| at the tip of the loop of Henle |
|
|
Term
| where is the lowest osmolarity of urine? |
|
Definition
| proximal part of the DCT- 100milliosmoles/L |
|
|
Term
| Which diuretics work at the DCT |
|
Definition
|
|
Term
| Which diuretics work at the proximal CD? |
|
Definition
| K+ sparing Aldosterone antagonists |
|
|
Term
| which diuretics work at the thick ascending limb? |
|
Definition
|
|
Term
| Which diuretics workk in the distal part of the Collecting duct mainly? |
|
Definition
|
|
Term
| which drugs act at the PCT? |
|
Definition
| CA inhibitors and OSmotic diuretics |
|
|
Term
| which part of the nephron is intimately a/w the aff/eff arteriole? |
|
Definition
|
|
