Term
|
Definition
| sodium bicarbonate reab osrption, sodiu mchloride rea bosrotpin and alot of water rea bsorpbed |
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Term
| carbonic anhydrase lcaiton and funciton |
|
Definition
apical membrane- facing lumen. of proximal tubule .
cataylzes co2 andh2o -> eventuall ydiscoaite to bicarb and proton |
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Term
| carbonic anhydrase inhbiitors moa |
|
Definition
inhibit generaito nof protons, which normally are echhanged for sodium via NHE3. without proton forming ,n o protons can be excreted ine xchange for sodium entering back into body
also alkalinezes urine by preventing bicarb reabsorption |
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Term
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Definition
| transfers sodium from inside the cell into the inter stisiutm . |
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Term
| acetazoloamide, drug type and moa |
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Definition
| carbonic anhydrasei nhbiitior, inhibiting sodium bicar brabsorption |
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Term
|
Definition
| weak diuretic, wakly blockign adneosine recp eotrs , contorllign proximal tubule sodium reabsorptrion |
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Term
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Definition
| impearmeabol solutes which promote water retnion in the tubular fluid. |
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Term
| Proximal tubule diuretics side ffects |
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Definition
| utilize the organic acid secertoyr system to get secreted into thel umen, will cause retnetion of other stuff that also gets secreted that way. Ie..e uric acid, nsaids. etc. |
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|
Term
| acetolozamide funcitonal group of activity |
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Definition
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Term
|
Definition
| hyperchoeloremic metaoblic acidosis (dueto bicarb excretion). rare effects: paresthesias, gi distress, smnolence. Alelrgic reac tiosn to those senstivie to sulfonamides. Renal potasium wasting. (sodium excretio proximally leads to reabsorption at hte expense of potassium distally) |
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|
Term
| effectiv enss of acetoazlomideo ver time |
|
Definition
| enhanced naclreabsorp at distal sites due to bicarb depletion. |
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|
Term
| CA inhibitors therpauteic uses |
|
Definition
glaucoma- (decrease produciton of aques humor)
acutem outnain sickenss- will raiase CO2 content of tissues.
metabholic alkoalosis csorrection
alkanize urine briefly
anticonvulsant properties. |
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Term
|
Definition
| CA inbhitior used for glaucoma |
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Term
|
Definition
| CA inbhitior used for glaucoma |
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Term
| CA inhibitors ocntraindications |
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Definition
| patient with heapatic cirrhosis, due to impaired excretion of urea which cant be metaoblzied as well by liver. |
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Term
| osmotic diuretics MOA/site of action |
|
Definition
| acti np rox tubule and descneindg limb ofh enles lop ( water freely eprmeable). They expand ECF briefly, and decrase blod ovisc oity and inhibit renin release. |
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Term
| osmotic diuretics pharmcokientics |
|
Definition
| pooryl absorbed, so must be given par enterlaly (potential use as osmotic diarrhea to c lear gi trac t). |
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Term
| osmotic diuretics clincial use |
|
Definition
icnrase urine volume ( incresed water excretion in preference to Na excretion).
reduciton of intracranial and itnraocular pressure.
prompt removal of renal toxins. |
|
|
Term
| osotmic diuretics toxicity |
|
Definition
ecf expansion (pre=diuresis), whcih can complciate CHF- and canl ead to headache, nausea and vmoting.
Dehydration and hypernatermia (post diuresis) |
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Term
|
Definition
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|
Term
| loop diuretics site of action and specific transporter |
|
Definition
| thick ascending limb, nkcc transporter |
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|
Term
|
Definition
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Term
|
Definition
| only loop diur etic WITHOUT sulfonamide |
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|
Term
|
Definition
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|
Term
| loop diuretics net effect |
|
Definition
slective inhbiition of nacl reabosrption . in thick ascending limb. Most ef fec tive diuretic agents curently available
also inhibit tulberoglomerular feedback by inhibtingt salt trnasport into the macula densa.
idncue syntehsis of postraglandins (PGE2) via COX-2. This incresed renal blodo flow. NSAIDs may inhbiit this effect.
relief of pulmoanry c ongestion and LEFT ventirulcar iflling presure before diuretic effects due to above mechanism. |
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|
Term
| loopi duiretics pharmacokinetics |
|
Definition
| short halflives of only af ew hours. |
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|
Term
| Loop diuertic cation effects |
|
Definition
| increase magnesium and celcium excretion, becuase they rly on potassium recyling to form positive luminal potential and support their reabsorption. |
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|
Term
| loop diuretic theraputic uses |
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Definition
| most commonly for: pulmoanry edema and other edemas and Hypercalcemia. also hyeprkalemia, acute rneal failure, anion overdose, NOT used for hypertension (short halflives) |
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|
Term
| loop diuretics adverse efefcts |
|
Definition
hypokalemic met ao b lic alkalosis. ecretin of sodium results in increased sodium at eth coleclting duct, rea bsorption tehr is in echagne for potasisum and protons
ototoxicity- rev ersible.
hyperuricemia- competition for organic acid trnasporters .
hypomagnisemia.
aelrgic reacitons- duet o soulfonamides, use ethacrynic acid.
hyperglycemia- decerasedi nsulin synethesis form pancreas. |
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|
Term
| thiazide diuretics siteo factio nand specific transporter |
|
Definition
distal convultued tubule. BLocks NCC pump. some have some CA inhibitor activity
(blockage of NCC pump results in increased activity of basoalteral (na/ca pump which pumps calcium into interstitium in exchange for pumping NA into cells). |
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|
Term
|
Definition
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|
Term
| hydrhclohorhtiazide method of ab sorption, and pharmacokinetics |
|
Definition
orally. slowly absorbed with a logner DOA .
secreted by org anic acid secretory system, may precipiatete gout. |
|
|
Term
| thiazides pahramcoydnpaics |
|
Definition
| inhibit nacl abosprtion, increase calcium reabosprtion |
|
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Term
|
Definition
| HTN, neprhothiliais (kindey stones , by removing calcium from urine). Nephrogenic Diabetes insipidus (ADH insensitivty). |
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|
Term
|
Definition
hypokalemia metabolic alkalosis and hyperuricemia (liek loop diuretics).
hyperglycemia (decreased pacn reatic release of insulin) .
Hyperlipidemia.
Hyponatermia
Alelrgic reaction (is a sulfonamide) |
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|
Term
| principal cells fucntino and lco ation |
|
Definition
late distal convulted tubule.
aldosterone acts here. Principel cells contain EnaC (transprots sodium into cell), Basolateral sodium/potassium atpase (pulls sodium out itno interstitum and potassium into cell) . Both of htese are effected by aldosterone . This is the area where ptoasisum is secreted as wel las protosn are s ecreted due to increase delivery of sodium to lumen (due to activity of proximal diuretics). |
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|
Term
| interaclated cel locatio and fucntion |
|
Definition
proton secretion,
late distal tubule and collecting duct. |
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|
Term
| potassiu msparing diuretics moa |
|
Definition
| antagonisze aldosterone at cortical collecitng tubule and late distal tubule. |
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Term
|
Definition
| potassium sparing diuretic (ALDOSTERONE RECEPTOR ANTAGONIST) |
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Term
|
Definition
| k sparing diuretic with greater slectivity for aldosterone recpetor than spironolactone |
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|
Term
|
Definition
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|
Term
|
Definition
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|
Term
| aldosterone re lease promotion via |
|
Definition
|
|
Term
| aldosterone is usually hgih in |
|
Definition
| cirhosis with ascites, renalvascular hypertension, adrenal tumors, cardiac or nephrotic edema |
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Term
|
Definition
| bidns to mineralcorticoid recpetors and prevents trnaslocaitonof receptor ocpmelx to nucleus. |
|
|
Term
| triamterene pharamcokientics elimination |
|
Definition
| metabolzied by lvier, excreted renally |
|
|
Term
| Amiloride pharmacokinetics elemiantino |
|
Definition
| excreted uncahnegd in urine- amilorideh as logner halflife htan triamterene sicne it is not metabolized |
|
|
Term
| Triamterene and spinorolactone inhibited bby what? |
|
Definition
| NSAIDS- due to depepndance on renal prostaglandin production |
|
|
Term
| Clinical indications of potassium sparing diuretics |
|
Definition
primary hyeprsecretion of aldosterone (conn's syndrome, ectopic acth production).
seondary hypersecretion of aldosterone (heart failure, irrhosis, nephrotic syndrome).
Triamterne and amiloride can be used for liddle's sydnrome hypertension (gain of function mutation in ENaC channel. |
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|
Term
| k sparing diuretics toxicity |
|
Definition
hyperkalemia.
hyperhcloermic metaoblic acidosis- inhibits proton secetion alogn with k secretion. |
|
|
Term
|
Definition
Acute renal failure= triamterine with indomethacin.
Kdiney stones- Triamterene- due to poor solublity in urine |
|
|
Term
| mineralicortiocoid receptor antagonist toxicity |
|
Definition
| gynecomastia- cross reacitvity with other stereoid recpetors (epleronone can avoid this). |
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|
Term
| k sparing diuertics contraindications |
|
Definition
fatal hyperkalemia- dont wgive iwth other agentst hat lbunt RAAS systemm. (betablockers ace inhibitors).
the toxicites below ewre not mentioned:
Patinetts with chornic rneal insufficiency shoudl nto betreated with aldosterone antagonists.
liver disease patients- impaired metaoblism of trimaterene and spironolactone, cyp3a4 inhibitors will icnrease blodo elvels of epleranone. |
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Term
|
Definition
| V2 receptors on basolateral side whcih actiavte cam pand increaseaquaporin channels on apical side.- onp rincipal cells in late distal tubule an colelting duct. |
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|
Term
| conivaptan drugtype and lcinical use |
|
Definition
| adh antagonist, IV infusiion for inhospital treatmetn of euvolemic hyponatermia. Nonslectiev anataognist of v1a and v2 reeptors . |
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Term
|
Definition
| selectiev against v2 receptors |
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Term
|
Definition
| selectiev against v2 receptors |
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Term
|
Definition
| v2 receptora natagonists, induce hypotonic diuresis |
|
|
Term
| demclocyline/lithium funciton |
|
Definition
| reduciton of fomraiton of CAMP in repsosne to ADH , nonselsective. |
|
|
Term
| conivaptin pharmacokinetics |
|
Definition
|
|
Term
|
Definition
| orally acitve, and reabosred in proximal tubule |
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|
Term
| Demeclocyline pharmacokientics |
|
Definition
| metabolized in liver, oraly active (not really i nuse ad adh antagonist.) |
|
|
Term
| adh antaognists lcinial utilities. |
|
Definition
SIADH. (al can be used except conivaptan, sicne that is iv inejciton and only short term use, tolvaptan is the best).
other cuases of ADh elevation- dminished ECF.. |
|
|
Term
|
Definition
Nephrogenic diabetes insiipidus- (treated by thiazide or amiloride)
Renal failure
many adverseeffects, tremuloussness, mental obundation, cardiotoxciity, thyroid dysfunciton, leukocytosis. |
|
|
Term
|
Definition
renal failure.
shoudl beavoided inaptients with liver disease. |
|
|
Term
| loop agents andt hiazides |
|
Definition
| can be used when enitehr agenta citng alone is very effective. |
|
|
Term
| potassium sparing diuretics and loop agents/thiazides |
|
Definition
| use potassium sparing diuretics with other diuretics to avoid potassium wasting. (dotn use wiht patientsiwth renal isnuffeiicency ) |
|
|
Term
| severek dineydisease and diuretics |
|
Definition
| diuretics are usulaly not effecitvei nsevere kidney disease. (jneedto be secreted by kdiney in order to do their job). |
|
|
Term
|
Definition
| (associated iwth hyeprkealemia, can use thizideo r loop diueretic to enhacne potassium excretion). |
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|
Term
| acetazolamie and potassium sparingd iuretics word of caution |
|
Definition
| generally avoided due to tendency to exacerbate acidosis and hyperkalemia. |
|
|
Term
|
Definition
| thiazides becocme ineffective |
|
|
Term
| Edema asosciated with kdineyf ailure best treawtment |
|
Definition
| loop diuretisc and thiazdie diuretics |
|
|
Term
|
Definition
| resitatn to lop diuertics (due to high aldosterone secretion rates in cirrhosis), usually respsnive to spirnolactone |
|
|
Term
|
Definition
|
|
Term
|
Definition
| thiazide diuretics, sicne htey reabsorb calcium |
|
|
Term
|
Definition
|
|
Term
| Diabetes Insipidus treamtnet |
|
Definition
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