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Superconductivity

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The phenomenon in which certain substances at certain temperatures conduct electricity without any resistance

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afferent arterioles

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the small blood vessels approaching the glomerlus

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aldosterone

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a mineralocorticoid steroid hormone produced by the adrenal cortex that regulates sodium potassium balance

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ascites

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intraperitoneal accumulation of fluid, containing large amounts of portion and electrolytes

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collecting duct

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the most distal part of the nephron between the distal convoluted tubule and the ureters which lead to the urinary bladder

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distal convoluted tubule

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the part of the nephrotoxicity immidiately distal to the ascending loop of hence and proximal to the collecting duct

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diuretics

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drugs or other substances that tend to promote the formation and excretion of urine

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efferent arteriols

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the small blood vessels exciting the glomerulus; at this point blood has completed its forting in the glomerulus

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filtrate

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the material that passes through a filter; in the case of the kidney, the filter is the glomerular and the filtrate is the material extracted from the blood

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glomerular capsule

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the open, rounded, and most proximal part of the proximal convoluted tubule that surrounds the glomerulus and receives the filtrate from the blood

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glomerular filtration rate (GFR)

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an estimate of the volume of blood that passes through the glomeruli of the kidney per minute

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glomerulus

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the cluster of kidney capillaries that mark the beginning of the nephron and is immediately proemial to the proximal convoluted tubule

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loop of henle

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the part of the nephron that is immediately distal to the proximal convoluted tubules

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nephron

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the functional filtration unit of the kidney, consisting of the glomerulus, proximal convoluted tubule, loop of hence, distal convoluted....

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open angle glaucoma

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condition in which pressure is elevated in the eye because of obstruction of the outflow of aqueous humour

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proximal convoluted (twisted) tubule

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the part of the nephron that is immediately distal to the glomerulus and proximal to the loop of henle

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diuretics are first line therapy for

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hypertension

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kidneys

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filter out toxic waste products from the blood while simultaneously conserving essential substances

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balance between elimination of toxins, and retention of essential chemicals is maintained by the

answer

nephron

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diuretics exert their effect on the

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nephrons

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afferent arterioles mnemonic

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A is for approach and afferent

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Efferent arteriol mnemonic

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E is for exit and efferent

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the proximal convoluted tubule returns

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60-70% of the sedum and water from the filtered fluid back into the bloodstream

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most potent diuretics are

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the loop diuretics

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potency of diuretics is a function of

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where they act in the nephron to inhibit sodium and water resorption

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the more sodium and water the diuretic inhibit the

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greater the diuresis and consequently the greater the potency

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Carbonic anhydrase inhibitors (CAIs)

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chemical derivatives of sulphonamide antibiotics, inhibit the activity of the enzyme carbonic anhydrase found in the kidneys, eyes, and other parts

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carboni anhydrase inhibitors act at

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the location of the carbonic anhydrase enzyme system along the nephron, primarily in the proximal tubule.

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Acetazolamide

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most commonly used CAI (carbon anhydrase inhibitor)

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for sodium and water to be resorbed back into the blood

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hydrogen myst be exchanged for it

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carbonic anhydrase makes

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hydrogen ions for exchange with sodium and water - making little sodium and water resorbed into the blood, and eliminated with urine

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CAI's reduce the formation of

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hydrogen and bicarbonate (HCO3-)which results in reduction in the availability of the ions for active transport system

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CAI's can induce

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respiratory and metabolic acidosis - which can increase oxygenation during hypoxiaq

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undesirable effect of CAI's is

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the elevation of blood glucose levels which causes glycosuria in patients with diabetes

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indications for CAI's

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treatment of glaucoma, edema, epilepsy, and high altitude sickness

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Acetazolamide is also used

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to manage edema secondary to heart failure that has become resistant to other diuretics

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CAIs are much less

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potent diuretics than loop diuretics or thiazides

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contraindications for sure of CAIs include

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hyponatremia, hypokalemia, severe kidney or liver dysfunction, adrenal gland insufficiency and cirrhosis

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ADE of CAI's are

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metabolic abnormalities such as acidosis and hypokalemia. Drowsiness, anorexia, paresthesias, hematuria, urticaria, photosensitivity and melena

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loop diuretics have effects on

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kidney, cardiovascular, and metabolic, and activate kidney prostaglandins which result in dilation of the blood vessels of the kidneys, lungs and body

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loop diuretics hemodynamic effect is in

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both the preload and central venous pressures (filling pressures of the ventricles)

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loop diuretics have

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rapid onset, which is useful when rapid diuresis is needed

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loop diuretics have an advantage over thiazide diuretics in that

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diuretic action continues even when the creatinine clearance decreases below 25mL/min

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loop diuretics can still work even when

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kidney function diminishes

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major ADE of loop diuretics

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electrolyte disturbance - prolonged admin of high dosages can also result in hearing loss stemming from ototoxicity although rare

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loop diuretics indicated to

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manage edema associated with heart failure and liver or kidney disease, manage hypertension and to increase kidney excretion of calcium in hypercal

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contraindications to the use of loop diuretics

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hepatic coma, severe electrolyte loss

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loop diuretics also affect lab results

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increase in serum levels of uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase

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osmotic diuretics (manitol, urea, organic acids, and glucose)

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works along the entire nephron. major site of action is the proximal tubule and descending limb of the loop of Henle

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mannitol (most commonly used osmotic diuretic)

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increases osmotic pressure in the glomerular filtrate, which in turn pulls fluid, primarily water into the renal tubules from surrounding tissue

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mannitol only produces a slight

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loss of electrolytes, especially sodium. therefore not indicated for patients with peripheral edema

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mannitol may induce

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vasodilation, and when it does it increases both glomerular filtration and kidney plasma flow

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Mannitol can prevent kidney damage

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during acute kidney injury

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Mannitol is also used to

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reduces intracranial pressure and cerebral deem resulting from head trauma

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for mannitol to be effective there must be enough

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blood flow to the kidney and glomerular filtration must still remain to enable the drug to reach the kidney tubules

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contraindications for Mannitol

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severe kidney disease, pulmonary edema, and active intracranial bleedin

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ADE of mannitol

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convulsions, thrombophlebitis, and pulmonary congestionheadaches, chest pain, tachycardia, blurred vision, chills, and fever

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potassium sparing diuretics (aldosterone inhibiting diuretics)

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block aldosterone and causes sodium and water to be excreted and potassium retained

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Potassium sparing diuretics act in the

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collecting ducts and distal convoluted tubules where they interfere with sodium potassium exchange

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potassium sparing are often used as

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adjuncts with thiazide treatment

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spironolactone and triamterene (potassium sparing diuretics) used to

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treat hyperaldosteronism and hypertension and to reverse potassium loss caused by potassium wasting diuretics

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contraindications for potassium sparing diuretics

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hyperkalemia, and severe kidney failure or anuria

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ADE of potassium sparing diuretics

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gynecomastia, amenorrhea, irregular menses, and postmenopausal bleeding

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thiazide and thiazide like diuretics site of action

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distal convoluted tubule, where they inhibit the resorption of sodium, potassium, and chloride - resulting in osmotic water loss

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as kidney function decreases the efficacy of thiazides

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diminishes because delivery of the drug to the site of activity is impaired

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thiazides not to be used if

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creatinine clearance is less than 30 to 50 mL/min (normal is 125mL/min)

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thiazide are used in

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treatment of edema of various origins, idiopathic hypercalciuria, and diabetes insipidus, and hypertension

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major ADE for thiazide is

answer

electrolyte and metabolic disturbances

Unit 8.1 Diuretics Chapter 29 diuretic drugs – Flashcards

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