Unit 8.1 Diuretics Chapter 29 diuretic drugs – Flashcards

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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
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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
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electrolyte and metabolic disturbances
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