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Pharm renal 1

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britt611's version from 2017-01-20 03:13

Section 1

Question Answer
what are 2 ways in decreasing venous pressure1. diuretics, 2. venodilators
what is the function of diuretics?increasing rate of urine flow via water, Sodium (natriuresis), Anions (usually chloride)
How do diuretics increase rate of urine flowmostly by decreasing reabsorption of sodium
do diuretics effect GFR?NO! except osmotic diuretics
What is the major indication of diureticsdecrease extracellular fluid volume, which decreases total body NaCl content
what are diuretics used for?treatment of edema and effusions
What are the traditional Classification of diuretics?Mosaic of Idea: 1. Osmotic (mechansim of action), Loop diuretics (site of action), Thiazides (chemistry), Potassium-sparing diuretics (effects K excretion)
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Section 2

Question Answer
Location of osmotic diureticsProximal tubule + loop of henle
which one increased GFR?osmotic diuretics
What type of symport is the loop diuretics?inhibitor of Na/K/2Cl symport
where do loop diuretics workthick ascending limb of the loop of henle
What type of symport is thiazides?inhibitors of Na/Cl symport
where to thiaziedes work?distal convoluted tubule
Where do mineralocorticoid receptor antagonist work?late distal tubule and collecting duct
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Section 3

Question Answer
What are the characteristics of osmotic diuretics freely filtered in glomerulus, limited reabsorption, relatively inert pharmacologically
What are 3 example of osmotic diureticsmannitol, glucose, urea
what is the Mechanism of Action of osmotic diureticsDecrease reabsorption in loop of henle (#1), increased GFR, decrease proximal tubule reabsorption ( hold on to Na so water cat be reabsorbed)
What is the water:electrolyte ratio for osmotic diuretics?Water > electrolytes - increase Na and Mg excretion
What are the therapeutic uses of osmotic diuretics?anuric/oliguric renal failure, nephroprotection, control intraocular pressure (glaucoma), decrease cerebral edema
What are the toxicity and adverse effects of diureticspatients that cannot tolerate increase ECF volume, hyponatremia
What are inhibitors of Na/K/2Cl symport commonly known as?loop diuretics
how potent are loop duretics?highly efficacious - 25% of Na reabsorbed in the loop of henle.
how is the reabsorption of distal segments?limited
What are 3 examples of Na/K/2Cl symportfurosemide (#1), bumetamide, torsemide
What is the mechansim of action of loop diuretics?block Na/K/Cl symport - thick ascending loop - leading to salt transport virtually stops at this site
describe the Wate:electrolyte ratio of loop diruetics Water = electrolyte-- you see an increase in Na, K, Ca, Ma excretion
What are the therapeutic uses of loop diureticsAnuric/Oliguric Renal failure, acute pulmonary edema, edematous states, ascites, CHF
What are the toxicity and adverse effects of loop diuretics (diuretic-releated)Dehydration and hypotension, hyponaturemia, hypochloremia, hypokalemia (long term can see K and Mg depletion)
What is the drug of choice for pulmonary edema?loop diuretics
What are common drug interaction of loop diureticsAminoglycosides #1 , digitalis, propranolol, thiazides
what 2 drugs lead to increase toxicity with loop diuretics?aminoglycosides and digitalis
Which drug causes a synergistic effect of diuresis when combined with a loop diuretic thiazides
what are inhibitors of Na/Cl symport?thiazides
What is the potency of thiazides less potent then loop diuretics- 90% of Na is reabsorbed before reaching the distal tubules
What type of effect does thiazide causea synergistic diuretic effect
what are thiazides better then loop diureticsless dehydration and hypokalemia
What are examples of thiazides?Chlorothiazide, hydrochlorothiazide (also metolazone)
Mechansim of action of thiazides Block the Na/Cl symport in the distal convoluted tubule. Maximum excretion of filtered load of Na is 5%. Does not alfter renal repsone to hydropenia
describe the water: electrolyte ratio thiazides Water = Electrolytes: increase in K and variable Ca excretion
What is the therapeutic use of thiazides Edematous states, CHF, ascities, Calcium oxalate stones (adjuvant therapy), nephrogenic diabetes insipidus
What are the toxicity and adverse effects of thiazidesless prnounced than with loop diuretics, dehydration and hypotension, hyponaturemia, hypochloremia, hypokalemia
What are mineralocorticoid receptor antagonists commonly known asAldosterone antagonist or K sparing diuretics
how does mineralocorticoid receptor antagonists become more effectsthey are competitive inhibtors - more of an effect via increased aldosterone
what is the main example of mineralocorticoid receptor antagonists ?Spironolactone and (eplerenone
What is the mechansim of action of mineralocorticoid receptor antagonistsBlock the mineralocorticoid receptor at the late distal convoluted tubule and collecting duct. Its a competitive inhibitor that does not alter renal response to hydropenia
What is the water:electrolytes ratio of mineralocorticoid receptor antagonists Water = electrolytes you see a decrease in K and Mg excretion
What are the therapeutic uses of mineralocorticoid receptor antagonists Main function: used as a 2nd diuretic in CHF (may prolong survival). Other: primary hyperaldosteronism, proteinuria and hypertension. Also a 2nd diruetic for edema and ascities (ess. in cirrhosis)
What are the toxicity and adverse effects of mineralocorticoid receptor antagonists Hyperkalemia, severe facial ulcerative dermatitis
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