Pharm (Final)
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| Which 2 GFR forces favor filtration? | 1)glomerular hydrostatic pressure (60mmHg), 2)Bowman's capsule colloid osmotic pressure (0mmHg)
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| Which 2 GFR forces oppose filtration? | 1)Bowman's capsule hydrostatic pressure (18mmHg), 2)Glomerular capillary colloid osmotic pressure (32mmHg)
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| What is the net filtration pressure? | 10mmHg
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| What is the "autoregulation" range in MAP? | 50-150mmHg
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| GFR is normally preserved by maintaining a constant _____________ over a range of systemic blood pressures. | renal blood flow
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| How does HTN affect GFR and RBF? | hypertensive pts have a higher GFR when RBF is constant
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| What are the 2 types of autoregulation of RBF and GFR? | 1)myogenic, 2)tubuloglomerular
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| Describe myogenic autoregulation of RBF and GFR. | inc. arterial pressure stretches afferent arteriole wall then a reflex constriction occurs; dec. arterial pressure causes arteriole dilation
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| Describe tubuloglomerular autoregulation of RBF and GFR. | dec. RBF --> dec. GFR which results in afferent arteriolar dilation which inc. GFR and RBF and restores filatration; renin release --> angiotensin II --> inc. GFR
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| Where does the term "diuretic" originate? | dioure'tos: Greek word meaning to urinate
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| What are 3 solutes found in urine? | 1) electrolytes (Na+, K+, Cl-, HCO3), 2)waste products (creatinine), 3)pharmacologic metabolites
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| What are 6 indications for diuretic use? | 1)reduce HTN, 2)treat pulmonary and peripheral edema, 3)electrolyte and pH corrections (hyperkalemia), 4)reduce ICP/brain bulk, 5)prevent ARF due to ischemic insult, 6)drug clearance
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| Urine excretion=? | filtration rate - reabsorption rate + secretion rate
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| What 2 things determine classifications of diuretics? | 1)site of action on renal tubules, 2)how they excrete solute
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| What are the 5 main classifications of diuretics? | 1)thiazide, 2)loop, 3)osmotic, 4)potassium-sparing, 5)carbonic-anhydrase inhibitors
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| What are 4 examples of loop diuretics? | 1)Lasix, 2)torsemide, 3)bumex, 4)edecrin
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| What is the mechanism of action of loop diuretics? | inhibit reabsorption of NaCl in ascending loop
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| How do loop diuretics decrease BP? | decreases intravascular fluid volume; stimulates production of prostaglandins (vasodilation)
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| Which is the most effective diuretic class? | loop diuretics
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| True or False: Thiazide diuretics work faster than loop diuretics. | False: Loop diuretics work faster than thiazide diuretics
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| Loop diuretics (increase or don't increase?) RBF, and (increase or don't increase?) GFR. | increase RBF, don't increase GFR
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| What are some indications of loop diuretics? | 1)rapid intravascular fluid removal, 2)hyperkalemia treatment, 3)acute pulmonary edema, 3)kidney stone extraction, lithotripsy, 4)reduce ICP
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| In what 2 ways do loop diuretics decrease ICP? | 1)systemic diuresis and dec. CSF production, 2)can be used in combination with mannitol
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| What are 9 disadvantages to loop diuretics? | 1)hypokalemia, 2)depletes myocardial K+ stores, 3)potential digitalis toxicity, 4)enhanced NMB effects, 5)ototoxicity, 6)cardiac dysrhythmias, 7)mild hyperglycemia, 8)orthostatic hypotension, 9)hemoconcentration
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| What are some examples of thiazide diuretics? | 1)diuril, 2)chlorthalidone, 3)indapamide, 4)hydrochlorothiazide, 5)benzthiazide, 6)cyclothiazide, 7)metolazone
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| What is the mechanism of action of thiazide diuretics? | inhibits reabsorption of NaCl in loop, proximal and distal tubules
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| What are some indications for thiazide diuretics? | 1)reduces edema, 2)reduces intravascular fluid volume, 3)treatment for HTN, 4)treatment for CHF edema, 5)treatment for renal failure
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| How do thiazide diuretics decrease BP? | diuresis, vasodilation (dec. SNS in peripheral vascular smooth muscle d/t dec. total body Na+ stores)
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| Which electrolytes are excreted by thiazide diuretics? | Na+, Cl-, bicarb, Mg+, K+
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| What are some adverse effects of thiazide diuretics? | hypokalemia, hypomagnesemia, hypochloremia, hyperglycemia, hyperuricemia, orthostatic hypotension, hemoconcentration, gouty arthritis
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| What are some potential complications of hypokalemia? | digitalis toxicity, cardiac dysrhythmias, muscle weakness, neuropathy, potentiation of NMB
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| What are 2 examples of osmotic diuretics? | mannitol, urea
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| What is the site of action of osmotic diuretics? | proximal convoluted tubule, loop of henle
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| Osmotic diuretics (do or don't?) affect GFR. | don't
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| What is the mechanism of action of osmotic diuretics? | large molecular weight molecule; filtered but too large to be reabsorbed; acute expansion of intravascular fluid volume
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| What is the most typical use for osmotic diuretics? | in craniotomies to reduce brain bulk
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| What are some side effects of osmotic diuretics? | increased intravascular volume until filtered; rebound HTN in non-intact BBB, pulmonary edema, can exacerbate CHF, electrolyte disturbances
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| What are some indications for mannitol? | 1)reduction of ICP and brain mass, 2)reduction of high IOP when unable to lower pressure by any other mechanism, 3)urinary excretion of toxic materials
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| What is an example of an aldosterone antagonist? | aldactone (spironolactone)
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| What is the mechanism of action of aldosterone antagonists? | competes with aldosterone; allows secretion of Na+ and Cl-
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| What are 2 indications for use of aldosterone antagonists? | edema reduction r/t: 1)CHF, 2)liver cirrhosis
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| What is a side effect of aldosterone antagonists? | hyperkalemia
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| Aldosterone antagonists are often given with... | thiazide diuretics
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| What are 2 examples of potassium-sparing diuretics? | 1)triamaterene, 2)amiloride
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| What is the mechanism of action of potassium-sparing diuretics? | spares K+ independent of aldosterone; increased excretion of Na+, Cl-, bicarb
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| What is the site of action of potassium-sparing diuretics? | distal tubules and collecting ducts
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| What is a common use of potassium-sparing diuretics? | used in combination with loop diuretics to limit potassium losses in the distal tubule
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| True or False: Potassium-sparing diuretics are used alone as anti-HTN or for edema. | False (used in combo.)
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| What is a side-effect of potassium-sparing diuretics? | hyperkalemia
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| Which pts should use potassium-sparing diuretics cautiously? | pts prone to hyperkalemia, pts using ACEi, NSAIDS
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| What are 2 examples of carbonic anhydrase inhibitors? | Diamox, neptazane
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| What is the site of action of carbonic anhydrase inhibitors? | proximal tubules
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| What is the mechanism of action of carbonic anhydrase inhibitors? | inhibits Ca+, blocks Nabicarb and causes diuresis
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| What is a common indication for carbonic anhydrase inhibitors? | used in glaucoma to reduce IOP by decreasing aqueous humor
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| What are 4 side effects of carbonic anhydrase inhibitors? | 1)hyperchloremic metabolic acidosis, 2)drowsiness, 3)paresthesia, 4)renal caliculi
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| Aldactazide is a combo drug of __________ + __________. | spironolactone + HCTZ
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| Dyaside is a combo drug of __________ + __________. | triamterene + HCTZ
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| Hydra-zide is a combo drug of __________ + __________. | hydralazine + HCTZ
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| Clopress is a combo drug of ___________ + _________. | clonidine + chlothalidone
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| Which diuretic class is known to cause gouty arthritis? | thiazide diuretics
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| Which diuretic class is a treatment for glaucoma? | carbonic anhydrase inhibitors
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| Which diuretic class can cause rebound HTN in pts w/ non-intact BBB? | osmotic diuretics
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| Which diuretic class can cause mild hyperglycemia? | loop, thiazide diuretics
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| Which diuretic class should be taken cautiously in pts taking ACE inhibitors and NSAIDs? | potassium sparing diuretics
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| Which diuretic class can cause temporary or permanent deafness? | loop diuretics
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| Which diuretic class can cause pulmonary edema? | osmotic diuretics
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| Which diuretic class dec. ICP? | loop, osmotic diuretics
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| Which diuretic class dec. IOP? | osmotic diuretics, carbonic anhydrase inhibitors
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| Which diuretic class is used for urinary excretion of toxic materials? | osmotic diuretics
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| Which diuretic class is used for lithotripsy? | loop diuretics
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| Which diuretics class can cause drowsiness, paresthesia, and renal caliculi? | carbonic anhydrase inhibitors
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| Which diuretic class can cause hypochloremic metabolic acidosis? | thiazide diuretics, carbonic anhydrase inihibitors
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