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The kidneys maintain __________ and ____________ of the body fluids constant despite wide variation in the daily intake of water and solutes.
Volume and composition
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The kidney’s filter how much blood a day?
180 Liters
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How much urine is produced in a day?
~1.5 Liter
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What are the common clinical reasons for diuretic use?
Essential Hypertension and Edema associated with Liver failure, CHF and Kidney Failure
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What type of diuretics can be classified as “K loosing”?
Thiazide diuretics, loop diuretics, carbonic anhydrase inhibitors and osmotic diuretics
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What diuretics can be classified as K sparing?
Spirolactone, Triamterene and amiloride
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What is the MOA of Thiazide diuretics?
Na/Cl blockers
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What is the MOA of Loop diuretics?
Na/K/2Cl cotransporter blockers
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Are Carbonic anhydrase inhibitors commonly used?
No
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What is the MOA of Spirolactone?
Aldosterone antagonist, blocks aldosterone binding to the receptor reducing N reabsorption and K excretion
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What is the MOA of triamterene and amoliride?
Blocks Na channel in collecting duct, reducing Na reabsorption and K excretion
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What part of the nephron does Mannitol act on?
Proximal convoluted tubule
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What part of the nephron does Furosemide act on?
Thick segmented ascending loop
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What part of the nephron do Thiazides act on?
Early distal convoluted tubule
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What part of the nephron do Spirolactone and Triamterene act on?
Late distal convoluted tubule and the collecting duct
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Do K sparing diuretics cause a substantial increase in Urine volume?
No, very modest
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What is the brand name for Spirolactone?
Aldactone
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What is the OOA for Spirolactone?
48 hours
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Why does it take 48 hours for Spirolactone to have an effect?
Steroids (aldosterone) produce slow effects
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What is Spirolactone often used in combination with?
Loop or Thiazide diuretics
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What is Spirolactone used to treat?
Hypertension and edema, hyperaldosteronism, reduce mortality in patients with Severe HF
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What are the adverse effect of Spirolactone?
Hyperkalemia, endocrine effects (gynecomastia, menstrual irregularities, impotence, hirsutism, voice deepening)
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Spirolactone directly blocks Na reabsorption (True/False)
False
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What drugs should Spirolactone or other K-sparing diuretics not be co-administered with?
Any drugs that increase plasma K, like ACE inhibitors
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A patient on an ACE inhibitor can be given a K-sparing diuretic (True/False)
False, ACE inhibitors can increase potassium levels
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Effects of Tramterene/Amiloride or Spirolactone occur more quickly?
Tramterene/Amiloride
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Why does Tramterene/Amiloride have a fast OOA that Spirolactone?
Tramterene/Amiloride directly block the Na channel
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What is the OOA of Tramterene/Amiloride?
2-4 hours
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What is the DOA for Tramterene/Amiloride?
12-16 hours
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Tramterene/Amiloride are used in the treatment of what?
Edema and Hypertension
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What are Tramterene/Amiloride often used in combination with?
Loop or Thiazide Diuretics
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What are the potential adverse effects of Tramterene/Amiloride?
Hyperkalemia, N and V, Leg cramps, dizziness, blood dyscrasias
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What is the MOA for thiazide diuretics?
Blocks Na/Cl co-transporter in early distal tubule
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Rank Diuresis effects of the following: Thiazide diuretics, Loop diuretics and K sparing diuretics
Loop diuretics > Thiazide diuretics > K sparing diuretics
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Under what conditions do thiazide diuretics not work well?
Low renal blood flow/Glomerular filtration rate
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Why should you not take Thiazide diuretics at bedtime?
Diuresis begins 2 hours after taking and ends 12 hours later
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In what form and by what route are Thiazide Diuretics excreted?
Unchanged in urine
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Thiazide diuretics cause peak diuresis at what time point?
4-6 hours after administration
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