Podcast
Questions and Answers
Which of the following is an acute complication of Acute Kidney Injury (AKI)?
Which of the following is an acute complication of Acute Kidney Injury (AKI)?
- Nutritional deficiencies
- Fluid overload (correct)
- Progression to chronic kidney disease
- Long-term cardiovascular complications
Diuretics increase urine output by enhancing absorption of sodium and water in the nephron.
Diuretics increase urine output by enhancing absorption of sodium and water in the nephron.
False (B)
What is the primary site of action for thiazide diuretics?
What is the primary site of action for thiazide diuretics?
Distal convoluted tubule
______ is the brand name for the loop diuretic furosemide.
______ is the brand name for the loop diuretic furosemide.
Match the following diuretics with their sites of action:
Match the following diuretics with their sites of action:
What is the main pharmacologic reason for the high efficacy of loop diuretics?
What is the main pharmacologic reason for the high efficacy of loop diuretics?
Spironolactone and triamterene can both potentially cause hypokalemia.
Spironolactone and triamterene can both potentially cause hypokalemia.
What type of reaction can sulfonamide-containing diuretics trigger in sensitive patients?
What type of reaction can sulfonamide-containing diuretics trigger in sensitive patients?
What is the primary effect of K-sparing diuretics on serum potassium levels?
What is the primary effect of K-sparing diuretics on serum potassium levels?
Loop diuretics are associated with the risk of hyperkalemia.
Loop diuretics are associated with the risk of hyperkalemia.
List one common clinical use for loop diuretics.
List one common clinical use for loop diuretics.
The _____ is used for drug dosing adjustments in acute kidney injury (AKI).
The _____ is used for drug dosing adjustments in acute kidney injury (AKI).
Match the following findings with the type of Acute Kidney Injury (AKI):
Match the following findings with the type of Acute Kidney Injury (AKI):
Which of the following drugs is associated with prerenal AKI?
Which of the following drugs is associated with prerenal AKI?
Name one indication for renal replacement therapy (RRT).
Name one indication for renal replacement therapy (RRT).
Daily labs should include monitoring serum electrolytes and creatinine in AKI patients.
Daily labs should include monitoring serum electrolytes and creatinine in AKI patients.
What effect do K-sparing diuretics have on serum potassium levels?
What effect do K-sparing diuretics have on serum potassium levels?
Loop diuretics are typically used to treat hypertension.
Loop diuretics are typically used to treat hypertension.
What is the common clinical use for thiazide diuretics?
What is the common clinical use for thiazide diuretics?
Drugs like NSAIDs can lead to prerenal Acute Kidney Injury (AKI) because they reduce _____ mediated afferent vasodilation.
Drugs like NSAIDs can lead to prerenal Acute Kidney Injury (AKI) because they reduce _____ mediated afferent vasodilation.
What is a common risk associated with using ACE inhibitors in combination with K-sparing diuretics?
What is a common risk associated with using ACE inhibitors in combination with K-sparing diuretics?
Monitoring intake and output is essential for managing patients with Acute Kidney Injury (AKI).
Monitoring intake and output is essential for managing patients with Acute Kidney Injury (AKI).
What is the standard IV dose range for furosemide?
What is the standard IV dose range for furosemide?
The hallmark of Acute Kidney Injury (AKI) is the decline in _____.
The hallmark of Acute Kidney Injury (AKI) is the decline in _____.
Name one indication for renal replacement therapy (RRT).
Name one indication for renal replacement therapy (RRT).
What is a chronic complication of Acute Kidney Injury (AKI)?
What is a chronic complication of Acute Kidney Injury (AKI)?
Diuretics work by promoting the reabsorption of sodium and water in the nephron.
Diuretics work by promoting the reabsorption of sodium and water in the nephron.
What is the brand name for spironolactone?
What is the brand name for spironolactone?
Drug formulations for IV must be sterile and _____.
Drug formulations for IV must be sterile and _____.
Match the following diuretics with their sites of action:
Match the following diuretics with their sites of action:
Which electrolyte is commonly increased as a side effect of loop diuretics?
Which electrolyte is commonly increased as a side effect of loop diuretics?
Thiazide diuretics increase potassium excretion.
Thiazide diuretics increase potassium excretion.
What is the mechanism of action of loop diuretics at the cellular level?
What is the mechanism of action of loop diuretics at the cellular level?
Spironolactone acts as an _____ receptor antagonist.
Spironolactone acts as an _____ receptor antagonist.
Which of the following is a common adverse effect of thiazide diuretics?
Which of the following is a common adverse effect of thiazide diuretics?
Which mechanism does Angiotensin II primarily utilize to increase glomerular capillary hydrostatic pressure?
Which mechanism does Angiotensin II primarily utilize to increase glomerular capillary hydrostatic pressure?
What is a significant effect of Angiotensin II on systemic hydrostatic pressure?
What is a significant effect of Angiotensin II on systemic hydrostatic pressure?
Which diuretic is NOT classified as a potassium-sparing diuretic?
Which diuretic is NOT classified as a potassium-sparing diuretic?
Which statement regarding the osmotic diuretic Mannitol is accurate?
Which statement regarding the osmotic diuretic Mannitol is accurate?
Which combination product includes hydrochlorothiazide?
Which combination product includes hydrochlorothiazide?
What is the primary action of thiazide diuretics on plasma electrolytes?
What is the primary action of thiazide diuretics on plasma electrolytes?
Which of the following diuretics is known for having a similarity in structure to sulfonamides?
Which of the following diuretics is known for having a similarity in structure to sulfonamides?
How does Angiotensin II indirectly promote vasodilation?
How does Angiotensin II indirectly promote vasodilation?
Which loop diuretic is also known by the brand name 'Bumex'?
Which loop diuretic is also known by the brand name 'Bumex'?
Which of the following drugs is primarily used for acute management of conditions leading to fluid overload?
Which of the following drugs is primarily used for acute management of conditions leading to fluid overload?
What physiological effect occurs when the efferent arteriole constricts?
What physiological effect occurs when the efferent arteriole constricts?
An increased glomerular filtration rate (GFR) is most likely to result from which of the following mechanisms?
An increased glomerular filtration rate (GFR) is most likely to result from which of the following mechanisms?
What is a potential consequence of an increased GFR?
What is a potential consequence of an increased GFR?
How does efferent arteriole constriction primarily affect kidney function?
How does efferent arteriole constriction primarily affect kidney function?
Which of the following statements best describes the relationship between efferent arteriole constriction and urine output?
Which of the following statements best describes the relationship between efferent arteriole constriction and urine output?
What is the minimum increase in serum creatinine (SCr) that qualifies as Acute Kidney Injury (AKI) within a 48-hour period?
What is the minimum increase in serum creatinine (SCr) that qualifies as Acute Kidney Injury (AKI) within a 48-hour period?
Which diuretic mechanism primarily causes electrolyte excretion in the kidneys?
Which diuretic mechanism primarily causes electrolyte excretion in the kidneys?
What does the fractional excretion of sodium (FeNa) help to assess in AKI diagnosis?
What does the fractional excretion of sodium (FeNa) help to assess in AKI diagnosis?
In relation to pharmacokinetics of loop diuretics, what is a common resistance mechanism noted in patients?
In relation to pharmacokinetics of loop diuretics, what is a common resistance mechanism noted in patients?
What lab finding is typically monitored daily to assess the impact of AKI on a patient?
What lab finding is typically monitored daily to assess the impact of AKI on a patient?
What effect does afferent arteriole dilation have on peritubular capillary oncotic pressure?
What effect does afferent arteriole dilation have on peritubular capillary oncotic pressure?
What is the net effect of constricting the efferent arteriole on filtration and reabsorption?
What is the net effect of constricting the efferent arteriole on filtration and reabsorption?
Which statement is true regarding the changes that occur when the afferent arteriole is constricted?
Which statement is true regarding the changes that occur when the afferent arteriole is constricted?
What is the effect of dilating the efferent arteriole on glomerular filtration?
What is the effect of dilating the efferent arteriole on glomerular filtration?
How does constriction of the afferent arteriole affect the risk of developing prerenal acute kidney injury?
How does constriction of the afferent arteriole affect the risk of developing prerenal acute kidney injury?
Which factor primarily influences the oncotic pressure in peritubular capillaries after fluid has exited the glomerulus?
Which factor primarily influences the oncotic pressure in peritubular capillaries after fluid has exited the glomerulus?
What is the overall effect of the renal actions of prostaglandins on afferent arterioles?
What is the overall effect of the renal actions of prostaglandins on afferent arterioles?
What is the relationship between increased glomerular hydrostatic pressure and peritubular capillary reabsorption?
What is the relationship between increased glomerular hydrostatic pressure and peritubular capillary reabsorption?
Which diuretic class is associated with the development of metabolic acidosis due to a significant decrease in bicarbonate levels?
Which diuretic class is associated with the development of metabolic acidosis due to a significant decrease in bicarbonate levels?
What is the primary mechanism by which NSAIDs contribute to prerenal Acute Kidney Injury?
What is the primary mechanism by which NSAIDs contribute to prerenal Acute Kidney Injury?
Which type of diuretic primarily increases calcium reabsorption, leading to decreased calcium excretion?
Which type of diuretic primarily increases calcium reabsorption, leading to decreased calcium excretion?
Which of the following medications is most likely to cause intrinsic AKI through crystalluria or nephrotoxicity?
Which of the following medications is most likely to cause intrinsic AKI through crystalluria or nephrotoxicity?
Which type of diuretic is associated with both a decrease in sodium and an increase in bicarbonate levels, potentially leading to metabolic alkalosis?
Which type of diuretic is associated with both a decrease in sodium and an increase in bicarbonate levels, potentially leading to metabolic alkalosis?
In the context of Acute Kidney Injury, which medication is primarily responsible for postrenal AKI by precipitating crystals in the tubules?
In the context of Acute Kidney Injury, which medication is primarily responsible for postrenal AKI by precipitating crystals in the tubules?
Which of the following diuretics does not cause any change in uric acid levels?
Which of the following diuretics does not cause any change in uric acid levels?
How do ACE Inhibitors and NSAIDs interact to worsen prerenal AKI?
How do ACE Inhibitors and NSAIDs interact to worsen prerenal AKI?
What is the mechanism of action of acetazolamide?
What is the mechanism of action of acetazolamide?
Which of the following effects is associated with furosemide administration?
Which of the following effects is associated with furosemide administration?
What is the primary site of action for hydrochlorothiazide?
What is the primary site of action for hydrochlorothiazide?
Which drug class does spironolactone belong to?
Which drug class does spironolactone belong to?
What adverse effect is commonly associated with the use of NSAIDs?
What adverse effect is commonly associated with the use of NSAIDs?
What is the primary effect of mannitol in renal physiology?
What is the primary effect of mannitol in renal physiology?
Which diuretic specifically reduces sodium reabsorption while increasing potassium retention?
Which diuretic specifically reduces sodium reabsorption while increasing potassium retention?
What is the mechanism by which ACE inhibitors lower blood pressure?
What is the mechanism by which ACE inhibitors lower blood pressure?
What is the total osmolarity contributed by 30 mM of glucose, 20 mM of CaCl₂, and 10 mM of KCl?
What is the total osmolarity contributed by 30 mM of glucose, 20 mM of CaCl₂, and 10 mM of KCl?
Which of the following substances contributes the highest number of particles to osmolarity in solution?
Which of the following substances contributes the highest number of particles to osmolarity in solution?
When fluid overload is unresponsive to diuretics, what condition can likely arise as a complication?
When fluid overload is unresponsive to diuretics, what condition can likely arise as a complication?
Which of the following conditions is characterized by symptoms such as pericarditis and encephalopathy?
Which of the following conditions is characterized by symptoms such as pericarditis and encephalopathy?
In osmolarity calculations, how does the dissociation of electrolytes like CaCl₂ and KCl affect the total osmolarity compared to non-dissociating compounds like glucose?
In osmolarity calculations, how does the dissociation of electrolytes like CaCl₂ and KCl affect the total osmolarity compared to non-dissociating compounds like glucose?
What is the primary mechanism of action for carbonic anhydrase inhibitors?
What is the primary mechanism of action for carbonic anhydrase inhibitors?
Which of the following types of AKI is characterized by an increase in fractional excretion of sodium (FeNa) greater than 1%?
Which of the following types of AKI is characterized by an increase in fractional excretion of sodium (FeNa) greater than 1%?
What is the clinical significance of a serum creatinine increase of 0.3 mg/dL within a 48-hour period?
What is the clinical significance of a serum creatinine increase of 0.3 mg/dL within a 48-hour period?
Which electrolyte imbalance is a key indication for renal replacement therapy (RRT)?
Which electrolyte imbalance is a key indication for renal replacement therapy (RRT)?
Which treatment strategy is appropriate for prerenal AKI associated with volume depletion?
Which treatment strategy is appropriate for prerenal AKI associated with volume depletion?
In the context of diuretics, which class is known to potentially cause hyperuricemia as a side effect?
In the context of diuretics, which class is known to potentially cause hyperuricemia as a side effect?
What distinguishes intrinsic AKI from prerenal and postrenal AKI during urinalysis?
What distinguishes intrinsic AKI from prerenal and postrenal AKI during urinalysis?
Which class of diuretics primarily works at the distal convoluted tubule?
Which class of diuretics primarily works at the distal convoluted tubule?
Which diuretic class primarily inhibits sodium reabsorption in the distal convoluted tubule?
Which diuretic class primarily inhibits sodium reabsorption in the distal convoluted tubule?
What is a notable characteristic of osmotic diuretics like Mannitol in relation to kidney function?
What is a notable characteristic of osmotic diuretics like Mannitol in relation to kidney function?
Which mechanism of action is characteristic of ACE inhibitors in the context of AKI?
Which mechanism of action is characteristic of ACE inhibitors in the context of AKI?
In patients with renal impairment, which class of drugs is likely to worsen prerenal AKI?
In patients with renal impairment, which class of drugs is likely to worsen prerenal AKI?
Which is the primary mechanism of action for potassium-sparing diuretics classified as aldosterone antagonists?
Which is the primary mechanism of action for potassium-sparing diuretics classified as aldosterone antagonists?
Which of the following drugs is known to potentially cause post-renal AKI due to direct nephrotoxicity?
Which of the following drugs is known to potentially cause post-renal AKI due to direct nephrotoxicity?
Which type of diuretic is primarily associated with the risk of causing hypokalemia?
Which type of diuretic is primarily associated with the risk of causing hypokalemia?
Which statement accurately describes the impact of thiazide diuretics on serum electrolytes?
Which statement accurately describes the impact of thiazide diuretics on serum electrolytes?
Which diuretic should be used cautiously in patients with heart failure due to its potassium-sparing effects?
Which diuretic should be used cautiously in patients with heart failure due to its potassium-sparing effects?
Which diuretic may require monitoring of lithium levels due to potential drug interactions?
Which diuretic may require monitoring of lithium levels due to potential drug interactions?
Which diuretic may result in hearing loss if administered in large doses or used over a prolonged period?
Which diuretic may result in hearing loss if administered in large doses or used over a prolonged period?
Which of the following diuretics is classified as a potassium-sparing diuretic?
Which of the following diuretics is classified as a potassium-sparing diuretic?
Which combination product contains both hydrochlorothiazide and another diuretic?
Which combination product contains both hydrochlorothiazide and another diuretic?
Which diuretic is known for its use via intravenous administration in acute cases of fluid overload?
Which diuretic is known for its use via intravenous administration in acute cases of fluid overload?
Which of the following statements accurately describes a characteristic of thiazide diuretics?
Which of the following statements accurately describes a characteristic of thiazide diuretics?
Which loop diuretic is known by the brand name 'Lasix'?
Which loop diuretic is known by the brand name 'Lasix'?
Which of the following diuretics belongs to the combination products class?
Which of the following diuretics belongs to the combination products class?
Which loop diuretic is unique in that it does not have a brand name specified in the document?
Which loop diuretic is unique in that it does not have a brand name specified in the document?
Which of the following potassium-sparing diuretics is specifically noted for its brand name in the document?
Which of the following potassium-sparing diuretics is specifically noted for its brand name in the document?
What is the effect of afferent arteriole dilation on glomerular filtration rate (GFR)?
What is the effect of afferent arteriole dilation on glomerular filtration rate (GFR)?
Constriction of the efferent arteriole directly decreases glomerular pressure (PGC) and GFR.
Constriction of the efferent arteriole directly decreases glomerular pressure (PGC) and GFR.
What effect does efferent arteriole dilation have on glomerular filtration rate (GFR)?
What effect does efferent arteriole dilation have on glomerular filtration rate (GFR)?
Efferent arterioles have an __________ relationship with glomerular filtration rate (GFR).
Efferent arterioles have an __________ relationship with glomerular filtration rate (GFR).
Match the actions with their effects on GFR:
Match the actions with their effects on GFR:
Which of the following statements about aldosterone antagonists is true?
Which of the following statements about aldosterone antagonists is true?
NSAIDs can lead to increased GFR by dilating afferent arterioles.
NSAIDs can lead to increased GFR by dilating afferent arterioles.
Name one clinical use for ACE inhibitors.
Name one clinical use for ACE inhibitors.
Which of the following drugs is less likely to cause gynecomastia?
Which of the following drugs is less likely to cause gynecomastia?
ENaC blockers act independently of aldosterone.
ENaC blockers act independently of aldosterone.
List one condition where aldosterone antagonists are particularly useful.
List one condition where aldosterone antagonists are particularly useful.
The drug ______ is classified as an ENaC blocker.
The drug ______ is classified as an ENaC blocker.
Match the following drugs with their class:
Match the following drugs with their class:
What is a primary effect of both Aldosterone-Dependent and Aldosterone-Independent drugs on potassium levels?
What is a primary effect of both Aldosterone-Dependent and Aldosterone-Independent drugs on potassium levels?
Amiloride works by inhibiting the aldosterone receptor.
Amiloride works by inhibiting the aldosterone receptor.
What is the effect of spironolactone on sodium reabsorption?
What is the effect of spironolactone on sodium reabsorption?
What effect does afferent arteriole constriction have on glomerular filtration rate (GFR)?
What effect does afferent arteriole constriction have on glomerular filtration rate (GFR)?
The efferent arteriole plays a crucial role in decreasing glomerular hydrostatic pressure.
The efferent arteriole plays a crucial role in decreasing glomerular hydrostatic pressure.
What is the primary mechanism of osmotic diuretics in the nephron?
What is the primary mechanism of osmotic diuretics in the nephron?
The ______ is the equation used to estimate creatinine clearance.
The ______ is the equation used to estimate creatinine clearance.
Which diuretic class is the most effective at reducing calcium excretion?
Which diuretic class is the most effective at reducing calcium excretion?
Match the following diuretics with their specific action:
Match the following diuretics with their specific action:
When should ideal body weight (IBW) be used in calculating creatinine clearance?
When should ideal body weight (IBW) be used in calculating creatinine clearance?
Prostaglandin synthesis enhances afferent arteriole dilation, increasing GFR.
Prostaglandin synthesis enhances afferent arteriole dilation, increasing GFR.
Which class of diuretics is most associated with causing hypokalemia?
Which class of diuretics is most associated with causing hypokalemia?
Mannitol is known to increase serum sodium and potassium levels.
Mannitol is known to increase serum sodium and potassium levels.
What is the primary clinical implication of thiazide diuretics increasing uric acid levels?
What is the primary clinical implication of thiazide diuretics increasing uric acid levels?
Acute kidney injury classified as prerenal is mainly due to __________.
Acute kidney injury classified as prerenal is mainly due to __________.
Which drug class is known to be nephrotoxic and should be avoided in AKI patients?
Which drug class is known to be nephrotoxic and should be avoided in AKI patients?
Match the drug with its effect on renal function:
Match the drug with its effect on renal function:
Acetazolamide increases bicarbonate reabsorption in the kidneys.
Acetazolamide increases bicarbonate reabsorption in the kidneys.
Name one drug associated with intrinsic AKI.
Name one drug associated with intrinsic AKI.
Which of the following is a common cause of postrenal acute kidney injury?
Which of the following is a common cause of postrenal acute kidney injury?
Furosemide monitoring requires careful attention to __________ and fluid balance.
Furosemide monitoring requires careful attention to __________ and fluid balance.
Aldosterone antagonists are effective without the presence of aldosterone.
Aldosterone antagonists are effective without the presence of aldosterone.
List one indication for using renal replacement therapy (RRT).
List one indication for using renal replacement therapy (RRT).
Match the following drugs with their effects:
Match the following drugs with their effects:
Which diuretic decreases bicarbonate levels and causes metabolic acidosis?
Which diuretic decreases bicarbonate levels and causes metabolic acidosis?
The AEIOU mnemonic for indications for RRT includes __________, __________, __________, __________, and __________.
The AEIOU mnemonic for indications for RRT includes __________, __________, __________, __________, and __________.
Loop diuretics can increase calcium excretion by inhibiting sodium reabsorption.
Loop diuretics can increase calcium excretion by inhibiting sodium reabsorption.
Which medications can lead to increased risk of acute kidney injury when used together?
Which medications can lead to increased risk of acute kidney injury when used together?
How does afferent arteriole dilation affect glomerular filtration rate (GFR)?
How does afferent arteriole dilation affect glomerular filtration rate (GFR)?
Loop diuretics can potentially cause metabolic alkalosis.
Loop diuretics can potentially cause metabolic alkalosis.
The __________ effect of loop diuretics includes the loss of potassium and metabolic alkalosis.
The __________ effect of loop diuretics includes the loss of potassium and metabolic alkalosis.
How does constriction of the efferent arteriole influence glomerular filtration rate (GFR)?
How does constriction of the efferent arteriole influence glomerular filtration rate (GFR)?
What is the primary mechanism by which spironolactone reduces aldosterone’s effects?
What is the primary mechanism by which spironolactone reduces aldosterone’s effects?
The primary site of action for osmotic diuretics is the ________ of the nephron.
The primary site of action for osmotic diuretics is the ________ of the nephron.
Thiazides are contraindicated in patients with heart failure.
Thiazides are contraindicated in patients with heart failure.
Which of the following diuretics is most commonly associated with ototoxicity when combined with aminoglycosides?
Which of the following diuretics is most commonly associated with ototoxicity when combined with aminoglycosides?
What happens to GFR when the efferent arteriole is constricted?
What happens to GFR when the efferent arteriole is constricted?
NSAIDs can cause __________ AKI by blocking prostaglandin synthesis.
NSAIDs can cause __________ AKI by blocking prostaglandin synthesis.
Which of the following is a characteristic effect of thiazide diuretics?
Which of the following is a characteristic effect of thiazide diuretics?
Osmotic diuretics are beneficial in treating heart failure.
Osmotic diuretics are beneficial in treating heart failure.
What effect does the constriction of the efferent arteriole have on glomerular filtration rate (GFR)?
What effect does the constriction of the efferent arteriole have on glomerular filtration rate (GFR)?
Afferent arteriole dilation will lead to decreased GFR.
Afferent arteriole dilation will lead to decreased GFR.
What is the role of prostaglandins in kidney physiology?
What is the role of prostaglandins in kidney physiology?
The Cockcroft-Gault Equation is used to estimate ______.
The Cockcroft-Gault Equation is used to estimate ______.
Match the following diuretics with their mechanism of action:
Match the following diuretics with their mechanism of action:
What is the primary effect of osmotic diuretics on tubular fluid?
What is the primary effect of osmotic diuretics on tubular fluid?
NSAIDs can lead to decreased GFR by blocking ______ synthesis.
NSAIDs can lead to decreased GFR by blocking ______ synthesis.
What is a common indication for spironolactone?
What is a common indication for spironolactone?
Mannitol increases intracranial pressure by promoting water retention in brain tissue.
Mannitol increases intracranial pressure by promoting water retention in brain tissue.
What electrolyte level is typically increased by thiazide diuretics?
What electrolyte level is typically increased by thiazide diuretics?
ACE inhibitors are avoided in patients with _____ renal artery stenosis due to their effect on GFR.
ACE inhibitors are avoided in patients with _____ renal artery stenosis due to their effect on GFR.
Match the following diuretics with their effects on electrolytes:
Match the following diuretics with their effects on electrolytes:
Which condition is characterized by obstruction leading to AKI?
Which condition is characterized by obstruction leading to AKI?
Loop diuretics lead to hyperkalemia as a common side effect.
Loop diuretics lead to hyperkalemia as a common side effect.
What mechanism do prostaglandins utilize to maintain GFR?
What mechanism do prostaglandins utilize to maintain GFR?
NSAIDs can lead to prerenal AKI by inhibiting _____ mediated afferent dilation.
NSAIDs can lead to prerenal AKI by inhibiting _____ mediated afferent dilation.
What adverse effect is associated with combining loop diuretics and aminoglycosides?
What adverse effect is associated with combining loop diuretics and aminoglycosides?
Flashcards
Acute Kidney Injury (AKI) - Acute Complications
Acute Kidney Injury (AKI) - Acute Complications
Fluid overload, electrolyte imbalances (like hyperkalemia), metabolic acidosis, and uremia.
Acute Kidney Injury (AKI) - Chronic Complications
Acute Kidney Injury (AKI) - Chronic Complications
Progression to chronic kidney disease (CKD) and long-term cardiovascular complications.
Diuretics - Mechanism
Diuretics - Mechanism
Increase urine production by inhibiting sodium and water reabsorption in the nephron.
Loop Diuretics - Site of Action
Loop Diuretics - Site of Action
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Loop Diuretics - Mechanism
Loop Diuretics - Mechanism
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Thiazide Diuretics - Site of Action
Thiazide Diuretics - Site of Action
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Thiazide Diuretics - Mechanism
Thiazide Diuretics - Mechanism
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K-Sparing Diuretics - Site of Action
K-Sparing Diuretics - Site of Action
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Spironolactone - Mechanism
Spironolactone - Mechanism
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Triamterene - Mechanism
Triamterene - Mechanism
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Diuretic Efficacy
Diuretic Efficacy
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Diuretic Potency
Diuretic Potency
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Loop Diuretic Efficacy Explanation
Loop Diuretic Efficacy Explanation
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Loop Diuretics - Serum Effect (Sodium)
Loop Diuretics - Serum Effect (Sodium)
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Loop Diuretics - Serum Effect (Potassium)
Loop Diuretics - Serum Effect (Potassium)
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Loop Diuretics - Serum Effect (Calcium)
Loop Diuretics - Serum Effect (Calcium)
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Loop Diuretics - Serum Effect (Uric Acid)
Loop Diuretics - Serum Effect (Uric Acid)
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Thiazide Diuretics - Serum Effect (Sodium)
Thiazide Diuretics - Serum Effect (Sodium)
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Thiazide Diuretics - Serum Effect (Potassium)
Thiazide Diuretics - Serum Effect (Potassium)
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Thiazide Diuretics - Serum Effect (Calcium)
Thiazide Diuretics - Serum Effect (Calcium)
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IV Drug Formulation - Sterility
IV Drug Formulation - Sterility
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IV Drug Formulation - Pyrogens
IV Drug Formulation - Pyrogens
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AKI Prevention Examples
AKI Prevention Examples
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AKI Definition
AKI Definition
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Fractional Excretion of Sodium (FeNa)
Fractional Excretion of Sodium (FeNa)
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Loop Diuretics: MOA
Loop Diuretics: MOA
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Aldosterone Antagonists
Aldosterone Antagonists
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NSAID-induced AKI
NSAID-induced AKI
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Glomerular Hydrostatic Pressure (PGC)
Glomerular Hydrostatic Pressure (PGC)
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Peritubular Capillary Oncotic Pressure (πPC)
Peritubular Capillary Oncotic Pressure (πPC)
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How does glomerular filtration affect πPC?
How does glomerular filtration affect πPC?
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Afferent Arteriole Dilation
Afferent Arteriole Dilation
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Afferent Arteriole Constriction
Afferent Arteriole Constriction
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Efferent Arteriole Constriction
Efferent Arteriole Constriction
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Efferent Arteriole Dilation
Efferent Arteriole Dilation
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Relationship between afferent/efferent changes and reabsorption
Relationship between afferent/efferent changes and reabsorption
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Carbonic Anhydrase Inhibitors: Effect on Electrolytes
Carbonic Anhydrase Inhibitors: Effect on Electrolytes
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Loop Diuretics: Effect on Electrolytes
Loop Diuretics: Effect on Electrolytes
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Thiazide Diuretics: Effect on Electrolytes
Thiazide Diuretics: Effect on Electrolytes
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Potassium-Sparing Diuretics: Effect on Electrolytes
Potassium-Sparing Diuretics: Effect on Electrolytes
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NSAIDs and AKI
NSAIDs and AKI
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ACE Inhibitors and AKI
ACE Inhibitors and AKI
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Diuretics and Gout
Diuretics and Gout
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Osmotic Diuretics and Heart Failure
Osmotic Diuretics and Heart Failure
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Acetazolamide Class
Acetazolamide Class
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Acetazolamide Mechanism
Acetazolamide Mechanism
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Mannitol Mechanism
Mannitol Mechanism
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Furosemide Mechanism
Furosemide Mechanism
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Hydrochlorothiazide (HCTZ) Mechanism
Hydrochlorothiazide (HCTZ) Mechanism
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ACE Inhibitors Mechanism
ACE Inhibitors Mechanism
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Osmolarity Calculation
Osmolarity Calculation
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Glucose Contribution to Osmolarity
Glucose Contribution to Osmolarity
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CaCl₂ Contribution to Osmolarity
CaCl₂ Contribution to Osmolarity
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KCl Contribution to Osmolarity
KCl Contribution to Osmolarity
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Total Osmolarity
Total Osmolarity
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Creatinine Clearance (CrCl)
Creatinine Clearance (CrCl)
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Adjusted Body Weight (ABW)
Adjusted Body Weight (ABW)
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Prerenal AKI
Prerenal AKI
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Intrinsic AKI
Intrinsic AKI
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Postrenal AKI
Postrenal AKI
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Potassium-Sparing Diuretics - Mechanism
Potassium-Sparing Diuretics - Mechanism
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Loop Diuretics
Loop Diuretics
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Thiazide Diuretics
Thiazide Diuretics
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Potassium-Sparing Diuretics
Potassium-Sparing Diuretics
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Osmotic Diuretics
Osmotic Diuretics
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Carbonic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitors
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Renal Replacement Therapy (RRT)
Renal Replacement Therapy (RRT)
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Spironolactone (Aldactone®)
Spironolactone (Aldactone®)
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Acetazolamide (Diamox®)
Acetazolamide (Diamox®)
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Furosemide (Lasix®)
Furosemide (Lasix®)
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Hydrochlorothiazide (Microzide®)
Hydrochlorothiazide (Microzide®)
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Mannitol (Osmitrol®)
Mannitol (Osmitrol®)
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Aldosterone - Dependent Drugs
Aldosterone - Dependent Drugs
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ENaC Blockers
ENaC Blockers
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Eplerenone vs. Spironolactone
Eplerenone vs. Spironolactone
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Aldosterone-Dependent vs. Independent Diuretics
Aldosterone-Dependent vs. Independent Diuretics
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Aldosterone Antagonist Uses
Aldosterone Antagonist Uses
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ENaC Blocker Uses
ENaC Blocker Uses
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K+-Sparing Diuretics
K+-Sparing Diuretics
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Key Feature of K+-Sparing Diuretics
Key Feature of K+-Sparing Diuretics
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Cockcroft-Gault Equation
Cockcroft-Gault Equation
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Loop Diuretics: Potassium Levels
Loop Diuretics: Potassium Levels
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Thiazide Diuretics: Calcium Levels
Thiazide Diuretics: Calcium Levels
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Aldosterone Antagonists: Mechanism
Aldosterone Antagonists: Mechanism
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Loop Diuretics: Hypokalemia
Loop Diuretics: Hypokalemia
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Thiazide Diuretics & Uric Acid
Thiazide Diuretics & Uric Acid
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Mannitol's Electrolyte Effects
Mannitol's Electrolyte Effects
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ENaC Blockers: Potassium Retention
ENaC Blockers: Potassium Retention
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Prerenal AKI: Definition
Prerenal AKI: Definition
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Postrenal AKI: Causes
Postrenal AKI: Causes
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RRT Indications: AEIOU
RRT Indications: AEIOU
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ACE Inhibitors & Prerenal AKI
ACE Inhibitors & Prerenal AKI
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NSAID & ACE Inhibitor Synergy in AKI
NSAID & ACE Inhibitor Synergy in AKI
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Loop Diuretics & Ototoxicity
Loop Diuretics & Ototoxicity
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Thiazides & Lithium Toxicity
Thiazides & Lithium Toxicity
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Loop Diuretics & Digoxin: Interactions
Loop Diuretics & Digoxin: Interactions
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Nephrotoxic Drugs in AKI
Nephrotoxic Drugs in AKI
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Nephrotoxic Drugs
Nephrotoxic Drugs
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GFR and Afferent Arteriole
GFR and Afferent Arteriole
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GFR and Efferent Arteriole
GFR and Efferent Arteriole
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Prostaglandins and GFR
Prostaglandins and GFR
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Mannitol's Action
Mannitol's Action
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Spironolactone Uses
Spironolactone Uses
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Diuretics for AKI
Diuretics for AKI
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ACE Inhibitors and Renal Artery Stenosis
ACE Inhibitors and Renal Artery Stenosis
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Loop Diuretics and Uric Acid
Loop Diuretics and Uric Acid
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Loop Diuretics: Electrolyte Effects
Loop Diuretics: Electrolyte Effects
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Thiazide Diuretics: Electrolyte Effects
Thiazide Diuretics: Electrolyte Effects
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Prerenal AKI: Cause
Prerenal AKI: Cause
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Study Notes
Acute Kidney Injury (AKI) Complications
- Acute: Fluid overload, electrolyte imbalances (e.g., hyperkalemia), metabolic acidosis, and uremia.
- Chronic: Progression to chronic kidney disease (CKD) and long-term cardiovascular complications.
Diuretics
- Medications increasing urine production by inhibiting sodium and water reabsorption in the nephron.
Generic Names, Classes, and Brand Names
- Furosemide (Loop Diuretic) → Lasix
- Triamterene (K-sparing diuretic) → Dyrenium
IV Drug Formulations
- Common vehicles are Sterile Water for Injection (SWFI) and Normal Saline.
- Bacteriostatic water is used for multidose vials.
IV Drug Formulation Requirements
- Must be sterile
- Must be pyrogen-free
Chemical Basis for IV Drug Incompatibilities
- Precipitation occurs due to pH changes or incompatibility between cations and anions (e.g., calcium and phosphate).
Sulfonamide Allergy from Diuretics
- Diuretics like loop diuretics (except ethacrynic acid) and thiazides contain sulfonamide groups which may trigger allergic reactions.
Sites of Action of Diuretics
- Carbonic Anhydrase Inhibitors: Proximal tubule
- Loop Diuretics: Thick ascending limb of the loop of Henle
- Thiazides: Distal convoluted tubule
- K-sparing diuretics: Collecting duct
Molecular Sites of Action for Diuretics
- Loop Diuretics: Inhibit Na+/K+/2Cl- cotransporter.
- Thiazides: Inhibit the Na+/Cl- symporter in the distal tubule.
Spironolactone vs. Triamterene
- Spironolactone: Aldosterone receptor antagonist.
- Triamterene: Blocks ENaC channels in the collecting duct.
Efficacy vs. Potency of Diuretics
- Efficacy: Maximum diuretic effect.
- Potency: The dose required to produce a specific effect.
Pharmacologic Reason for Efficacy Variation
- Loop diuretics have high efficacy due to their action on the loop of Henle, where a significant portion of sodium reabsorption occurs.
Effects on Serum Concentrations
- Loop Diuretics: ↓ Na+, K+, Ca2+; ↑ Uric acid
- Thiazides: ↓ Na+, K+; ↑ Ca2+
Spironolactone and Aldosterone
- Spironolactone competes with aldosterone, reducing sodium reabsorption and potassium excretion.
Common Adverse Effects of Diuretics
- Hypokalemia with loop/thiazides
- Hyperkalemia with K-sparing diuretics
Effect on Serum Potassium
- Loop and thiazides: Promote potassium loss
- K-sparing diuretics: Retain potassium
Hypokalemia vs. Hyperkalemia Risks
- Hypokalemia: Loop, thiazides.
- Hyperkalemia: Spironolactone, triamterene.
Elimination Profiles of Diuretics
- Loop diuretics: Rapid elimination via kidneys.
- Thiazides: Longer half-lives.
PK/PD of Loop Diuretics
- Furosemide: High-ceiling diuretic with a short duration; requires frequent dosing for a persistent effect.
Common Drug-Drug Interactions
- NSAIDs reduce efficacy by decreasing renal blood flow
- Combination with ACE inhibitors increases hyperkalemia risk.
NSAID- and ACE/ARB-Induced AKI
- NSAIDs: Reduce prostaglandin-mediated afferent vasodilation.
- ACE inhibitors/ARBs: Block efferent arteriole constriction, lowering GFR.
Diuretics and Drug-Drug Interactions
- Loop diuretics with aminoglycosides increase ototoxicity
- K-sparing diuretics with ACE inhibitors increase hyperkalemia risk
Common Clinical Uses for Diuretics
- Loop diuretics: Edema, CHF
- Thiazides: Hypertension
- K-sparing diuretics: Heart failure, cirrhosis
Signs and Symptoms of AKI
- Prerenal AKI: Hypotension, tachycardia
- Intrinsic AKI: Oliguria, proteinuria.
- Postrenal AKI: Flank pain, anuria.
Role of CrCl and GFR in AKI
- GFR decline represents the hallmark of AKI.
- CrCl is used for drug dosing adjustments.
Differentiating AKI Causes
- Prerenal: BUN/Cr ratio > 20:1.
- Intrinsic: Urinalysis reveals casts and protein.
- Postrenal: Imaging reveals obstruction.
Drugs Causing AKI
- Prerenal AKI: NSAIDs, ACE inhibitors.
- Intrinsic AKI: Aminoglycosides.
- Postrenal AKI: Anticholinergics (urinary retention).
Criteria for Renal Replacement Therapy (RRT)
- Indications: Acidosis, electrolyte imbalances, volume overload, and uremia.
Furosemide Dosing
- Standard IV dose: 20–40 mg.
- Brand: Lasix.
Evidence-Based Therapeutic Plan for AKI
- Non-pharmacologic: Fluid management.
- Pharmacologic: Loop diuretics for volume overload.
Rationale for AKI Interventions
- Loop diuretics relieve fluid overload.
- Avoid nephrotoxins to prevent further damage.
Monitoring Parameters for AKI
- Daily Labs: Serum electrolytes, creatinine
- Fluid Balance: Monitor intake/output every shift.
AKI Prevention
- Hydration before contrast media.
- Avoid nephrotoxic drugs in at-risk patients.
Renal Adjustments for AKI Patients
- Use CrCl for dose modifications
- Be cautious with narrow therapeutic index drugs.
Issues in Renally Adjusting Medications
- Timing of drug levels is crucial (e.g., aminoglycosides).
- Adjust doses based on dynamic changes in kidney function.
Acute Kidney Injury (AKI) Complications
- AKI can cause fluid overload, electrolyte imbalances (hyperkalemia), metabolic acidosis, and uremia
- Chronic complications can occur, progressing to CKD and long-term cardiovascular complications
Diuretics
- Diuretics are medications that increase urine production by inhibiting sodium and water reabsorption in the nephron
Diuretic Classes
- Loop Diuretics (e.g., Furosemide [Lasix]) act on the thick ascending limb of the loop of Henle.
- K-sparing Diuretics (e.g., Triamterene [Dyrenium]) act on the collecting duct.
- Thiazides act on the distal convoluted tubule.
- Carbonic Anhydrase Inhibitors act on the proximal tubule.
IV Drug Formulation
- Sterile water for injection (SWFI) and Normal Saline are common vehicles for IV drugs
- Bacteriostatic water is used for multi-dose vials
IV Drug Incompatibilities
- Precipitation can occur due to pH changes or incompatibility between cations and anions (e.g., calcium and phosphate)
Sulfonamide Allergy
- Diuretics, including loop diuretics (except ethacrynic acid) and thiazides, contain sulfonamide groups, which can trigger allergic reactions.
Diuretic Mechanisms of Action
- Loop Diuretics inhibit the Na+/K+/2Cl- cotransporter
- Thiazides inhibit the Na+/Cl- symporter in the distal tubule
- Spironolactone is an aldosterone receptor antagonist, reducing sodium reabsorption and potassium excretion
- Triamterene blocks ENaC channels in the collecting duct
Diuretic Potency and Efficacy
- Efficacy refers to the maximum diuretic effect
- Potency refers to the dose required to achieve a specific effect
- Loop diuretics generally have high efficacy because they act on the loop of Henle, where a significant amount of sodium reabsorption occurs
Diuretic Effects on Serum Concentrations
- Loop Diuretics: ↓ Na+, K+, Ca2+; ↑ Uric acid.
- Thiazides: ↓ Na+, K+; ↑ Ca2+.
Diuretic Adverse Effects
- Hypokalemia (low potassium): Associated with loop and thiazide diuretics
- Hyperkalemia (high potassium): Associated with K-sparing diuretics like spironolactone and triamterene
Diuretic Elimination Profiles
- Loop Diuretics: Rapid elimination via kidneys
- Thiazides: Longer half-lives
Diuretic PK/PD
- Furosemide: High-ceiling diuretic with short duration, requiring frequent dosing for sustained effect
Diuretic Drug-Drug Interactions
- NSAIDs: Reduce diuretic efficacy by decreasing renal blood flow
- ACE Inhibitors: Increase risk of hyperkalemia when combined with K-sparing diuretics
- Aminoglycosides: Increase ototoxicity when combined with loop diuretics.
NSAID and ACE/ARB-Induced AKI
- NSAIDs reduce afferent arteriole vasodilation by inhibiting prostaglandin-mediated effects
- ACE inhibitors/ARBs block efferent arteriole constriction, leading to a decline in GFR.
Diuretic Clinical Uses
- Loop Diuretics: Edema, CHF
- Thiazides: Hypertension
- K-sparing Diuretics: Heart failure, cirrhosis
AKI Signs and Symptoms
- Prerenal AKI: Hypotension, tachycardia
- Intrinsic AKI: Oliguria, proteinuria
- Postrenal AKI: Flank pain, anuria
AKI Monitoring and Diagnosis
- GFR decline is the hallmark of AKI
- CrCl is used to assess kidney function and adjust drug doses.
- BUN/Cr ratio greater than 20:1 suggests prerenal AKI
- Urinalysis showing casts and protein is indicative of intrinsic AKI
- Imaging studies are used to identify postrenal obstruction
AKI Treatment and Prevention
- Non-pharmacologic: Fluid management
- Pharmacologic: Loop diuretics for volume overload
- Prevention: Hydration prior to contrast media, avoiding nephrotoxic drugs in at-risk patients
- Monitoring: Daily labs (electrolytes, creatinine) and fluid balance
Renal Adjustments for AKI Patients
- Adjust drug dosages based on CrCl
- Be cautious with drugs that have a narrow therapeutic index
AKI Renal Adjustment Complications
- Timing of drug levels is crucial (e.g., aminoglycosides)
- Dose adjustments should reflect dynamic changes in kidney function
Carbonic Anhydrase Inhibitors
- Acetazolamide is available for oral or intravenous administration.
Osmotic Diuretics
- Mannitol is administered intravenously.
Loop Diuretics
- Furosemide is available for oral or intravenous administration.
- Torsemide is available for oral or intravenous administration.
- Bumetanide is available for oral or intravenous administration.
- Ethacrynic acid is available for oral or intravenous administration.
Thiazide Diuretics
- Hydrochlorothiazide is available for oral administration but you should remember the brand name.
- Chlorthiazide is available for oral or intravenous administration.
- Chlorthalidone is available for oral administration.
- Indapamide is available for oral administration.
- Metolazone is available for oral administration.
Potassium-Sparing Diuretics
- Spironolactone is available for oral administration and you should remember the brand name.
- Eplerenone is available for oral administration.
- Triamterene is available for oral administration.
- Amiloride is available for oral administration.
Combination Products
- HCTZ and Triamterene are available in combination for oral administration.
General Information about Diuretics
- All diuretics are prescription only.
Diuretics
- Carbonic anhydrase inhibitors include acetazolamide (PO, IV).
- Osmotic diuretics include mannitol (IV).
- Loop diuretics include furosemide (Lasix) (PO, IV)*, torsemide (Demadex) (PO, IV), bumetanide (Bumex) (PO, IV) and ethacrynic acid (Edecrin) (PO, IV).
- Thiazide diuretics include hydrochlorothiazide (HCTZ) (PO)*, chlorthiazide (Diuril) (PO, IV), chlorthalidone (Thalitone) (PO), indapamide (Lozol) (PO), and metolazone (Zaroxolyn) (PO).
- Potassium-sparing diuretics include spironolactone (Aldactone) (PO)*, eplerenone (Inspra) (PO), triamterene (Dyrenium) (PO), and amiloride (Midamor) (PO).
- Combination products include HCTZ + Triamterene (Dyazide, Maxzide) (PO).
- All diuretics are prescription only.
- *Must know brand name in addition to generic name.
Angiotensin II Effects
- Angiotensin II is a potent vasoconstrictor.
- It directly constricts arterioles, particularly the efferent arteriole.
- Constriction increases glomerular capillary hydrostatic pressure to maintain GFR despite reduced renal perfusion during hypovolemia.
- Angiotensin II can indirectly promote prostaglandin synthesis in the kidneys, particularly PGE2 and PGI2.
- These prostaglandins act to vasodilate the afferent arteriole.
- Vasodilation counteracts excessive vasoconstriction and maintains renal perfusion.
- In systemic circulation, Angiotensin II reduces hydrostatic pressure in systemic capillaries, aiding in fluid retention.
- In the glomerulus, efferent arteriole constriction caused by Angiotensin II increases glomerular capillary hydrostatic pressure, supporting filtration.
Acute Kidney Injury (AKI) Complications
- Acute complications of AKI include acute tubular necrosis, hyperkalemia, metabolic acidosis, and volume overload.
Diuretics
- Diuretics increase urine output by inhibiting the reabsorption of sodium and water in the nephron.
Thiazide Diuretics
- Thiazide diuretics primarily act on the distal convoluted tubule, inhibiting the sodium-chloride symporter.
Loop Diuretics
- Loop diuretics are highly effective due to their action on the ascending limb of the loop of Henle, blocking the sodium-potassium-chloride cotransporter.
- Furosemide is the brand name for the loop diuretic furosemide.
- Loop diuretics can cause hypokalemia and hyperkalemia.
- Loop diuretics commonly used for edema, hypertension, and heart failure.
K-Sparing Diuretics
- K-sparing diuretics like spironolactone and triamterene can increase serum potassium levels due to their action on the collecting duct, blocking the sodium-potassium exchange and aldosterone receptors.
Sulfonamide-Containing Diuretics
- Sulfonamide-containing diuretics can trigger allergic reactions in sensitive patients.
Monitoring AKI
- Serum electrolytes and creatinine should be monitored daily in AKI patients.
- The eGFR is used to adjust drug dosages in AKI.
Prerenal AKI
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to prerenal AKI by reducing prostaglandin-mediated afferent vasodilation.
Renal Replacement Therapy (RRT)
- Renal replacement therapy (RRT) is indicated for acute kidney injury (AKI) with life-threatening electrolyte imbalances, severe fluid overload, or uremia.
Other Diuretics
- Carbonic anhydrase inhibitors block the enzyme carbonic anhydrase, reducing bicarbonate reabsorption and increasing urine flow.
- Osmotic diuretics like mannitol increase osmotic pressure in the renal tubules, promoting water excretion.
Adverse Effects of Diuretics
- Hypokalemia is a common side effect of loop diuretics.
- Thiazide diuretics primarily increase potassium excretion, leading to hypokalemia.
Actions of Diuretics
- Loop diuretics inhibit the sodium-potassium-chloride cotransporter, leading to increased sodium and chloride excretion.
- Spironolactone acts as an aldosterone receptor antagonist.
- Thiazide diuretics can cause hypokalemia, hyponatremia, and hyperglycemia.
Angiotensin II
- Angiotensin II primarily utilizes the renin-angiotensin-aldosterone system (RAAS) to increase glomerular capillary hydrostatic pressure.
- Angiotensin II significantly increases systemic hydrostatic pressure and promotes vasoconstriction.
Drug Combinations
- Hydrochlorothiazide is included in combination products like HCTZ/Losartan and HCTZ/Amlodipine.
Other Key Points
- Monitoring intake and output is essential for managing patients with AKI.
- Standard IV dose range for furosemide is 20-80mg.
- The hallmark of AKI is the decline in glomerular filtration rate (GFR).
- Chronic complications of AKI include chronic kidney disease (CKD) and cardiovascular disease.
- IV drug formulations must be sterile and pyrogen-free.
- Efferent arteriole constriction enhances glomerular filtration rate (GFR).
- Bumex is the brand name for bumetanide, a loop diuretic.
- Efferent arteriole constriction causes a decrease in urine output.
- Ace inhibitors can lead to hyperkalemia in combination with K-sparing diuretics.
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Description
This quiz covers key concepts related to acute kidney injury (AKI) complications and diuretics, including their mechanisms, drug formulations, and possible allergies. It is essential for understanding the impact of diuretics in managing fluid overload and electrolyte imbalances. Test your knowledge on these critical pharmacological topics.
