Diuretics and AKI Complications Overview
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Questions and Answers

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.

    False

    What is the primary site of action for thiazide diuretics?

    Distal convoluted tubule

    ______ is the brand name for the loop diuretic furosemide.

    <p>Lasix</p> Signup and view all the answers

    Match the following diuretics with their sites of action:

    <p>Carbonic Anhydrase Inhibitors = Proximal tubule Loop Diuretics = Thick ascending limb of the loop of Henle Thiazides = Distal convoluted tubule K-sparing diuretics = Collecting duct</p> Signup and view all the answers

    What is the main pharmacologic reason for the high efficacy of loop diuretics?

    <p>They act on the loop of Henle, which handles significant sodium reabsorption</p> Signup and view all the answers

    Spironolactone and triamterene can both potentially cause hypokalemia.

    <p>False</p> Signup and view all the answers

    What type of reaction can sulfonamide-containing diuretics trigger in sensitive patients?

    <p>Allergic reactions</p> Signup and view all the answers

    What is the primary effect of K-sparing diuretics on serum potassium levels?

    <p>Retain potassium</p> Signup and view all the answers

    Loop diuretics are associated with the risk of hyperkalemia.

    <p>False</p> Signup and view all the answers

    List one common clinical use for loop diuretics.

    <p>Edema or congestive heart failure (CHF)</p> Signup and view all the answers

    The _____ is used for drug dosing adjustments in acute kidney injury (AKI).

    <p>Creatinine clearance (CrCl)</p> Signup and view all the answers

    Match the following findings with the type of Acute Kidney Injury (AKI):

    <p>Prerenal = BUN/Cr ratio &gt; 20:1 Intrinsic = Urinalysis shows casts, protein Postrenal = Imaging reveals obstruction All types = Oliguria</p> Signup and view all the answers

    Which of the following drugs is associated with prerenal AKI?

    <p>NSAIDs</p> Signup and view all the answers

    Name one indication for renal replacement therapy (RRT).

    <p>Acidosis or electrolyte imbalances</p> Signup and view all the answers

    Daily labs should include monitoring serum electrolytes and creatinine in AKI patients.

    <p>True</p> Signup and view all the answers

    What effect do K-sparing diuretics have on serum potassium levels?

    <p>Retain potassium</p> Signup and view all the answers

    Loop diuretics are typically used to treat hypertension.

    <p>False</p> Signup and view all the answers

    What is the common clinical use for thiazide diuretics?

    <p>Hypertension</p> Signup and view all the answers

    Drugs like NSAIDs can lead to prerenal Acute Kidney Injury (AKI) because they reduce _____ mediated afferent vasodilation.

    <p>prostaglandin</p> Signup and view all the answers

    What is a common risk associated with using ACE inhibitors in combination with K-sparing diuretics?

    <p>Hyperkalemia</p> Signup and view all the answers

    Monitoring intake and output is essential for managing patients with Acute Kidney Injury (AKI).

    <p>True</p> Signup and view all the answers

    What is the standard IV dose range for furosemide?

    <p>20–40 mg</p> Signup and view all the answers

    The hallmark of Acute Kidney Injury (AKI) is the decline in _____.

    <p>GFR</p> Signup and view all the answers

    Name one indication for renal replacement therapy (RRT).

    <p>Acidosis</p> Signup and view all the answers

    What is a chronic complication of Acute Kidney Injury (AKI)?

    <p>Progression to chronic kidney disease (CKD)</p> Signup and view all the answers

    Diuretics work by promoting the reabsorption of sodium and water in the nephron.

    <p>False</p> Signup and view all the answers

    What is the brand name for spironolactone?

    <p>Aldactone</p> Signup and view all the answers

    Drug formulations for IV must be sterile and _____.

    <p>pyrogen-free</p> Signup and view all the answers

    Match the following diuretics with their sites of action:

    <p>Carbonic Anhydrase Inhibitors = Proximal tubule Loop Diuretics = Thick ascending limb of the loop of Henle Thiazides = Distal convoluted tubule K-sparing diuretics = Collecting duct</p> Signup and view all the answers

    Which electrolyte is commonly increased as a side effect of loop diuretics?

    <p>Uric acid</p> Signup and view all the answers

    Thiazide diuretics increase potassium excretion.

    <p>True</p> Signup and view all the answers

    What is the mechanism of action of loop diuretics at the cellular level?

    <p>Inhibition of Na+/K+/2Cl- cotransporter</p> Signup and view all the answers

    Spironolactone acts as an _____ receptor antagonist.

    <p>aldosterone</p> Signup and view all the answers

    Which of the following is a common adverse effect of thiazide diuretics?

    <p>Hypokalemia</p> Signup and view all the answers

    Which mechanism does Angiotensin II primarily utilize to increase glomerular capillary hydrostatic pressure?

    <p>By causing direct constriction of the efferent arteriole</p> Signup and view all the answers

    What is a significant effect of Angiotensin II on systemic hydrostatic pressure?

    <p>Decreases hydrostatic pressure in systemic circulation</p> Signup and view all the answers

    Which diuretic is NOT classified as a potassium-sparing diuretic?

    <p>Furosemide</p> Signup and view all the answers

    Which statement regarding the osmotic diuretic Mannitol is accurate?

    <p>It increases urine output by osmotically pulling water into the renal tubules</p> Signup and view all the answers

    Which combination product includes hydrochlorothiazide?

    <p>Maxzide</p> Signup and view all the answers

    What is the primary action of thiazide diuretics on plasma electrolytes?

    <p>They lead to excretion of sodium and chloride</p> Signup and view all the answers

    Which of the following diuretics is known for having a similarity in structure to sulfonamides?

    <p>Acetazolamide</p> Signup and view all the answers

    How does Angiotensin II indirectly promote vasodilation?

    <p>By stimulating prostaglandin synthesis</p> Signup and view all the answers

    Which loop diuretic is also known by the brand name 'Bumex'?

    <p>Bumetanide</p> Signup and view all the answers

    Which of the following drugs is primarily used for acute management of conditions leading to fluid overload?

    <p>Furosemide</p> Signup and view all the answers

    What physiological effect occurs when the efferent arteriole constricts?

    <p>Increased GFR</p> Signup and view all the answers

    An increased glomerular filtration rate (GFR) is most likely to result from which of the following mechanisms?

    <p>Constriction of the efferent arterioles</p> Signup and view all the answers

    What is a potential consequence of an increased GFR?

    <p>Increased urine output</p> Signup and view all the answers

    How does efferent arteriole constriction primarily affect kidney function?

    <p>It raises the hydrostatic pressure in glomeruli.</p> Signup and view all the answers

    Which of the following statements best describes the relationship between efferent arteriole constriction and urine output?

    <p>It increases GFR, thereby potentially increasing urine output.</p> Signup and view all the answers

    What is the minimum increase in serum creatinine (SCr) that qualifies as Acute Kidney Injury (AKI) within a 48-hour period?

    <blockquote> <p>0.3 mg/dL</p> </blockquote> Signup and view all the answers

    Which diuretic mechanism primarily causes electrolyte excretion in the kidneys?

    <p>Blocking sodium-potassium-chloride co-transporter</p> Signup and view all the answers

    What does the fractional excretion of sodium (FeNa) help to assess in AKI diagnosis?

    <p>Causative factors of AKI</p> Signup and view all the answers

    In relation to pharmacokinetics of loop diuretics, what is a common resistance mechanism noted in patients?

    <p>Upregulation of Na+/K+/2Cl- transporters</p> Signup and view all the answers

    What lab finding is typically monitored daily to assess the impact of AKI on a patient?

    <p>Serum electrolytes and creatinine</p> Signup and view all the answers

    What effect does afferent arteriole dilation have on peritubular capillary oncotic pressure?

    <p>It increases oncotic pressure by concentrating plasma proteins.</p> Signup and view all the answers

    What is the net effect of constricting the efferent arteriole on filtration and reabsorption?

    <p>It increases both filtration and reabsorption.</p> Signup and view all the answers

    Which statement is true regarding the changes that occur when the afferent arteriole is constricted?

    <p>It decreases glomerular hydrostatic pressure.</p> Signup and view all the answers

    What is the effect of dilating the efferent arteriole on glomerular filtration?

    <p>Decreased filtration rate due to reduced glomerular hydrostatic pressure.</p> Signup and view all the answers

    How does constriction of the afferent arteriole affect the risk of developing prerenal acute kidney injury?

    <p>It increases the risk due to reduced glomerular filtration rate.</p> Signup and view all the answers

    Which factor primarily influences the oncotic pressure in peritubular capillaries after fluid has exited the glomerulus?

    <p>The concentration of plasma proteins remaining in the blood.</p> Signup and view all the answers

    What is the overall effect of the renal actions of prostaglandins on afferent arterioles?

    <p>They contribute to vasodilation increasing glomerular filtration rate.</p> Signup and view all the answers

    What is the relationship between increased glomerular hydrostatic pressure and peritubular capillary reabsorption?

    <p>Increased glomerular pressure typically enhances reabsorption in the peritubular capillaries.</p> Signup and view all the answers

    Which diuretic class is associated with the development of metabolic acidosis due to a significant decrease in bicarbonate levels?

    <p>Carbonic Anhydrase Inhibitors</p> Signup and view all the answers

    What is the primary mechanism by which NSAIDs contribute to prerenal Acute Kidney Injury?

    <p>Afferent arteriole constriction</p> Signup and view all the answers

    Which type of diuretic primarily increases calcium reabsorption, leading to decreased calcium excretion?

    <p>Thiazide Diuretics</p> Signup and view all the answers

    Which of the following medications is most likely to cause intrinsic AKI through crystalluria or nephrotoxicity?

    <p>Fluoroquinolone Antibiotics</p> Signup and view all the answers

    Which type of diuretic is associated with both a decrease in sodium and an increase in bicarbonate levels, potentially leading to metabolic alkalosis?

    <p>Loop Diuretics</p> Signup and view all the answers

    In the context of Acute Kidney Injury, which medication is primarily responsible for postrenal AKI by precipitating crystals in the tubules?

    <p>Acyclovir</p> Signup and view all the answers

    Which of the following diuretics does not cause any change in uric acid levels?

    <p>Osmotic Diuretics</p> Signup and view all the answers

    How do ACE Inhibitors and NSAIDs interact to worsen prerenal AKI?

    <p>ACE Inhibitors dilate the efferent arteriole while NSAIDs constrict the afferent</p> Signup and view all the answers

    What is the mechanism of action of acetazolamide?

    <p>Inhibits carbonic anhydrase</p> Signup and view all the answers

    Which of the following effects is associated with furosemide administration?

    <p>Increased sodium, potassium, and calcium excretion</p> Signup and view all the answers

    What is the primary site of action for hydrochlorothiazide?

    <p>Distal Convoluted Tubule</p> Signup and view all the answers

    Which drug class does spironolactone belong to?

    <p>Potassium-Sparing Diuretic</p> Signup and view all the answers

    What adverse effect is commonly associated with the use of NSAIDs?

    <p>Decreased afferent arteriole dilation</p> Signup and view all the answers

    What is the primary effect of mannitol in renal physiology?

    <p>Increases osmotic pressure in tubular fluid</p> Signup and view all the answers

    Which diuretic specifically reduces sodium reabsorption while increasing potassium retention?

    <p>Spironolactone</p> Signup and view all the answers

    What is the mechanism by which ACE inhibitors lower blood pressure?

    <p>They inhibit angiotensin-converting enzyme (ACE)</p> Signup and view all the answers

    What is the total osmolarity contributed by 30 mM of glucose, 20 mM of CaCl₂, and 10 mM of KCl?

    <p>110 mM</p> Signup and view all the answers

    Which of the following substances contributes the highest number of particles to osmolarity in solution?

    <p>CaCl₂</p> Signup and view all the answers

    When fluid overload is unresponsive to diuretics, what condition can likely arise as a complication?

    <p>Respiratory distress</p> Signup and view all the answers

    Which of the following conditions is characterized by symptoms such as pericarditis and encephalopathy?

    <p>Uremia</p> Signup and view all the answers

    In osmolarity calculations, how does the dissociation of electrolytes like CaCl₂ and KCl affect the total osmolarity compared to non-dissociating compounds like glucose?

    <p>Electrolytes increase the total osmolarity significantly more.</p> Signup and view all the answers

    What is the primary mechanism of action for carbonic anhydrase inhibitors?

    <p>Inhibits HCO3 reabsorption</p> Signup and view all the answers

    Which of the following types of AKI is characterized by an increase in fractional excretion of sodium (FeNa) greater than 1%?

    <p>Intrinsic AKI</p> Signup and view all the answers

    What is the clinical significance of a serum creatinine increase of 0.3 mg/dL within a 48-hour period?

    <p>Diagnostic criteria for AKI</p> Signup and view all the answers

    Which electrolyte imbalance is a key indication for renal replacement therapy (RRT)?

    <p>Hyperkalemia</p> Signup and view all the answers

    Which treatment strategy is appropriate for prerenal AKI associated with volume depletion?

    <p>Fluid resuscitation</p> Signup and view all the answers

    In the context of diuretics, which class is known to potentially cause hyperuricemia as a side effect?

    <p>Thiazide Diuretics</p> Signup and view all the answers

    What distinguishes intrinsic AKI from prerenal and postrenal AKI during urinalysis?

    <p>Muddy brown casts</p> Signup and view all the answers

    Which class of diuretics primarily works at the distal convoluted tubule?

    <p>Thiazide Diuretics</p> Signup and view all the answers

    Which diuretic class primarily inhibits sodium reabsorption in the distal convoluted tubule?

    <p>Thiazide Diuretics</p> Signup and view all the answers

    What is a notable characteristic of osmotic diuretics like Mannitol in relation to kidney function?

    <p>Increases osmotic pressure in the renal tubule</p> Signup and view all the answers

    Which mechanism of action is characteristic of ACE inhibitors in the context of AKI?

    <p>Reduce efferent arteriole constriction</p> Signup and view all the answers

    In patients with renal impairment, which class of drugs is likely to worsen prerenal AKI?

    <p>NSAIDs</p> Signup and view all the answers

    Which is the primary mechanism of action for potassium-sparing diuretics classified as aldosterone antagonists?

    <p>Competitive inhibition of aldosterone</p> Signup and view all the answers

    Which of the following drugs is known to potentially cause post-renal AKI due to direct nephrotoxicity?

    <p>Acyclovir</p> Signup and view all the answers

    Which type of diuretic is primarily associated with the risk of causing hypokalemia?

    <p>Loop Diuretics</p> Signup and view all the answers

    Which statement accurately describes the impact of thiazide diuretics on serum electrolytes?

    <p>They decrease sodium reabsorption and have a modest potassium excretion increase.</p> Signup and view all the answers

    Which diuretic should be used cautiously in patients with heart failure due to its potassium-sparing effects?

    <p>Amiloride (Midamor®)</p> Signup and view all the answers

    Which diuretic may require monitoring of lithium levels due to potential drug interactions?

    <p>Furosemide (Lasix®)</p> Signup and view all the answers

    Which diuretic may result in hearing loss if administered in large doses or used over a prolonged period?

    <p>Furosemide (Lasix®)</p> Signup and view all the answers

    Which of the following diuretics is classified as a potassium-sparing diuretic?

    <p>Eplerenone</p> Signup and view all the answers

    Which combination product contains both hydrochlorothiazide and another diuretic?

    <p>Dyazide</p> Signup and view all the answers

    Which diuretic is known for its use via intravenous administration in acute cases of fluid overload?

    <p>Mannitol</p> Signup and view all the answers

    Which of the following statements accurately describes a characteristic of thiazide diuretics?

    <p>They primarily promote the excretion of sodium and chloride.</p> Signup and view all the answers

    Which loop diuretic is known by the brand name 'Lasix'?

    <p>Furosemide</p> Signup and view all the answers

    Which of the following diuretics belongs to the combination products class?

    <p>HCTZ + Triamterene</p> Signup and view all the answers

    Which loop diuretic is unique in that it does not have a brand name specified in the document?

    <p>Ethacrynic acid</p> Signup and view all the answers

    Which of the following potassium-sparing diuretics is specifically noted for its brand name in the document?

    <p>Spironolactone</p> Signup and view all the answers

    What is the effect of afferent arteriole dilation on glomerular filtration rate (GFR)?

    <p>Increases GFR</p> Signup and view all the answers

    Constriction of the efferent arteriole directly decreases glomerular pressure (PGC) and GFR.

    <p>False</p> Signup and view all the answers

    What effect does efferent arteriole dilation have on glomerular filtration rate (GFR)?

    <p>Decreases GFR</p> Signup and view all the answers

    Efferent arterioles have an __________ relationship with glomerular filtration rate (GFR).

    <p>inverse</p> Signup and view all the answers

    Match the actions with their effects on GFR:

    <p>Afferent Dilation = Increased GFR Afferent Constriction = Decreased GFR Efferent Constriction = Increased GFR Efferent Dilation = Decreased GFR</p> Signup and view all the answers

    Which of the following statements about aldosterone antagonists is true?

    <p>They increase sodium excretion.</p> Signup and view all the answers

    NSAIDs can lead to increased GFR by dilating afferent arterioles.

    <p>False</p> Signup and view all the answers

    Name one clinical use for ACE inhibitors.

    <p>To reduce GFR by dilating efferent arterioles.</p> Signup and view all the answers

    Which of the following drugs is less likely to cause gynecomastia?

    <p>Eplerenone</p> Signup and view all the answers

    ENaC blockers act independently of aldosterone.

    <p>True</p> Signup and view all the answers

    List one condition where aldosterone antagonists are particularly useful.

    <p>Heart failure with reduced ejection fraction (HFrEF)</p> Signup and view all the answers

    The drug ______ is classified as an ENaC blocker.

    <p>amiloride</p> Signup and view all the answers

    Match the following drugs with their class:

    <p>Eplerenone = Aldosterone Antagonist Amiloride = ENaC Blocker Spironolactone = Aldosterone Antagonist Triamterene = ENaC Blocker</p> Signup and view all the answers

    What is a primary effect of both Aldosterone-Dependent and Aldosterone-Independent drugs on potassium levels?

    <p>Increased potassium retention</p> Signup and view all the answers

    Amiloride works by inhibiting the aldosterone receptor.

    <p>False</p> Signup and view all the answers

    What is the effect of spironolactone on sodium reabsorption?

    <p>Reduces sodium reabsorption</p> Signup and view all the answers

    What effect does afferent arteriole constriction have on glomerular filtration rate (GFR)?

    <p>Decreases GFR</p> Signup and view all the answers

    The efferent arteriole plays a crucial role in decreasing glomerular hydrostatic pressure.

    <p>False</p> Signup and view all the answers

    What is the primary mechanism of osmotic diuretics in the nephron?

    <p>They increase osmolarity in the renal tubules, restricting water reabsorption.</p> Signup and view all the answers

    The ______ is the equation used to estimate creatinine clearance.

    <p>Cockcroft-Gault equation</p> Signup and view all the answers

    Which diuretic class is the most effective at reducing calcium excretion?

    <p>Thiazides</p> Signup and view all the answers

    Match the following diuretics with their specific action:

    <p>Acetazolamide = Inhibits bicarbonate reabsorption Mannitol = Reduces intracranial pressure Spironolactone = Blocks aldosterone effects Furosemide = Inhibits sodium reabsorption in the loop of Henle</p> Signup and view all the answers

    When should ideal body weight (IBW) be used in calculating creatinine clearance?

    <p>In underweight patients.</p> Signup and view all the answers

    Prostaglandin synthesis enhances afferent arteriole dilation, increasing GFR.

    <p>True</p> Signup and view all the answers

    Which class of diuretics is most associated with causing hypokalemia?

    <p>Loop diuretics</p> Signup and view all the answers

    Mannitol is known to increase serum sodium and potassium levels.

    <p>False</p> Signup and view all the answers

    What is the primary clinical implication of thiazide diuretics increasing uric acid levels?

    <p>Increased risk of gout attacks.</p> Signup and view all the answers

    Acute kidney injury classified as prerenal is mainly due to __________.

    <p>reduced blood flow to the kidneys</p> Signup and view all the answers

    Which drug class is known to be nephrotoxic and should be avoided in AKI patients?

    <p>Aminoglycosides</p> Signup and view all the answers

    Match the drug with its effect on renal function:

    <p>Thiazide Diuretics = Increase calcium reabsorption Loop Diuretics = Decrease calcium reabsorption Potassium-sparing Diuretics = Prevent potassium loss ACE Inhibitors = Reduce renin activity</p> Signup and view all the answers

    Acetazolamide increases bicarbonate reabsorption in the kidneys.

    <p>False</p> Signup and view all the answers

    Name one drug associated with intrinsic AKI.

    <p>Vancomycin</p> Signup and view all the answers

    Which of the following is a common cause of postrenal acute kidney injury?

    <p>Ureteral obstruction</p> Signup and view all the answers

    Furosemide monitoring requires careful attention to __________ and fluid balance.

    <p>electrolytes</p> Signup and view all the answers

    Aldosterone antagonists are effective without the presence of aldosterone.

    <p>False</p> Signup and view all the answers

    List one indication for using renal replacement therapy (RRT).

    <p>Severe metabolic acidosis.</p> Signup and view all the answers

    Match the following drugs with their effects:

    <p>Mannitol = Reduces intracranial pressure Spironolactone = Blocks aldosterone receptors Aminoglycosides = Causes nephrotoxicity Thiazides = Increases calcium reabsorption</p> Signup and view all the answers

    Which diuretic decreases bicarbonate levels and causes metabolic acidosis?

    <p>Carbonic anhydrase inhibitors</p> Signup and view all the answers

    The AEIOU mnemonic for indications for RRT includes __________, __________, __________, __________, and __________.

    <p>Acidosis, Electrolyte imbalance, Intoxication, Overload, Uremia.</p> Signup and view all the answers

    Loop diuretics can increase calcium excretion by inhibiting sodium reabsorption.

    <p>True</p> Signup and view all the answers

    Which medications can lead to increased risk of acute kidney injury when used together?

    <p>NSAIDs and ACE inhibitors</p> Signup and view all the answers

    How does afferent arteriole dilation affect glomerular filtration rate (GFR)?

    <p>Increases GFR</p> Signup and view all the answers

    Loop diuretics can potentially cause metabolic alkalosis.

    <p>True</p> Signup and view all the answers

    The __________ effect of loop diuretics includes the loss of potassium and metabolic alkalosis.

    <p>electrolyte</p> Signup and view all the answers

    How does constriction of the efferent arteriole influence glomerular filtration rate (GFR)?

    <p>It increases glomerular hydrostatic pressure and subsequently increases GFR.</p> Signup and view all the answers

    What is the primary mechanism by which spironolactone reduces aldosterone’s effects?

    <p>Blocking aldosterone receptors</p> Signup and view all the answers

    The primary site of action for osmotic diuretics is the ________ of the nephron.

    <p>proximal tubule</p> Signup and view all the answers

    Thiazides are contraindicated in patients with heart failure.

    <p>False</p> Signup and view all the answers

    Which of the following diuretics is most commonly associated with ototoxicity when combined with aminoglycosides?

    <p>Loop diuretics</p> Signup and view all the answers

    What happens to GFR when the efferent arteriole is constricted?

    <p>Increases</p> Signup and view all the answers

    NSAIDs can cause __________ AKI by blocking prostaglandin synthesis.

    <p>prerenal</p> Signup and view all the answers

    Which of the following is a characteristic effect of thiazide diuretics?

    <p>Increased potassium excretion</p> Signup and view all the answers

    Osmotic diuretics are beneficial in treating heart failure.

    <p>False</p> Signup and view all the answers

    What effect does the constriction of the efferent arteriole have on glomerular filtration rate (GFR)?

    <p>Increases GFR</p> Signup and view all the answers

    Afferent arteriole dilation will lead to decreased GFR.

    <p>False</p> Signup and view all the answers

    What is the role of prostaglandins in kidney physiology?

    <p>Prostaglandins dilate the afferent arteriole, increasing GFR.</p> Signup and view all the answers

    The Cockcroft-Gault Equation is used to estimate ______.

    <p>creatinine clearance</p> Signup and view all the answers

    Match the following diuretics with their mechanism of action:

    <p>Acetazolamide = Inhibits carbonic anhydrase Loop diuretics = Inhibit Na+/K+/2Cl⁻ cotransporter Thiazides = Enhance Na+/Ca²⁺ exchange Spironolactone = Blocks aldosterone receptors</p> Signup and view all the answers

    What is the primary effect of osmotic diuretics on tubular fluid?

    <p>Increase tubular fluid osmolarity</p> Signup and view all the answers

    NSAIDs can lead to decreased GFR by blocking ______ synthesis.

    <p>prostaglandin</p> Signup and view all the answers

    What is a common indication for spironolactone?

    <p>Hypertension</p> Signup and view all the answers

    Mannitol increases intracranial pressure by promoting water retention in brain tissue.

    <p>False</p> Signup and view all the answers

    What electrolyte level is typically increased by thiazide diuretics?

    <p>calcium</p> Signup and view all the answers

    ACE inhibitors are avoided in patients with _____ renal artery stenosis due to their effect on GFR.

    <p>bilateral</p> Signup and view all the answers

    Match the following diuretics with their effects on electrolytes:

    <p>Loop diuretics = Decrease calcium levels Thiazides = Increase calcium levels Mannitol = Decrease sodium concentrations ENaC blockers = Reduce potassium excretion</p> Signup and view all the answers

    Which condition is characterized by obstruction leading to AKI?

    <p>Postrenal AKI</p> Signup and view all the answers

    Loop diuretics lead to hyperkalemia as a common side effect.

    <p>False</p> Signup and view all the answers

    What mechanism do prostaglandins utilize to maintain GFR?

    <p>Dilate the afferent arteriole</p> Signup and view all the answers

    NSAIDs can lead to prerenal AKI by inhibiting _____ mediated afferent dilation.

    <p>prostaglandin</p> Signup and view all the answers

    What adverse effect is associated with combining loop diuretics and aminoglycosides?

    <p>Ototoxicity</p> Signup and view all the answers

    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.

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