Renal Medications - Tonicity and Crystalloids
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Questions and Answers

Which of the following medications can cause reflex tachycardia as a common effect?

  • Aliskiren
  • Methyldopa
  • Hydralazine (correct)
  • Clonidine

What is the primary action of alpha-2 agonists in the central nervous system?

  • Decrease sympathetic outflow (correct)
  • Stimulate sympathetic outflow
  • Block renin activity
  • Increase heart rate and cardiac output

Which medication is known for inducing hypertrichosis as a side effect?

  • Minoxidil (correct)
  • Hydralazine
  • Doxazosin
  • Clonidine

What common effect is associated with the abrupt discontinuation of alpha-2 agonists?

<p>Rebound hypertension (A)</p> Signup and view all the answers

Which of the following statements about renin inhibitors is true?

<p>They block the formation of angiotensin II. (B)</p> Signup and view all the answers

What is a key difference between ARBs and ACE inhibitors?

<p>ARBs do not increase bradykinin levels. (C)</p> Signup and view all the answers

Which of the following is a common effect of Calcium Channel Blockers?

<p>Peripheral edema (B)</p> Signup and view all the answers

Which type of Calcium Channel Blockers primarily act on the heart and blood vessels?

<p>Non-dihydropyridines (C)</p> Signup and view all the answers

What is the mechanism of action of beta blockers?

<p>Block beta-adrenergic receptors (D)</p> Signup and view all the answers

Which of the following is a common effect of non-selective beta blockers?

<p>Bronchospasm (A)</p> Signup and view all the answers

What action do alpha-1 adrenergic blockers perform?

<p>Prevent vasoconstriction (A)</p> Signup and view all the answers

Which of the following examples represents a dihydropyridine Calcium Channel Blocker?

<p>Amlodipine (D)</p> Signup and view all the answers

Which effect is least common with ARBs compared to ACE inhibitors?

<p>Cough (A)</p> Signup and view all the answers

What is the site of action for potassium-sparing diuretics?

<p>Collecting Duct (B)</p> Signup and view all the answers

Which of the following is a mechanism of action of aldosterone antagonists?

<p>Block the action of aldosterone (B)</p> Signup and view all the answers

What is a significant side effect of potassium-sparing diuretics?

<p>Hyperkalemia (D)</p> Signup and view all the answers

Which of the following is a use for potassium-sparing diuretics?

<p>Managing hypertension (B)</p> Signup and view all the answers

Which of the following substances is increased in urinary excretion when using carbonic anhydrase inhibitors?

<p>Bicarbonate (C)</p> Signup and view all the answers

What is the primary function of the Proximal Convoluted Tubule (PCT)?

<p>Reabsorption of sodium, chloride, and water (C)</p> Signup and view all the answers

Which segment of the nephron is impermeable to water?

<p>Loop of Henle (ascending limb) (C)</p> Signup and view all the answers

What is the primary action of carbonic anhydrase inhibitors in the kidney?

<p>Inhibit carbonic anhydrase enzyme (C)</p> Signup and view all the answers

What is the mechanism of action of thiazide diuretics?

<p>Inhibit Na+/Cl- symporter (A)</p> Signup and view all the answers

Which condition can be treated with carbonic anhydrase inhibitors?

<p>Altitude sickness (C)</p> Signup and view all the answers

For which condition are thiazide diuretics commonly used?

<p>Hypertension (D)</p> Signup and view all the answers

What effect do potassium-sparing diuretics have on body sodium levels?

<p>Inhibit sodium reabsorption (A)</p> Signup and view all the answers

What effect do loop diuretics have on calcium levels?

<p>Cause calcium loss (B)</p> Signup and view all the answers

What is the main site of action for loop diuretics?

<p>Thick Ascending Limb of the Loop of Henle (D)</p> Signup and view all the answers

What is a common side effect of thiazide diuretics?

<p>Hypokalemia (D)</p> Signup and view all the answers

Which condition would NOT typically be treated with loop diuretics?

<p>Kidney stones (D)</p> Signup and view all the answers

What is the primary mechanism of action of osmotic diuretics?

<p>Increase osmolarity of filtrate to prevent water reabsorption (C)</p> Signup and view all the answers

Which condition is NOT typically treated with osmotic diuretics?

<p>Heart failure (C)</p> Signup and view all the answers

How do ACE inhibitors lower blood pressure?

<p>By blocking the activity of angiotensin-converting enzyme (D)</p> Signup and view all the answers

Which of the following is a common effect of taking ACE inhibitors?

<p>Dry cough due to increased bradykinin (C)</p> Signup and view all the answers

What is the effect of ARBs?

<p>Prevent the actions of angiotensin II (D)</p> Signup and view all the answers

What is the site of action for osmotic diuretics in the nephron?

<p>Proximal convoluted tubule and loop of Henle (D)</p> Signup and view all the answers

Which mechanism do diuretics utilize to lower blood pressure?

<p>Reducing blood volume via sodium and water excretion (A)</p> Signup and view all the answers

Which of the following drugs is NOT classified as an antihypertensive?

<p>Osmotic diuretics (C)</p> Signup and view all the answers

Which intravenous solution is considered isotonic?

<p>0.9% NaCl (A)</p> Signup and view all the answers

What is the main purpose of colloid solutions like albumin?

<p>To expand plasma volume (B)</p> Signup and view all the answers

Which of the following is a mechanism for diuretic drugs?

<p>Interfere with sodium and water reabsorption (A)</p> Signup and view all the answers

What is a characteristic of hypotonic solutions?

<p>They have lower osmotic pressure than blood plasma. (A)</p> Signup and view all the answers

What electrolyte is most abundant inside cells and critical for normal body functions?

<p>Potassium (B)</p> Signup and view all the answers

Which intravenous solution is categorized as hypertonic?

<p>3% NaCl (D)</p> Signup and view all the answers

Which blood product is used primarily to increase oxygen carrying capacity?

<p>Packed RBC (B)</p> Signup and view all the answers

Lactated ringers is an example of which type of solution?

<p>Both B and C (B)</p> Signup and view all the answers

Flashcards

Alpha-2 Agonists

Medications that stimulate alpha-2 adrenergic receptors in the central nervous system (CNS), leading to a decrease in sympathetic outflow. This results in reduced norepinephrine release, vasodilation, decreased heart rate, and lower blood pressure.

Direct Vasodilators

Medications that directly relax the smooth muscle of blood vessels, causing vasodilation and lowering blood pressure. This reduces systemic vascular resistance (SVR).

Hydralazine

A direct vasodilator that primarily affects arterial dilation, leading to lower blood pressure.

Minoxidil

A potent direct vasodilator that can cause excessive hair growth (hypertrichosis).

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Renin Inhibitors

Medications that block the activity of renin, an enzyme responsible for converting angiotensinogen to angiotensin I. This prevents the formation of angiotensin II, leading to vasodilation, reduced aldosterone secretion, and lower blood pressure.

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Isotonic Solutions

Intravenous solutions with the same osmotic pressure as blood plasma, preventing fluid shifts between the veins and surrounding tissues.

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Hypotonic Solutions

Intravenous solutions with lower osmotic pressure than blood plasma, causing fluid to move out of the veins into surrounding tissues.

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Hypertonic Solutions

Intravenous solutions with higher osmotic pressure than blood plasma, causing fluid to move into the veins from surrounding tissues.

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Crystalloids

Intravenous solutions containing fluids and electrolytes normally found in the body, used to treat dehydration and maintain fluid balance.

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Colloids

Solutions containing larger molecules (like proteins), which increase plasma volume and colloid oncotic pressure, helping to draw fluid back into the bloodstream.

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Potassium's Role

A vital electrolyte responsible for muscle contraction, nerve impulse transmission, heart rate regulation, and maintaining acid-base balance.

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Diuretic Action

Drugs that interfere with sodium and water reabsorption in the kidneys, promoting urine production and fluid excretion.

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Packed RBC

Blood product used to increase oxygen-carrying capacity in patients with anemia or blood loss.

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Osmotic Diuretics

These drugs increase urine output by making the filtrate in the nephron more concentrated, preventing water reabsorption.

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Examples of Osmotic Diuretics

Mannitol and Glycerin are common examples of osmotic diuretics.

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How Osmotic Diuretics Work

Osmotic diuretics are filtered by the glomerulus but not reabsorbed, creating an osmotic gradient that pulls water into the urine.

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Antihypertensive Drugs

Drugs used to lower blood pressure in patients with hypertension.

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Mechanism of Action: Diuretics

Diuretics lower blood pressure by increasing sodium and water excretion in the urine, reducing blood volume and lowering cardiac output.

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ACE Inhibitors

These drugs block the enzyme ACE which converts angiotensin I to angiotensin II, a potent vasoconstrictor.

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Effects of ACE Inhibitors

ACE inhibitors cause vasodilation, lower aldosterone secretion, and reduce blood volume, leading to lower blood pressure.

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Angiotensin II Receptor Blockers (ARBs)

ARBs block the receptors for angiotensin II, preventing its vasoconstriction and aldosterone release effects.

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Potassium-Sparing Diuretics

Diuretics that prevent potassium loss while promoting urine production.

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Spironolactone & Eplerenone

Potassium-sparing diuretics that block aldosterone, a hormone that promotes sodium reabsorption.

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Amiloride & Triamterene

Potassium-sparing diuretics that block sodium channels in the collecting duct, reducing sodium reabsorption.

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Carbonic Anhydrase Inhibitors

Diuretics that inhibit the enzyme carbonic anhydrase, reducing bicarbonate reabsorption and promoting urine production.

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Acetazolamide & Methazolamide

Examples of carbonic anhydrase inhibitors. These drugs affect the proximal convoluted tubule.

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Effects of Potassium-Sparing Diuretics

Mild diuresis, potassium retention (hyperkalemia), which can be dangerous if used with other diuretics or in renal dysfunction.

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Uses of Potassium-Sparing Diuretics

Treat heart failure, edema due to cirrhosis or nephrotic syndrome, and hypertension (often combined with other diuretics).

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Effects of Carbonic Anhydrase Inhibitors

Increase excretion of bicarbonate, sodium, potassium, and water. Can cause metabolic acidosis.

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Proximal Convoluted Tubule (PCT)

The first part of the renal tubule where most of the sodium, chloride, and water are reabsorbed back into the bloodstream.

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What are ARBs?

Angiotensin II Receptor Blockers (ARBs) are a class of medications that block the angiotensin II receptors in the body, preventing the vasoconstrictive and aldosterone-releasing effects of angiotensin II.

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Descending Limb of Loop of Henle

This segment is permeable to water, allowing water to move out of the tubule and back into the bloodstream, concentrating the urine.

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What is a common side effect of ARBs?

ARBs can cause dizziness, hyperkalemia (high potassium levels), and hypotension (low blood pressure).

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Ascending Limb of Loop of Henle

This segment is impermeable to water but actively transports sodium, potassium, and chloride out of the tubule, diluting the urine.

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How do Calcium Channel Blockers work?

Calcium Channel Blockers (CCBs) block calcium channels in vascular smooth muscle and cardiac muscle, leading to vasodilation and a decrease in heart rate, contractility, and conduction velocity.

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What are Dihydropyridines?

Dihydropyridines are a type of calcium channel blocker that primarily act as vasodilators. Examples include Amlodipine and Nifedipine.

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Distal Convoluted Tubule (DCT)

This part of the tubule fine-tunes sodium reabsorption and regulates potassium and calcium levels in the blood.

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Collecting Duct

The final segment of the nephron where sodium and water reabsorption is regulated by hormones, ultimately determining urine concentration.

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What are non-dihydropyridines?

Non-dihydropyridines are another type of calcium channel blocker that affect both the heart and blood vessels. Examples include Verapamil and Diltiazem.

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How do Beta Blockers work?

Beta Blockers reduce heart rate, contractility, and cardiac output by blocking beta-adrenergic receptors in the heart. They also decrease renin secretion, leading to vasodilation.

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Thiazide Diuretics (e.g., Hydrochlorothiazide)

These drugs block the sodium-chloride cotransporter in the distal convoluted tubule, increasing sodium, chloride, and water excretion in urine.

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Loop Diuretics (e.g., Furosemide)

These drugs block the sodium-potassium-chloride cotransporter in the thick ascending limb of the Loop of Henle, causing a significant increase in urine output.

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What are common side effects of Beta Blockers?

Common side effects of beta blockers include bradycardia (slow heart rate), fatigue, depression, erectile dysfunction, and bronchospasm (especially with non-selective blockers).

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Effects of Diuretics

Diuretics can cause potassium loss (hypokalemia), magnesium loss (hypomagnesemia), and calcium loss (hypocalcemia). Some diuretics can also increase renal blood flow.

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How do Alpha-1 Adrenergic Blockers work?

Alpha-1 Adrenergic Blockers selectively block alpha-1 adrenergic receptors in vascular smooth muscle, preventing vasoconstriction and leading to vasodilation.

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Study Notes

Renal Medications - Tonicity

  • Isotonic Solutions:
    • Osmotic pressure remains the same
    • Examples include 0.9% NaCl (normal saline), lactated ringers (LR), and D5W (dextrose 5% in water)
    • Similar solute concentration to blood plasma
  • Hypotonic Solutions:
    • Lower osmotic pressure than blood plasma
    • Examples include 0.45% NaCl and D5W
    • Cause fluid to move out of blood vessels into surrounding tissues
  • Hypertonic Solutions:
    • Higher osmotic pressure than blood plasma
    • Examples include 3% NaCl and D10W (dextrose 10% in water), D5NS (dextrose 5% in normal saline), and D5L (dextrose 5% in lactated ringer's)
    • Cause fluid to move from surrounding tissues into blood vessels

Renal Medications - Crystalloids

  • Mechanism of Action:
    • Contain fluids and electrolytes naturally found in the body
    • Do not contain proteins, lowering risk of allergic reactions and viral transmission
    • Useful for treating dehydration, replacing lost fluids, and managing fluid/electrolyte imbalances
    • Promote urinary flow

Renal Medications - Types of Crystalloids

  • 0.9% NS (Normal Saline)
  • Lactated Ringers (LR)
  • Dextrose (D5W)
  • 3.3% Dextrose and 0.3% NS
  • D5W and 0.225% NS (D5 1/4 NS)
  • Plasma-lyte
  • 0.45% NaCl
  • 3% NaCl
  • D5W and 0.45% NS

Renal Medications - Colloids

  • Mechanism of Action:
    • Contain specific albumin natural proteins
    • Primarily produced in the liver
    • Responsible for approximately 70% of colloid oncotic pressure (draws fluid into blood vessels)
    • Sterile solutions of serum albumin prepared from pooled human blood, plasma, serum, or placenta
    • Pasteurized to remove contaminants

Renal Medications - Blood Products

  • Mechanism of Action:
    • Only class of fluids that carries oxygen
    • Increases tissue oxygenation
    • Increases plasma volume
    • Most expensive and least available fluid
    • Increases colloid oncotic pressure and plasma volume

Renal Medications - Potassium

  • Mechanism of Action:
    • Most abundant positively charged electrolyte inside cells
    • Makes up 95% of body's potassium
    • Potassium content outside cells ranges from 3.5 to 5 mmol per liter
    • Critical for normal body function (muscle contraction, nerve impulse transmission, heartbeat regulation, acid/base balance, isotonicity)

Renal Medications - Diuretic Drugs

  • Mechanism of Action:
    • Act on different parts of the nephron (kidney's functional unit) to interfere with sodium and water reabsorption
  • Nephron Function:
    • Proximal Convoluted Tubule (PCT): Primarily responsible for sodium, chloride, and water reabsorption
    • Loop of Henle: Divided into descending (water permeable) and ascending (water impermeable) limbs; actively transports sodium, potassium, and chloride
    • Distal Convoluted Tubule (DCT): Involved in further sodium reabsorption and regulation of potassium and calcium
    • Collecting Duct: Final site of sodium and water reabsorption; influenced by aldosterone and antidiuretic hormone (ADH)

Renal Medications - Thiazide Diuretics

  • Site of Action: Distal Convoluted Tubule (DCT)
  • Mechanism: Inhibit sodium/chloride co-transporter, preventing sodium and chloride reabsorption
  • Effects: Increased sodium, chloride, and water excretion

Renal Medications - Loop Diuretics

  • Site of Action: Thick Ascending Limb of Loop of Henle
  • Mechanism: Inhibit Na+/K+/2Cl− symporter, reducing sodium, potassium, and chloride reabsorption
  • Effects: Profound diuresis (increased urine output); potassium, magnesium, and calcium loss; increased renal blood flow

Renal Medications - Potassium-Sparing Diuretics

  • Mechanism: Block the action of aldosterone (hormone increasing sodium reabsorption) or inhibit sodium channels in the collecting duct
  • Effects: Mild diuresis compared to loop/thiazide diuretics; potassium retention (hyperkalemia)

Renal Medications - Carbonic Anhydrase Inhibitors

  • Mechanism: Inhibit the carbonic anhydrase enzyme in the proximal renal tubule, decreasing bicarbonate, sodium, and water reabsorption
  • Effects: Increased excretion of bicarbonate, sodium, potassium, and water; metabolic acidosis

Renal Medications - Osmotic Diuretics

  • Mechanism: Increase the osmolarity of the renal filtrate, preventing water reabsorption and increasing urine output
  • Effects: Increased urine volume; reduced cerebral/intraocular pressure

Renal Medications - Antihypertensive Drugs

  • Mechanism: Lower blood pressure by acting on various parts of the body (heart, blood vessels, kidneys, nervous system) to decrease cardiac output, reduce systemic vascular resistance, or both
    • Examples: Adrenergic drugs, ACE inhibitors, Angiotensin II receptor blockers (ARBS), Calcium channel blockers, Direct renin inhibitors, Diuretics, Vasodilators

Renal Medications - Beta Blockers

  • Mechanism of Action: Block beta-adrenergic receptors in heart, kidneys, and blood vessels
  • Effects: Reduced heart rate, decreased myocardial contractility, lowered cardiac output, reduced renin secretion, vasodilation

Renal Medications - Alpha-1 Adrenergic Blockers

  • Mechanism of Action: Block alpha-1 adrenergic receptors in blood vessels; prevents norepinephrine-stimulated vasoconstriction
  • Effects: Vasodilation

Renal Medications - Alpha-2 Agonists

  • Mechanism of Action: Stimulate alpha-2 adrenergic receptors in the central nervous system, decreasing sympathetic nervous system outflow; reducing norepinephrine release
  • Effects: Reduced heart rate, vasodilation

Renal Medications - Direct Vasodilators

  • Mechanism of Action: Relax vascular smooth muscle directly, lowering systemic vascular resistance and blood pressure
  • Examples: Hydralazine, Minoxidil, Nitroprusside

Renal Medications - Renin Inhibitors

  • Mechanism of Action: Block the enzyme renin, preventing the formation of angiotensin II; leading to vasodilation, decreased aldosterone secretion, and reduced blood volume
  • Example: Aliskiren

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Description

This quiz explores the various types of renal medications, particularly focusing on tonicity and crystalloid solutions. It covers isotonic, hypotonic, and hypertonic solutions, along with their mechanisms of action and applications in treatment. Test your understanding of how these medications affect fluid balance in the body.

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