Renal Medications
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Questions and Answers

Which intravenous solution is classified as isotonic?

  • 0.45% NaCl
  • 3% NaCl
  • 0.9% NaCl (correct)
  • D10W
  • What is the primary effect of hypotonic solutions on fluid movement?

  • Fluid moves into veins from surrounding tissues.
  • Fluid expands the plasma volume significantly.
  • Fluid moves out of veins into surrounding tissues. (correct)
  • Fluid remains in the bloodstream.
  • Which of the following is a characteristic of crystalloids?

  • They promote urinary flow and are used for hydration. (correct)
  • They increase the risk of viral transmission.
  • They are effective for expanding plasma volume.
  • They contain proteins and electrolytes.
  • Which solution would cause fluid to move into the bloodstream from surrounding tissues?

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

    What is a common use of isotonic solutions in clinical settings?

    <p>As maintenance fluids to prevent dehydration. (B)</p> Signup and view all the answers

    What is the primary mechanism by which osmotic diuretics increase urine output?

    <p>They increase the osmolarity of the filtrate in the nephron. (A)</p> Signup and view all the answers

    Which of the following common effects is associated with ACE inhibitors?

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

    Which class of antihypertensive medications primarily decreases cardiac output?

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

    What is the primary action of angiotensin II receptor blockers (ARBs)?

    <p>Prevent vasoconstriction by blocking angiotensin II type 1 receptors (B)</p> Signup and view all the answers

    Which of the following is a common side effect of calcium channel blockers?

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

    What effect do direct vasodilators primarily have on blood vessels?

    <p>They directly relax smooth muscle, causing vasodilation. (A)</p> Signup and view all the answers

    What is a common side effect of alpha-1 adrenergic blockers?

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

    Which medication class is primarily used to manage increased intraocular pressure?

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

    What condition is typically treated with the use of osmotic diuretics?

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

    How do beta blockers affect the renin-angiotensin-aldosterone system (RAAS)?

    <p>They reduce renin secretion from the kidneys. (B)</p> Signup and view all the answers

    What distinguishes non-dihydropyridine calcium channel blockers from dihydropyridines?

    <p>They primarily reduce heart rate and contractility. (D)</p> Signup and view all the answers

    What is a potential side effect of abrupt discontinuation of alpha-2 agonists?

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

    Which mechanism is primarily used by direct renin inhibitors to lower blood pressure?

    <p>They block the conversion of angiotensinogen to angiotensin I. (B)</p> Signup and view all the answers

    Which type of fluid is primarily used to increase oxygen carrying capacity in patients?

    <p>Whole Blood (A), Packed RBC (D)</p> Signup and view all the answers

    What is the primary mechanism of action for thiazide diuretics?

    <p>Inhibit Na+/Cl- symporter in the distal convoluted tubule (B)</p> Signup and view all the answers

    Which statement about carbonic anhydrase inhibitors is true?

    <p>They cause metabolic acidosis due to bicarbonate loss. (D)</p> Signup and view all the answers

    What is the primary effect of loop diuretics?

    <p>Increase urine output significantly (D)</p> Signup and view all the answers

    In which condition are potassium-sparing diuretics especially beneficial?

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

    What characterizes the mechanism of action of albumin as a colloid?

    <p>It helps to maintain oncotic pressure in the blood. (B)</p> Signup and view all the answers

    Which of the following is a common use for loop diuretics?

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

    What is the correct range for normal potassium levels in the extracellular fluid?

    <p>3.5 to 5.0 mmol per litre (B)</p> Signup and view all the answers

    What distinguishes blood products from crystalloids and colloids?

    <p>They carry oxygen and increase tissue oxygenation (A)</p> Signup and view all the answers

    Which diuretic class is least likely to cause hypokalemia?

    <p>Potassium-sparing diuretics (D)</p> Signup and view all the answers

    Where does the major reabsorption of water occur in the nephron?

    <p>Proximal Convoluted Tubule (B)</p> Signup and view all the answers

    Which combination represents a common crystalloid solution used for maintenance therapy?

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

    Which statement about thiazide diuretics is false?

    <p>They act primarily on the Collecting Duct. (A)</p> Signup and view all the answers

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

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

    Flashcards

    Isotonic solution

    A solution with the same osmotic pressure as blood plasma, meaning it won't cause fluid to move in or out of cells.

    Hypotonic solution

    A solution with lower osmotic pressure than blood plasma, causing fluid to move out of blood vessels and into surrounding tissues.

    Hypertonic solution

    A solution with higher osmotic pressure than blood plasma, drawing fluid from surrounding tissues into blood vessels.

    Crystalloids: Mechanism of Action

    Crystalloids are solutions containing fluids and electrolytes found naturally in the body. They help rehydrate, replace fluid losses, correct electrolyte imbalances, and promote urine production.

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    What are some examples of isotonic IV solutions?

    Normal saline (0.9% NaCl) and Lactated Ringer's (LR) are common examples of isotonic IV solutions.

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    Crystalloids

    Fluid solutions composed of water, electrolytes, and small molecules that can pass through cell membranes. They are used to replenish fluids and electrolytes.

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    NS 0.9%

    Normal saline is a crystalloid solution containing 0.9% sodium chloride (NaCl) in water. It is isotonic to blood, meaning it has the same salt concentration as blood plasma.

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    Lactated Ringer's

    A balanced electrolyte solution containing sodium, potassium, calcium, chloride, and lactate. It is similar to blood plasma and is often used for fluid resuscitation.

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    What is D5W?

    A crystalloid solution containing 5% dextrose (a type of sugar) in water. It is hypotonic to blood, meaning it has a lower salt concentration than blood plasma.

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    3.3% Dextrose and 0.3% NS

    A combination of dextrose and sodium chloride in water. It is slightly hypotonic to blood and often used for hydrating patients.

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    Colloids

    Large molecules that cannot pass through cell membranes. They remain in the bloodstream, increasing blood volume and oncotic pressure.

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    Albumin

    A natural protein produced by the liver, responsible for generating a significant portion of blood's oncotic pressure.

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    Packed RBCs

    Red blood cells that have been concentrated without plasma. Used to increase oxygen carrying capacity for patients with anemia.

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    Whole Blood

    Contains all blood components, used for significant blood volume loss.

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    Potassium

    A critical electrolyte found primarily inside cells. It plays a vital role in muscle contraction, heart function, and nerve impulses.

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    Diuretics

    Drugs that increase urine output by interfering with sodium and water reabsorption in the kidneys.

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    Thiazide Diuretics

    Diuretics like hydrochlorothiazide that act on the distal convoluted tubule, blocking sodium and water reabsorption.

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    Loop Diuretics

    Drugs like furosemide that act on the loop of Henle, powerfully inhibiting sodium and water reabsorption.

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    Potassium Sparing Diuretics

    Drugs like spironolactone that retain potassium while promoting sodium and water excretion, used for specific conditions.

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    Osmotic Diuretics

    Medications that increase urine output by drawing water from the body into the urine. They work by making the filtrate in the kidneys more concentrated, preventing water reabsorption.

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    Mannitol

    An example of an osmotic diuretic often used to reduce swelling in the brain (cerebral edema) and eyes (glaucoma).

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    Antihypertensive Drugs

    Medications used to lower blood pressure in individuals with hypertension. They work by various mechanisms to reduce the amount of blood pumped by the heart and/or expand blood vessels.

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    Adrenergic Drugs

    A broad class of drugs that affect the sympathetic nervous system, which controls 'fight or flight' responses. They can be used to increase or decrease blood pressure.

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    ACE Inhibitors

    Medications that block the conversion of angiotensin I to angiotensin II, a powerful vasoconstrictor.

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    How do ACE inhibitors lower blood pressure?

    By blocking the conversion of angiotensin I to angiotensin II, they reduce blood vessel constriction and lower aldosterone levels, reducing sodium and water retention.

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    Examples of ACE inhibitors

    Enalapril, Lisinopril, Ramipril, Captopril

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    ARBs (Angiotensin II Receptor Blockers)

    Medications that block the action of angiotensin II by preventing it from binding to its receptors, leading to vasodilation.

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    How do ARBs differ from ACE inhibitors?

    They work directly on the angiotensin II receptors rather than blocking its production, which prevents the cough and angioedema associated with ACE inhibitors.

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    Calcium Channel Blockers (CCBs)

    Medications that block the flow of calcium into the heart and blood vessel muscles, leading to relaxation and reduced blood pressure.

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    Types of Calcium Channel Blockers

    There are two main types: Dihydropyridines (e.g., Amlodipine, Nifedipine) mainly dilate blood vessels and Non-dihydropyridines (e.g., Verapamil, Diltiazem) affect both the heart and blood vessels.

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    Beta Blockers

    Medications that block the effects of adrenaline (epinephrine) on the heart, reducing heart rate and contractility.

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    Alpha-1 Adrenergic Blockers

    Medications that block the effects of adrenaline on blood vessels, leading to dilation and lower blood pressure.

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    Study Notes

    Renal Medications: Tonicity and Types

    • Isotonic solutions: Have the same osmotic pressure as blood plasma, preventing fluid shifts. Examples include 0.9% NaCl (normal saline), Lactated Ringers (LR), and D5W (dextrose 5% in water).

    • Hypotonic solutions: Have a lower osmotic pressure than blood plasma. This causes fluid to move out of the blood vessels into surrounding tissues. Examples include 0.45% NaCl and D5W.

    • Hypertonic solutions: Have a higher osmotic pressure than blood plasma. These solutions cause fluid to move into the blood vessels from surrounding tissues. Examples include 3% NaCl, D10W (dextrose 10% in water), D5NS (dextrose 5% in normal saline), and D5L.

    Crystalloids: Mechanism and Types

    • Mechanism of Action: Contain fluids and electrolytes found in the body. They do not contain proteins, minimizing the risk of allergic or viral reactions. More suitable for treating dehydration or restoring normal fluid balance, rather than expanding plasma volume.

    • Types: Including NS 0.9%, Lactated Ringers, various dextrose solutions, and Plasma-lyte, as well as specific ratios (e.g., D5W, 0.45% NS).

    Colloids: Mechanism and Types

    • Mechanism of Action: Contain large molecules (proteins) that remain within the blood vessels more effectively than crystalloids to increase the colloid oncotic pressure. This helps maintain blood volume and reduces fluid leaking from the blood vessels into surrounding tissues.

    • Examples: Albumin (produced by the liver, crucial for generating colloid oncotic pressure); blood products (plasma, blood).

    Blood Products

    • Blood products (Whole blood, Packed RBCs) are unique fluids that increase tissue oxygenation and plasma volume but are expensive and less accessible.

    • Packed RBCs: Increase oxygen-carrying capacity, beneficial for people with anemia or significant blood loss.

    • Whole blood: More beneficial in cases of severe blood loss due to its plasma protein content, which helps draw fluid back into the blood vessels from the surrounding tissues.

    Potassium: Mechanism and Role

    • Mechanism of Action: The most abundant intracellular positive electrolyte, critical to many bodily functions (muscle contraction, nerve impulse transmission, heartbeat regulation, acid-base balance, isotonicity).

    • Normal levels: 3.5 to 5 mmol/L. Potassium levels are crucial for normal body functions. 95% of the body's potassium is inside cells.

    Diuretic Drugs: Mechanism of Action

    • Mechanism of Action: Affect different segments of the nephron, the kidney's functional unit, interfering with sodium and water reabsorption.
    • Nephron Segments:
      • Proximal Convoluted Tubule (PCT): Re-absorbs significant amounts of sodium, chloride and water.
      • Loop of Henle: Descending limb is permeable to water, ascending limb reabsorbs sodium, potassium and chloride.
      • Distal Convoluted Tubule (DCT): Further reabsorption of sodium, potassium, and calcium regulation.
      • Collecting Duct: Final reabsorption of sodium and water, regulated by aldosterone and ADH.

    Types of Diuretics

    • Thiazide Diuretics (e.g., Hydrochlorothiazide): Act in the Distal Convoluted tubule, increase sodium, chloride, water excretion, and have a calcium-sparing effect. Used in hypertension, heart failure, and kidney stones.

    • Loop Diuretics (e.g., Furosemide): Act in the Loop of Henle, cause significant diuresis, increase renal blood flow and are effective in severe heart failure and acute kidney failure. They can cause loss of potassium, magnesium and calcium.

    • Potassium-Sparing Diuretics (e.g., Spironolactone): Act in the Collecting Duct, Block the action of aldosterone to reduce sodium retention. They do not promote potassium excretion. Often used in combination with other diuretics to reduce potassium loss.

    • Carbonic Anhydrase Inhibitors (e.g., Acetazolamide): Act in the Proximal Convoluted Tubule, increase bicarbonate, sodium, potassium, and water excretion, causing metabolic acidosis, used for glaucoma, altitude sickness.

    • Osmotic Diuretics (e.g., Mannitol): Act in the Proximal Convoluted Tubule and Loop of Henle, increase filtrate osmolarity, preventing water reabsorption, used for cerebral edema, acute renal failure.

    Antihypertensive Drugs: Mechanisms and Types

    • Diuretics: Reduce blood volume by increasing sodium and water excretion in urine.

    • ACE Inhibitors (e.g., Enalapril): Block ACE, reduce Angiotensin II levels, leading to vasodilation and reduced blood volume. Side effects include dry cough.

    • ARBs (e.g., Losartan): Block the angiotensin II receptor, preventing vasoconstriction and aldosterone secretion, reducing blood volume. Side effects include dizziness and hypotension.

    • Calcium Channel Blockers: Inhibit calcium ion entry into smooth and cardiac muscle, cause vasodilation to reduce blood pressure and heart rate, commonly used for hypertension and angina. Side effects include peripheral edema, constipation, dizziness.

    • Beta Blockers: Block beta-adrenergic receptors, reducing heart rate, contractility, and cardiac output to lower blood pressure and renin secretion. Side effects include bradycardia, fatigue, bronchospasm.

    • Alpha-1 Blockers: Block alpha-1 receptors in blood vessels, leading to vasodilation and reduced systemic vascular resistance and side effects of orthostatic hypotension.

    • Alpha-2 Agonists: Stimulate alpha-2 receptors in the central nervous system, reducing sympathetic outflow to decrease heart rate and vasodilation. Side effects include sedation.

    • Direct Vasodilators (e.g., Hydralazine): Directly relax blood vessel smooth muscle to reduce systemic vascular resistance and blood pressure. Side effects include reflex tachycardia and fluid retention.

    • Renin Inhibitors (e.g., Aliskiren): Block renin, preventing the formation of Angiotensin II, resulting in vasodilation, decreased aldosterone secretion and reduced blood volume. Side effects include hyperkalemia and hypotension.

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    Description

    This quiz covers the different types of renal medications, specifically focusing on the tonicity of solutions such as isotonic, hypotonic, and hypertonic. Understand the effects these solutions have on fluid movement in the body, as well as examples of each type. Test your knowledge on crystalloids and their mechanisms of action.

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