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Terms in this set (152)
PCT) Bicarb reabsorption is started by _______ exchanger?
Na+/H+ exchanger is called ___?
Na+/H+-ATPase works at basolateral surface to put ______ into ______ space.
H+ combines with bicarb to form ______ ____
Carbonic anhydrase (CA) does what to carbonic acid?
Dehydrated to water and carbon dioxide
Bicarbonate reabsorption in PCT is dependent upon what?
What is released due to hypoxia or too much ATP consumption?
How many receptors does Adenosine have?
What does Adenosine doe to energy comsumption?
What does Adenosine do to NHE3 activity?
Where is most reabsorption taken place at in the PCT?
What does the luminal (urine) fluid mostly contain in the late-PCT?
What activity stops in the late-PCT?
What reabsorption still continues in the late-PCT?
What is the 2 things diuretics can act on in the PCT?
Water moves through ______ stress; thus the luminal fluid concentration is mostly retained along the PCT
Acids are secreted in what section of the PCT?
Bases are secreted in what section of PCT?
S1 and S2 segments
What 2 things make up the loop of Henle?
-Thin descending limb (TDL)
-Thick and then ascending limb (TAL)
What does the TDL do to water?
It extracts it from the urine into the space due to osmotic pressure
What will happen to the concentration of luminal fluid at the TDL?
Can water cross the thin AL?
No; only some solutes
Can water cross the thick AL?
What happens at the thick AL?
NaCl reabsorption (~25% of total)
What part of the nephron is considered as the diluting segment?
What happens to the concentration of the urine in the thick AL?
In the Loop of Henle, what cation gets an excessive buildup in the epithelial cells of TAL?
What two things are responsible for transporting K+ into the cell?
In the Loop of Henle, what cation diffuses back into the lumen and creates (+) potential?
What is the driving force to move Mg2+ and Ca2+ back in the interstitium blood?
The action potential created by the K+ diffusing across into the lumen
What will happen to Mg and Ca if you block NKCC2 in the Loop of Henle?
Ca and Mg will not move into the blood because there will be NO K+ potential to drive those cations back.
If you block Na/K ATPase what will happen to K in the Loop of Henle?
K will NOT be transported into the cell and you will NOT have action membrane potential
What diuretics work to block NKCC2 cotransporter?
What part of the nephron is responsible for ~10% of Na reabsorption?
What transporter is the main drug target in the DCT?
What types of drugs can inhibit NCC?
T/F) The DCT is relatively permeable to water.
False; relatively impermeable
What are the 3 segments that go from the DCT to the ureter?
What part of the DCT is responsible for 2-5% of NaCl reabsorption?
What section is the most important site for K+ secretion by the kidney?
From DCT to Ureter
What are the two principal cell types from the DCT to the Ureter?
Principal and Intercalated cells
What cells are a major site for water and cation tranport?
What cells are the primary site of H+ (alpha cells) or bicarbonate (Beta cells) secretion?
T/F) The collecting tubules have just one transport for Na+ and K+.
False; it has two seperate channels for Na+ intake and K+ outflow
What is another word used to describe Na+ channel on the collecting tubules?
Collecting Tubule Na+ inflow is regulated by what?
In the collecting tubule, Na+ inflow takes place on what side of the cell?
T/F) Na+ inflow into the cell in the collecting tubule take precedence over K+ and thus membrane potential will be created.
What happens to K+ when Na+ comes into the cell?
In the collecting tubule, what will create an enhanced outflow of K+ into the urine?
The more Na+ concentration you have in the urine
What controls the permeability of collecting tubule cells to water by controlling the localization of specific water channels?
Antidiuretic hormone (ADH)
What is another name for the specific water channels in the collecing tubules?
What type receptors do ADH bind to? (2)
T/F) V2 receptors are GPCRs.
What binds to V2 receptors in the kidney?
If you have no ADH to activate V2 what will happen?
No water permeability into the principal cells=dilute urine
Where do Carbonic anhydrase inhibitors act at?
Where does dehydration of carbonic acid to water and carobon dioxide work at?
Where does rehydration of carbon dioxide to carbonic acid work at?
Within the cell
Inhibitors of CA prevent what reabsorption?
Sodium Bicarbonate (Diuresis)
What are the 4 drugs that are CA inhibitors?
What is the most common application for CAi?
Glaucoma (decrease production of aqueous humor)
How does CAi MOA used with urinary alkalinazation?
It leaves bicarb in the luminal fluid which will increase urinary pH
What can happen when treating urinary alkalinazation with CAi?
Calcium stone formation from too high urine pH
How does CAi helps with metabolic alkalosis?
Inhibits bicarb reabsorption; help with fluid overload by diuresis
What other to things can CAi help with?
________ is not an anitbacterial sulfonamide, but is a sulfa drug, thus allergies are possible
Tox with CA inhibs? (4)
-Drowsiness and Parathesias
What is the class prototype of CAi?
What are two AE's that can happen with ACetazolomide?
What drugs are used for glaucoma? (3) Which ones are topical or systemic?
What drug only reduces intraocular pressure and has no systemic effects for treating GLaucoma?
What are two weak diuretics due to A1 antagonism?
Caffeine and Theophylline
Adenosine binds to what receptor?
When Adenosine binds to A1 what does it have an effect on?
At what dose does adenosine inhibit NHE3 activity? What about activating?
High doses; low doses
Where do A1 antagonist found? (2)
Pre-glomerular afferent arteriole and PCT
T/F) A1 antagonist appear to cause potassium wasting.
False; they DO NOT appear to cause potassium wasting
What WAS an A1 antagonist removed from market due to CNS toxicity?
What do you want to inhibit in with loop diuretics?
What happens to NaCl with a loop diuretic?
No NaCl reabsorption through TAL
What happens to the meduallary gradient with loop diuretics?
There isn't one
What happens to water reabsorption with loop diuretics?
There isn't any water reabsorbed
What happens to Na and K if you block NKCC2?
Stay in the urine
What happens to Mg and Ca with loop diuretics?
Stay in the urine
What are the types of drugs that are loop diuretics?
What are the sulfonamide names of loop diuretics? (4)
T/F) A1 antagonist appear to cause potassium wasting.
False; they do not appear to cause potassium wasting
______ and _____ are weak diuretics due to A1 antagonism.
Caffeine and Theophylline
_______ was an A1 antagonist removed from market due to CNS toxicity.
What side of the nephron does Loop diuretics work on?
_____ interfere with loop diuretic function at this level by blocking COX-2 activity.
What do loop diuretics induce expression of?
Blood flow is effected by loop diuretics in two places.
Renal and Pulmonary
What loop diuretic affects blood flow?
What loop diuretic effects the pulmonary?
What are some clinical app for Loop Diuretics? (5)
-Acute renal failure to increase rate of urine flow
A/E's for Loop diuretics?
-Hypokalemic metabolic alkalosis
-Allergic Response (sulfa)
Why do you not see hypocalcemia with loop diuretics?
Vitamin D can regulate absorption in the gut and we also have large storages in out bones
What drug can be used in people with a sulfa allergy?
Thiazides at on what in the DCT?
Thiazides enhance what atoms reabsorptio?
What two atoms does the NCC bring into the cell from the urine?
Na and Ca
If you block NCC, then more what will happen to Ca reabsorption?
What inhibit Thiazide actions?
What are the 5 Thiazide drugs?
What thiazide is not very lipid soluble thus it has to be given at large doses?
What thiazide has enhanced solubility and can be used a lower doses?
What thiazide is absorbed slowly with a longer DoA?
What thiazide has a 12-14 hour half life?
Clinical applications for Thiazides?
HTN, HF, Idiopathic Hypercalciuria, NDI
What antagonize aldosterone at Collecting Tubules?
K Sparing Diuretics
Why are K sparing Diuretics weaker diuretics?
Most of the water has already been absorbed by the time it gets to the collecting tubules
What drugs antagonize aldosterone receptors directly? (2)
Spironolactone and Eplerenone
What drugs inhibit Na influx and are K Sparing Diuretics?
What drug inhibits aldosterone receptors and androgen receptors?
A/E of Spironolactone
Hyperkalemia, Cardiac Arrhythmia, Menstral abnormalities, gynecomastia, sedation, HA, GI upset
Common CA for Spironolactone
_____ is commonly used to treat when someone has too much aldosterone
What drug is more selective anti-aldosterone activity with no effects on androgen receptors?
T/F) Care must be taken with 3A4 inhibitors and grape fruit juice when taking with Eplerenone
Most common A/E with Eplerenone?
What blocks Na reabsorption in DCT and CCT?
T/F) Amiloride is not well-tolerated?
False; it is well-tolerated
Do you get a loss of K with Amiloride?
What is much like Amiloride but is a recombinant humanized B-type natriuretic peptide?
What does Nesiritide do to vascular epithelial cells?
Increase cGMP thus vasodilation
Indication for Nesiritide?
HF w/ edema
T/F) Nesiritide comes in oral tablets?
What is an AE specific for Spironolactone?
K sparing drugs combined with RAAS drugs can lead to what?
What drugs alter water excretion and are independent of electrolytes?
Aquaretic that is works off of osmotic pressure?
Aquaretic drugs that antagonize ADH? (3)
T/F) Mannitol has good absorption in the GI?
False; has to be IV
T/F) Mannitol effects all water reabsorption?
Where does Mannitol have its biggest effect?
What happens to Na reabsorption when taking Mannitol?
T/F) Mannitol effects intracranial and intraocular pressure
Mannitol can be used to increase drug delivery to the brain?
A/E with Mannitol?
Dehydration, Extracellular volume increases and thus cell water loss, hyperkalemia, hypernatremia, Hyponatremia with severe renal impairment
T/F) Mannitol is secreted in the kidneys?
T/F) Lixivaptan is under FDA evaluation.
ADH antagonist that has high affinity for both V1 and V2 receptors?
Conivaptan _____ renal excretion of water
CA for Conivaptan?
How must Conivaptan be taken?
IV (IV site reactions A/E)
What ADH antag has a 30-fold preference for V2 than V1?
How can Tolvaptan be taken?
T/F) Tolvaptan is an P-gp inhibitor?
T/F) Tolvaptan has high protein binding?
A/E for Tolvaptan
Thirst, dry mouth, asthenia, constipation
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