Sodium and Fluid Disorders: Pharm and Med Chem

concentration and relative pressure across semi-permeable membranes

What do the number of dissolved particles per unit of water determine?

osmoles of a solute

is the number of ions formed by a substance x number of moles of that substance

osmolarity

Osmoles/liter of solvent

Osmolality

Osmoles/kg of solvent

concentration measurements

used to determine osmotic activity

normal

"eu"

high

"hyper"

low

"hypo"

refers to volume

"vole"

means sodium

"natrium"

refers to blood

"-emia" or "-emic"

euvolemia

is normal fluid volume in the blood

hypovolemia

is low fluid volume in the blood

hypervolemia

is high fluid volume in the blood

hyponatremia

is low sodium in the blood

hypernatremia

is high sodium in the blood

osmolality

is the concentration of particles in a weight of fluid

osmolarity

is the concentration of particles in a volume of fluid

Osmolarity equation

M x number of particles

mOsmolarity

mM x number of particles

moles

is grams/molecular weight

Molarity (M)

is moles/L

1

1000 mM = ___ M

1000

_______ mOsmol/L = 1 Osmol/L

volume

Osmoles are normalized to ___________ to get osmolarity

mass

Osmoles are normalized to ___________ to get osmolality

1

# of Dextrose particles

1

# of Glucose particles

2

# of potassium chloride particles

2

# of MgSO4 particles

3

# of CaCl2 particles

4

# of Sodium Citrate particles

osmotic diuretics

-produce osmotic effects

-inhibit tubular reabsorption of water

-effect renal corpuscle, proximal tubules, loop of henle, and collecting ducts

glomerulus

Where do osmotic diuretics increase osmotic pressure to enhance filtration at?

increase

Osmotic diuretics __________ urinary output.

out

Osmotic diuretics elevate blood plasma osmolality and draws water _________ of the body's tissues and organs.

Osmitrol

Mannitol

alcohol

Mannitol (Osmitrol) is a sugar __________

Mannitol (Osmitrol)

-occurs naturally in fruit and veggies

-IV injection

-reduces intracranial pressure and intraocular pressure

effective and ineffective osmoles

What are the types of osmoles?

effective osmoles.

-cannot cross cell membranes

-pull fluid to its side of the membrane

ineffective osmoles

-cross cell membranes

-cannot pull fluid across a membrane

effective osmole.

Sodium

ineffective osmole

ethanol

effective osmole

potassium

ineffective

oxygen

ineffective osmole

carbon dioxide

effective osmole.

glucose

effective osmole

mannitol

1) Vasopressin

2) Aldosterone

3) Angiotensin II

What are the 3 anti-diuretic hormones?

Vasopressin

-anti-diuretic hormone, peptide with 9 amino acids

-acts on kidney collecting ducts to increase water reabsoprtion

Aldosterone

-acts on kidney distal neuron to increase sodium reabsorption and potassium excretion

-helps indirectly retain water

Angiotensin II

-constricts blood vessels

-stimulates release of vasopressin and aldosterone

Conivaptan (Vaprisol) MOA

-vasopressin receptor antagonist

-dual antagonist for V1a and V2 receptors

Conivaptan (Vaprisol)

-Treats hyponatremia by increasing excretionof water while maintaining sodium

-Dilutes urine

injection and fast acting

How do you admin Conivaptan (Vaprisol)?

CYP3A4 drug interactions

What are the DDIs with Conivaptan (Vaprisol)?

Tolvaptan (Jynarque, Samsca) MOA

-vasopressin receptor antagonist

-selective for V2 receptors (V2: V1a selectivity is 29:1)

Tolvaptan (Jynarque, Samsca)

treat hyponatremia

oral

How do you admin Tolvaptan (Jynarque, Samsca)?

CYP3A4 drug interactions

What is the DDI with Tolvaptan?

risk of serious liver injury

What is the boxed warning with Tolvaptan?

toxic metabolites

When Tolvaptan undergoes CYP 3A4 and oxidation it leads to an open ring what does it leads to?

Desmopressin (DDAVP)

-Synthetic analogue of the anti-diuretic hormone vasopressin-first amino acid deaminated and arginine is D-configuration instead of L-configuration

-Increases water reabsorption in the kidney

-Decreases urine volume

-Increases urine osmolality

Declomycin

Demeclocycline

Demeclocycline (Declomycin)

-Tetracycline antibiotic

-Inhibits the action of anti-diuretic hormone (ADH) in patients with chronic SIADH- syndrome of inappropriate anti-diuretic hormone

-Acts in the kidney and reduces response from V2 receptors