blocks influx of Ca++ in smooth muscle cells - relaxation of SMCs - decrease BP
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Which of the following belong to diuretics? (list 6)
carbonic anhydrase inhibitors thiazides sodium glucose cotransporter 2 (SGLT2) inhibitors loop diuretics potassium sparing diuretic agents that alter water excretion (aquaretics)
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where does thiazide and carbonic anhydrase inhibitor belong to?
diuretic
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what is goal of the kidney?
excrete excess sodium in the body to make urine
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what does the afferent arteriole do?
blood comes in and filters it, adds filtrate
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what does the efferect arteriole do?
dumps protein and RBCs back into the blood as you are filtering throught the bowman's capsule
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what is the role of the PCT -proximal convoluted tubule?
reabsorbs 90% of water, sodium, potassium, glucose, amino acid into the blood reabsorbs nutrients ( tubular fluid) from the filtrate
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what is true about the descending loop
its permeable to water but impermeable to sodium
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what is true about the ascending loop?
impermeable to water, permeable to sodium
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where does aldosterone work?
collecting duct
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a cup shaped chamber in the renal corpuscle is called
glomerular capsule - bowman's capsule
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what concentrates urine and establishes osmotic gradient for water reabsorption?
nephron loop
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what adjust tubular fluid composition by reabsorption and secretion of potasium
distal convoluted tubule (DCT)
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what renal site determine efficacy and potency the most and is the most significant drug target?
loop
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what renal site determine efficacy and potency the least
late distal tubule
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drug that acts on early distal tubule
thiazides
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drug that acts on loop of henle
furosemide
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drugs acting on late distal tubule
triamterene, spironolactone, amiloride
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which of the following is true about carbonic anhydrase inhibitor?
they were found that bacteriostatic sulfonamides causes an alkaline diuresis and hypercholemic metabolic acidosis
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name a carbonic anhydrase inhibitor
acetazolamide
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describe the MOA of CA inhibitor
usually the more H+ that is pumped out into the urine, the more Na+ that is being reabsorbed into the blood -> water follows Na+ where-ever it goes so BP increases -> CARBONIC ANHYDRASE INHIBITORS PREVENT H FROM BEING MADE FROM BREAKDOWN OF CARBONIC ACID
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name naturetics
thiazides and loops
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what is the first step in treating htn that is inexpensive and effective
thiazide diuretics
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which of the following class of diuretics has vasodilator activity? ****
thiazides
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which of the following diuretics drugs has vasodilator activity? ****
hydrochlorothiazides
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what is the main function of thiazides
its a diuretic so it decrease sodium, water retention, decrease blood volume, cardiac output decrease
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what are hydrochlorothiazide effects?
HYPOTENSIVE!! gout -elevates UA dm -elevates glucose hypokalemia
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what metabolite cause vasodilator activity in HCTZ?
urinary kallikreain
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what drug and drug class has diuretic activity and vasodilation?
HCTZ - thiazides
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what drug can you not give if the patient has a sulfonamide allergy?
hydrochlorothiazide
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what drug causes lithium toxicity, decrease calcium excretions and decrease effectiveness of insulin/sulfonylureas?*** know these three
hydrochlorothiazide
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what is true about hydrochlorothiazides?**
glucose levels go up by decreasing effectivness of insulin/sulfonylureas -makes diabetes worse - so need to increase insulin dose
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what will happen if someone is taking lithium and hctz?
drug interaction - lithium toxicity -increase lithium levels
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what drug interaction will happen if a person takes HCTZ and calcium salts?
decrease calcium excretion which will increase calcium blood levels
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someone with diabetes take HCTZ what happen
drug interaction with insulin - decrease effectiveness
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what should you do if the thiazide therapy is failing?**
DO NOT increase dose, -may cause hypokalemia take another antihypertensive
add on loop diuretics when there is severe htn - combination therpay
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which of the following is true about indapamide
its a modified thiazide drug is lipid neutral - will not increase your lipid levels
used in patients with renal failure and nephrotic syndrome cardiovascular agent - quinazole diuretic related to the thiazide class inhibits sodium transport in distal tubules
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what drug is primarily used with furosemide to inhibit early distal tubular pump which is responsible for loop diuretic resitance?
furosemid
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what is the more effective and potent naturetics?
loop diuretic
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loop diuretic moa
blocks sodium, potassium, and chloride cotransporter (loop usually is meant to reabsorb ions and not water)
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which of the following drug belongs to loop diuretics?
furosemide
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if someone takes diuretics and take thiazide, what will happen?
increase glucose level (because potassium gets excreted out – it helps in production of insulin)
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what is the moa of furosemide
inhibits Na+Cl- reabsorption in the thick ascending limb
*which of the following is a potassium sparing diuretic?
spironlactone
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what drug is good for diabetes patients?
sparing potassium
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what is combined with spironlactone if using combination therapy?
thiazide diretics - K+losing naturetics
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If 3 Na go out, then how many cl comes in?
2
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what blocks sodium potassium chloride cotransporter?
loop diuretics
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what drugs are direct ENac inhibitors?
amloride and triamterene
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what is moa of amiloride and triamterene?
inhibit the influx through epithelial Na channel in the luminal membrane
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what inhibits aldosterone ?**** his favorite question
spironlactone
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what does triamterene inhibit? ***
membrane function
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what drug inhibits Na/K+ ATPase?
amiloride
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what drug can you not give if the patient has liver dysfunction?
spironolactone
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why is spironalctone better than HCTZ? ***
NO hypokalemia, hyperglycemia, hyperuricemia, which is seen with thiazide and loops
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what is the MOA of eplerenone?***
selectively binds to mineralocorticoid receptor and BLOCKS THE BINDING OF ALDOSTERONE, a component of the Renin angiotensin aldosterone system (RAAS)
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Which of the following is selective aldosterone-receptor antagonist?***
eplerone
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What block aldosterone (usually works through the mineralocorticoid receptor ?
eplerone
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which drug should you be cautious with if patient has type 2 diabetes?
eplerone
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eplerone is contraindicated in patients
high serum potassium creatinine clearance more than 30 concomitant administration of strong CYP3A4 inhibtors like ketoconazole, itraconazole, nefazodone, oleandomycin, clarithromycin, ritonavir, and nelfinavir)
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Which of the following is the metabolite of spironolactone?***
canrenoate and canrenone
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what is a good alternative to spironolactone if you have hepatic issue such as cirrhosis?
canrenoate and canrenone
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which of the following is true about canrenoate and canrenone?
theyre metabolites bypasses hepatic metabolism
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amiloride is used to treat
HTN and CHF
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which of the following is true about amiloride?
potassium sparing effect useful for preventing hypokalemia combined with THZ or other kaliuretic agents
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what produces angiotensinogen
liver
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what produces renin
kidney
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where does angiotensinogen 1 go to?
lungs
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angiotensin 2 causes
vasoconstriction
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what blocks angiotensin 2 from causing vasoconstriction
ARBS
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what blocks angiotensin 1 from converting to 2?
ACEi
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the production of angiotensinogen is increased by
corticosteroids, estrogen, thyroid homones, and ANG II
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renin is secreted in repsonse to what
-decrease in arterial blood pressure -decrease Na+ in macula densa -increased sympathetic nervous activity
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renin acts on a plasma protein like
angiotensinogen which is synthesized into the blood stream by the liver
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AT II is a
potent vasoconstictor which lead to increase BP
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AT II has a very
short half life - 1min
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nitric oxide is responsible for
vasodilation
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list actions of angiotensin ii
powerful vasoconstrictor aldosterone secretion stimulation vasoconstriction of renal arterioles (no blood filtration) decrease nitric oxide decrease fibronlysis in blood induce drinking behavior
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what are the ill effects of ATII?**
hypertension myocardial infaction renal damage
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Which of the following are true about ACEi?
they reverse cardiac and vascular hypertrophy and remodeling