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Pharmacology > Chapter 6 - Renal Drugs > Flashcards

Chapter 6 - Renal Drugs Flashcards

0
Q

What is a nephron

A

Basic functional unit of kidneys

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1
Q

How does a kidney maintain homeostasis

A

Filtration, reabsorption, secretion. Fluid balance regulation. Acid-base balance regulation. Production of hormones-erythropoietin. Blood pressure regulation.

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2
Q

What does a nephron consist of

A

Renal corpuscle, proximal convoluted tubule, loop of Henle, distal convoluted tubule

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3
Q

Describe the blood supply of the kidney

A

Renal artery enters the kidney at the hilus. Divides into smaller arteries and arterioles

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4
Q

What is the distal convoluted tubule

A

Continuation of the ascending loop of henle

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5
Q

What is the purpose of The distal convoluted tubule

A

Carrie tubular filtrate through the medulla. Empty into renal pelvis. Primary site of action of ADH and regulation of potassium an acid-base balance

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6
Q

Describe sodium reabsorption in the proximal convoluted tubule

A

Sodium in tubular filtrate attaches to carrier protein that moves it into the cytoplasm of the proximal convoluted tubule epithelial cell.

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7
Q

Describe sodium cotransport in the proximal convoluted tubule

A

Glucose and amino acids attach to the same carrier protein and follow sodium into the cell by passive transport.

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8
Q

Describe urine volume regulation in the kidney

A

Determined by amount of water contained in the tubular filtrate when it reaches the renal pelvis. Controlled by actions of ADH and aldosterone.

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9
Q

What gland created ADH hormone

A

Anterior pituitary gland

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10
Q

What does adh hormone do

A

Acts on the distal convoluted tubule and collecting ducts to promote reabsorption.

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11
Q

What disease do you have if you don’t have the ADH hormone

A

Diabetes insipitus

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12
Q

what does aldosterone hormone trigger

A

Increases reabsorption of sodium

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13
Q

What are the reflex components of urine control

A

A spinal reflex returns a motor impulses to the bladder muscles causing them to contract. Contraction gives the sensation of having to urinate

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14
Q

What are the three aspects of urine formation

A

️Glomerular filtration
Tubular reabsorption
Tubular secretion

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15
Q

What is erythropoiesis

A

Formation of erythrocytes.

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16
Q

What is erythropoietin

A

A hormone secreted by the healthy kidneys to cause the formation of erythrocytes.

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17
Q

What happens if the kidney is not producing erythropoietin

A

Animal may develop a non-regenerative anemia as a result

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18
Q

How do you confirm uremia

A

Blood tests

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19
Q

What can uremia do

A

Increase the sensitivity of some tissues to certain drugs

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20
Q

What blood tests do you do for uremia

A

Creatinine and bun (blood urea nitrogen)

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21
Q

What are diuretic drugs

A

Urine producing drugs. Used to remove excess extracellular fluid by increasing urine flow and sodium excretion and reducing hypertension

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22
Q

What is extracellular fluid

A

Edema

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23
Q

What are the two main reasons for diuretic use

A

To remove fluid from organs and to reverse high blood pressure

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24
Q

What are loop diuretics

A

Highly potent diuretics that inhibit the tubular reabsorption of sodium. They also promote the excretion of chloride, potassium and water.

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25
Q

What can happen to some patients on long term loop diuretic therapy

A

May also have to be placed on potassium supplementation

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26
Q

What are the dosage forms of the loop diuretics

A

Furosemide (lasix, disal, diuride)

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27
Q

What are the adverse side effects of loop diuretics

A

Hypokalemia

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28
Q

What are osmotic diuretics

A

Can be administered intravenously to promote diuresis by exerting high osmotic pressure in the kidney tubules and limiting tubular reabsorption

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29
Q

How does osmotic diuresis work

A

Water is drawn into the glomerular filtrate, reducing its reabsorption and increasing the excretion of water

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30
Q

What can osmotic diuretic drugs be used to treat

A

Oliguric acute renal failure and to reduce intracranial pressure

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31
Q

What are the dosage forms of osmotic diuretics

A

Mannitol 20% and Glucose

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32
Q

What do thiazide diuretics do

A

Reduce edema by inhibiting reabsorption of sodium, chloride and water. Their duration is longer than loop diuretics

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33
Q

What are the adverse side effects of loop diuretics

A

Hypokalemia if therapy is prolonged. A potassium supplement may be necessary to prevent Hypokalemia

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34
Q

What is a potassium sparing diuretic

A

Weaker diuretic and antihypertensive effects than other diuretics but they have the ability to conserve potassium.

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35
Q

What are potassium diuretics also called

A

Aldosterone antagonists.

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36
Q

What does an aldosterone antagonist do

A

Enhances the excretion of sodium and water and reduces the excretion of potassium.

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37
Q

What is special about edema associated with heart failure

A

Aldosterone might be a factor

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38
Q

What type of muscle is the detrusor muscle

A

Smooth muscle

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39
Q

What type of muscle is the internal urinary sphincter

A

Smooth muscle

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40
Q

What type of muscle is the external urinary spinchter

A

Skeletal muscle

41
Q

What are the clinical uses of cholinergics

A

Used to help void the urinary bladder. Their action increases the tone of the detrusor muscle of the bladder and decreases bladder capacity

42
Q

What is the dosage form of cholinergic agents

A

Bethanechol (urecholine and duvoid)

43
Q

In what clinical situations would you use cholinergic agents

A

Weakened bladder muscle from over distension due to a urinary blockage. Spinal cord injury

44
Q

Why do you use anticholinergic drugs

A

They block the action of acetylcholine at receptor sites in the parasympathetic nervous system.

45
Q

What are anticholinergic drugs considered

A

Parasympatholytic because of their ability to block the passage of impulses through the parasympathetic nerves. Promotes muscle relaxation.

46
Q

What is the clinical use of anticholinergic a

A

Used to treat urge incontinence by promoting the retention of urine in the urinary bladder.

47
Q

What are the dosage forms of anticholinergic drugs

A

Propantheline

Buscopan

48
Q

What are the Thiazide diuretics

A

Diuril

Hydrodiuril

49
Q

What is the dosage form of potassium sparing diuretics

A

Aldactone

50
Q

What does alpha adrenergic agonists do

A

Turn up the volume dial on the hold it message from the high neurologic areas. Increases internal spinchter tone

51
Q

What medication Is used as an Adrenergic agonist

A

Phenylpropanolamine

52
Q

What do adrenergic antagonists do

A

Relax vascular smooth muscle, enhance peripheral vasodilation and decrease blood pressure.

53
Q

What is the clinical use of adrenergic antagonists

A

Reduce internal sphincter tone when the urethral sphincter is in hypertonus. This action is useful in treatment of urinary retention because of detrusor areflexia

54
Q

What is detrusor areflexia

A

Functional urethral obstruction

55
Q

What is prazosin used for

A

Effective in controlling moderate to severe hypertension which is a complicating factor in chronic renal failure

56
Q

What are the dosage forms of adrenergic antagonists

A

Dibenzyline

Minipress

57
Q

What are the adverse side effects of adrenergic antagonists

A

Rapid decrease in blood pressure, resulting in weakness or syncope after the first dose of prazosin. Usually self limiting.

58
Q

What do beta adrenergic antagonists do

A

Inhibit the action of catecholamines and other sympathomimetic agents at the beta adrenergic receptor sites and therby inhibit stimulation of the sympathetic nervous system

59
Q

What are the clinical uses of beta adrenergic antagonists

A

Include the control of mild to moderate hypertension associated with chronic renal failure

60
Q

What is the dosage form of beta adrenergic antagonists

A

Inderal

61
Q

What are the adverse side effects

A

Decreased Cardiac output and promotion of bronchospasm.

62
Q

What is estrogen used for

A

Helps to increase sphincter tone

63
Q

What is the dosage form of estrogen

A

Stillbesterol

64
Q

What is the typical dosaging regime of estrogen

A

1 tablet sid for 5 days, then once weekly for 5 weeks than as needed

65
Q

What do ace inhibitors do

A

Block the conversion of angiotensin 1 to angiotensin 2
Decrease aldosterone secretion.
Reduce peripheral arterial resistance
Alleviate vasoconstriction.

66
Q

What is the clinical use of ace inhibitors

A

Treat hypertension

67
Q

What are the dosage forms of ace inhibitors

A

Benazepril (fortekor)
Capoten
Enacard

68
Q

What is a vasodilator

A

May be substituted for or used in combination with other medications if previous drug therapy to control hypertension fails.

69
Q

What are the clinical uses of vasodilator a

A

Used to treat non responding hypertension. Dopamine may be used to promote diuresis in patients unresponsive to loop or osmotic diuretics.

70
Q

What are the dosage forms of vasodilator a

A

Apresoline

Intropin

71
Q

What are the dosage forms of calcium channel blockers

A

Cardizem
Isoptin
Amiodipine

72
Q

What does the adh hormone do

A

Regulates fluid balance in the body

73
Q

In pituitary diabetes inspitidus what happens

A

The hormone fails to be synthesized or excreted properly and Polyuria/polydipsia occurs.

74
Q

What are the clinical uses of adh hormone

A

Used to treat diabetes insipidus

75
Q

What is the dosage form of adh

A

Vasopressin

Desmopressin

76
Q

What is Desmopressin

A

Usually given as an eye drop and a nasal spray. Can cause irritation to the eye or conjunctiva.

77
Q

What is Desmopressin used for during surgery

A

Type 1 Von willebrand’s disease

78
Q

What is a urinary acidifier

A

Used to produce acid urine which assists in dissolving and preventing formation of struvites uroliths. Not Routinely prescribed

79
Q

What are the dosage forms of urinary acidifiers

A

Methionine

Ammonium chloride

80
Q

What do xanthine oxidase inhibitors do

A

Decrease the production of uric acid. Prevent ammonium acid urate uroliths.

81
Q

What type of diet is usually prescribed to prevent reoccurance of uroliths

A

A urine alkalizing, low protein, low purine, low oxalate diet.

82
Q

What is the dosage form of xanthine oxidase inhibitors

A

Allopurinol

83
Q

What is the dosage form of urinary alkalizer a

A

Potassium citrate
Sodium bicarbonate
Tiopronin tablets

84
Q

What are the adverse side effects of the urinary alkalizer a

A

Fluid and electrolyte imbalance with the use of sodium bicarbonate

85
Q

What is the adverse side effects of epo

A

Local or systemic allergic reaction in animals and pain occurring at injection site.

86
Q

What is amitriptyline

A

A tricyclic antidepressant and anxiolytic drug with anticholinergic, antihistamine etc properties.

87
Q

What is amtriptyline used for

A

Idiopathic cystitis for cats

88
Q

Why do glycosaminoglycans do

A

Covering the transitional epithelium of the urinary tract.

89
Q

What is epakitin

A

Chitosen based nutritional supplement made from a polysaccharide from crab and shrimp shells

90
Q

What where the clinical uses of epakitin

A

Product information states that epakitin binds phosphorus in the intestine causing phosphorus to be eliminated through the intestinal tract.

91
Q

What is azodyl

A

Symbiotic mix containing a patented mixture of three beneficial bacteria. It’s a nitrogen trap. Reduces Azotemia.

92
Q

What are the first signs of renal insufficiency

A

Inappetence, pu/pd, proteinuria,

93
Q

What is renal insufficiency

A

66% or more nephrons lost. Can no longer concentrate urine but can get rid of waste.

94
Q

What is renal failure

A

75% or more nephrons lost

95
Q

What is renal failure caused by

A

Accumulation of waste products (bun/creatine).

96
Q

What is a specific clinical sign of kidney failure

A

Small lumpy kidneys

97
Q

What is advanced renal failure

A

90% or more nephrons lost.

98
Q

What are the clinical signs of advanced renal failure

A

Uremia, weight loss, vomiting, anorexia

99
Q

Diet for renal failure

A

Low protein, high fats, high b vitamins, low sodium, high potassium low phosphates

100
Q

What are the drug treatments for chronic renal failure

A 
Fluids 
Anti GI ulcer drugs (famotidine)
Antiemetics (cerenia)
Potassium 
Anti hypertensive drugs 
Appetite stimulant 
Phosphate binders (amphojel)
Erythropoetin if anemic

Pharmacology (15 decks)

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