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Pharmacology > Exam 2- Urinary > Flashcards

Exam 2- Urinary Flashcards

1
Q

What are the most common bacteria in UTIs for small animals, horses, cattle?

A

Horses- E. coli, Strep
Small animal- E. coli, Staph
Cattle- E. coli, Corynebacterium renale

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2
Q

What is “asymptomatic bacteriuria”?

A

The isolation of bacteria in an appropriately collected urine sample from an individual w/o UTI symptoms

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3
Q

What is the recommended treatment duration for small animals w/ UTIs for first-time UTIs, recurrent cases, prostatitis, & pyelonephritis?

A

First-time UTIs- 7d
Recurrent UTIs- 4wks
Prostatitis- 6wks
Pyelonephritis- 4-6wks

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4
Q

If the organism causing a UTI is susceptible to an antimicrobial, the urine should culture as sterile after how many days of therapy?

A

3 days of treatment

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5
Q

Name the first-line antimicrobials used to manage uncomplicated UTIs

A

Amoxicillin, Clavamox, Cephalexin, TMS

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6
Q

What is the standard first-line antimicrobial for prostatitis treatment?

A

Fluoroquinolones-
Gram neg: Enrofloxacin, Chloramphenicol, TMS
Gram pos: Clindamycin, Macrolides

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7
Q

What antimicrobials cross the blood-prostate barrier?

A 
Enrofloxacin
Chloramphenicol
TMS
Clindamycin
Macrolides
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8
Q

What antimicrobials are more active in acidic urine vs. basic urine?

A

Acidic urine- Beta-lactams, Methenamine

Basic urine- Fluoroquinolones

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9
Q

Discuss the pros and cons of methenamine use as a urinary tract antiseptic. Note the effect of urine pH and its suitability for cystitis versus pyelonephritis.

A

a. Converted to formaldehyde little resistance
b. Last resort to treat cystitis due to multi-drug resistant infections
c. Pros:
i. Treating patients w/ chronic recurring cystitis
ii. Only have to give once daily
d. Cons:
i. Must acidify urine
ii. Does not work in neutral pH
iii. Not useful for pyelonephritis

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10
Q

What antifungals are appropriate to manage a yeast/fungal UTI?

A

a. Fluconazole
b. Voriconazole
c. Nystatin infusion- LAST RESORT

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11
Q

When treating a patient with a systemic aminoglycoside, what role do the following tests play in monitoring the patient for impending nephrotoxicity?

A

a. BUN or serum creatinine
i. Values increase too late to be useful
b. Urinalysis
i. Serial testing, watch for casts, increased protein, decreased USG
c. Urine GGT: urine Cr ratio
i. Increases more than 3x baseline

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12
Q

What procedure(s) do we perform to minimize the nephrotoxic risk of regular amphotericin B or cisplatin?

A

a. To increase renal perfusion
i. Pretreat w/ mannitol or pre- & post-treat w/ isotonic saline diuresis
ii. Cisplatin: same with slow infusion of the drug

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13
Q

How do the lipid formulations of amphotericin B minimize nephrotoxic risk?

A

a. Bound to the lipid- does not contact the renal artery as much

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14
Q

What disease or physiologic states predispose to NSAID-induced nephrotoxicity?

A

a. Dehydration & concurrent use with other nephrotoxic drugs

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15
Q

In an NSAID overdose, what can we do to minimize the risk of nephrotoxicity?

A

a. Maintain hydration
b. Avoid other nephrotoxic drugs
c. Use Misoprostol (PGE) to prevent/treat NSAID GI ulcers

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16
Q

Under what conditions would the risk of crystalluria be an issue for sulfonamides? What about potentiated sulfonamides?

A

a. Dehydrated animal

b. Potentiated sulfas are dosed too low to cause crystalluria due to synergistic effects of combining with TMS

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17
Q

Explain the concept of “ion trapping” as it relates to management of toxicities.

A

a. A drug that is a weak acid placed in an alkaline environment becomes ionized
i. The molecules then do not cross membranes & remain in urine to be excreted

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18
Q

Identify the effects on urine pH of the following: DL methionine, Ammonium chloride, Potassium citrate, Sodium bicarbonate

A

a. DL methionine- ACIDIFY
b. Ammonium chloride- ACIDIFY
c. Potassium citrate- ACIDIFY
d. Sodium bicarbonate- ALKALIZE

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19
Q

What are the C/I for ammonium chloride administration?

A

Liver & kidney dz, metabolic acidosis

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20
Q

The efficacy of cranberry extract in preventing recurrent UTIs is not established. What is the proposed mechanism of benefit based on ex vivo studies?

A

a. Possibly the proanthocyanidins (PACs) or tannins in the juice can inhibit bacterial adherence to uroepithelial cells

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21
Q

Discuss the appropriate management of urate urolithiasis in a Dalmatian.

A

a. Alkalize urine to decrease risk of urate stone development
b. Feed diet low in purines
c. Administration of Allopurinol

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22
Q

What immunosuppressive does Allopurinol interact w/ such that severe bone marrow suppression can result?

A

Azathioprine

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23
Q

Allopurinol has antiprotozoal activity against what organism?

A

Leishmaniasis

24
Q

How does Fenoldopam differ from dopamine?

A

Fenoldopam has higher affinity for feline dopamine receptors

25
Q

Why are ACE inhibitors useful in the management of PLN?

A

Cause vasodilation of efferent arterioles → lowers filtration pressure → reduces amount of protein pushed out

26
Q

Why is it recommended to check the BUN/Cr of a patient recently placed on an ACE-inhibitor?

A

important to check for prerenal azotemia from hypotension

27
Q

Site of action for osmotic diuretics & example

A

Glomerulus

-Mannitol

28
Q

Site of action for carbonic anhydrase inhibitors & example

A

Proximal renal tubules

-Acetazolamide

29
Q

Site of action for Loop diuretics & example

A

Thick ascending loop of Henle

  • Furosemide
  • Most intense diuretics, can continue to cause diuresis in face of severe dehydration
30
Q

Site of action for Thiazide diuretics & example

A

Distal convoluted tubule

-Chlorothiazide

31
Q

Site of action for Potassium-sparing diuretics & example

A

Distal parts of nephron- late distal tubule to collecting duct
-Spironolactone

32
Q

Renal & nonrenal uses of mannitol

A

Renal- protective effect in renal hypoperfusion; use in oliguric renal failure
Nonrenal- cerebral edema, acute glaucoma

33
Q

Contraindications for Mannitol administration & why?

A

Never give w/ active bleeding, active CNS hemorrhage, congestive heart failure/pulmonary edema, use cautiously in renal failure cases

34
Q

What do Thiazide diuretics promote?

A

Potassium loss, magnesium loss, calcium retention

35
Q

What do carbonic anhydrase inhibitor diuretics promote?

A

Potassium & bicarb loss

36
Q

What does Spironolactone promote as diuretic?

A

Potassium retention

37
Q

What do loop diuretics promote?

A

Calcium loss

38
Q

What diseases can Mannitol be used to treat?

A

Glaucoma & cerebral edema

39
Q

What diseases can Furosemide be used for?

A

Acute CHF & hypercalcemia due to vitamin D rodenticide or hypercalcemia of malignancy

40
Q

What diseases can Acetazolamide be used for?

A

Equine hyperkalemic periodic paralysis

41
Q

What disease would Dorzolamide/Brinzolamide be used for to treat?

A

Glaucoma

42
Q

What disease can Spironolactone be used to treat?

A

Congestive heart failure that is diuretic refractory

43
Q

What are the supposed advantages of torsemide over furosemide as a loop diuretic?

A

a. Longer & smoother diuretic action

b. Less prone to diuretic resistance

44
Q

What is the basis for the most common cause of urinary incontinence in the spayed bitch? Name two drugs commonly used to treat the condition and how they work.

A

a. Hormone responsive- Estrogen responsive incontinence
b. Treatment
i. Estrogens
ii. Phenylpropanolamine

45
Q

What do the terms “upper motor neuron bladder” and “reflex dyssynergia” describe relative to urethral tone and bladder contraction?

A

a. Upper motor neuron bladder
i. High tone, increased urethral resistance despite full bladder
b. Reflex dyssynergia
i. Detrusor muscle & IUS contract at the same time

46
Q
  1. What drugs do we give, and on what receptors do they act, to relax the internal versus external urethral sphincters?
A

a. IUS
i. Smooth muscle- alpha1 receptors
ii. Drugs: Prazosin or Acepromazine
b. EUS
i. Skeletal muscle receptors
ii. Drugs: Diazepam or other Benzos

47
Q

How does bethanechol act to stimulate the bladder detrusor muscle? Accordingly, what side-effects are seen with this drug and how would you treat an accidental overdose of bethanechol?

A

a. Muscarinic agonist→ causes bladder contraction
b. Side effects:
i. Impacts GI system- salivation & defecation
ii. Overdosed: SLUD signs
c. Treat overdose
i. Atropine or Glycopyrrolate

48
Q

Why does chronic overstretching of the bladder impact its ability to contract?

A

a. Poor response to treatment w/ Bethanechol→ muscle tight junctions unable to properly transmit signal

49
Q

What is oxybutynin used for?

A

a. Relaxing bladder spasms

50
Q

For what purpose is phenazopyridine used in humans and why is seldom used in dogs or cats?

A

a. Low therapeutic index in dogs & cats
i. Cats: high risk for Heinz body anemia & methemoglobinemia
ii. Dogs: high incidence of KCS suspected

51
Q

Outline an approach for managing acute oliguric renal failure, including but not limited to the following:

  • Fluid therapy
  • Diuretics to use
  • Improve renal perfusion
  • Managing hyperkalemia
A

a. Fluid therapy. Note why it is included, its limitations and risks
i. Fluid diuresis at 6-8ml/kg over 4hr pd
1. Risk for fluid overload
2. Goal- convert oliguric to polyuric renal failure
b. Which diuretics may be of use and how they work?
i. Mannitol
ii. Furosemide
1. Both are used to reestablish urine formation
iii. Dopamine/Fenoldopam
1. Improves renal blood flow, GFR, & urine production for dogs & cats
c. How to improve renal perfusion other than fluid therapy
i. Dopamine agonist Dopamine or Fenoldopam CRI
d. Managing hyperkalemia
i. Volume load to dilute
ii. Sodium bicarb correct acidosis
iii. IV dextrose or insulin w/ dextrose- drives potassium back into cell

52
Q
  1. Outline an approach for managing chronic renal failure in dogs and cats, including but not limited to the following:
    - Dietary modification
    - Nutraceuticals
    - Fluid therapy
    - Renal failure sequala management
A

a. Dietary modifications and why they are warranted
i. Lower- protein, phosphorous, sodium
ii. Increase- potassium, omega 3 FA, Vit B, & fat content
b. The proposed mechanism for benefit of the nutraceuticals AminVast and Azodyl and the evidence that supports their use.
i. Slows kidney injury (no real benefit)
c. Fluid therapy, including at-home therapy
i. SQ fluids
d. Management of renal failure sequala
i. Hypertension
1. Cats: Amlodipine ± ACE-inhibitor
2. Dogs: ACE-inhibitor ± Amlodipine
ii. Proteinuria
1. Benazepril
iii. Hyperphosphatemia and hypocalcemia
1. Aluminum hydroxide added to food
iv. Anemia, including roles of erythropoietin and iron supplementation and associated risks
1. Recombinant human EPO Epoetin or Darbepoetin
a. Side effects: antibody development against the drug, cross rxn w/ endogenous EPO may cause red cell aplasia, hypertension, seizures w/ Darbepoetin
2. Iron supplementation often warranted Parenteral or oral
a. Side effects: OD can cause corrosive effects – GI signs, impaired oxidative phosphorylation & mitochondrial dysfunction cellular death, hypotension, metabolic acidosis, coagulopathy
v. Acidosis
1. Oral sodium bicarbonate
2. Potassium citrate
vi. Hypokalemia
1. Potassium gluconate
2. Potassium citrate
vii. Uremic gastroenteritis
1. Antiemetic & gastric protectants

53
Q

Name 2 NSAIDs used to manage transitional cell carcinoma in dogs

A

Piroxicam

Firocoxib

54
Q

Why is desmopressin preferred over vasopressin for central diabetes insipidus?

A

Longer half-life= less frequent administration

55
Q

How is nephrogenic diabetes insipidus managed?

A

a. Thiazide diuretics
i. Hydrochlorothiazide
ii. Chlorothiazide

Pharmacology (4 decks)

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