Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Exam 3 Renal > Flashcards

Exam 3 Renal Flashcards

1
Q

ROLE OF THE KIDNEY

A
  • Balance solute and water
  • Help control blood pressure
  • Cleansing (filtering) of extracellular fluid (ECF) and maintenance
  • of ECF volume and composition
  • Excrete metabolic water-soluble wastes & foreign substances
  • Convert nutrients
  • Regulates acid/base
  • Secretes renin and erythropoietin
  • Help maintain red blood cell levels
  • Converts vitamin D
  • Calcifediol to calcitriol, the active form
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

NEPHRONS

A
  • Nephrons are the functional unit of the kidney
    • Renal corpuscle (Glomerulus + Bowman capsule)
    • Proximal convoluted tubule
    • Loop of Henle
    • Distal convoluted tubule
    • Collecting duct
  • All the components of the nephrons contribute to URINE formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

GLOMERULAR FILTRATION RATE

(GFR)

A
  • Filtration rate of plasma per unit per time
  • 125 mL/minute
  • Prostaglandins increases GFR
  • Epinephinre and Endothelin decreases GFR
    *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HOW DO KIDNEYS AFFECT

BP

A

Blood Pressure

  • Juxtaglomerular cells measure blood flow in the afferent arteriole and urine flow and composition.
  • Release renin, to Angiotensin II to aldosterone (RAAS)
  • Turns on Na/K ATPase
  • Increases BP
  • Vasoconstriction/thirst
  • Does not change blood osmolarity
  • Na and H2O reabsorbed
  • Lowers K
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MICTURITION REFLEX

A

Micturition Reflex Begins when the bladder contains 150 to 250 mL of urine

Can be filled to ~500 ml, but pressure of detrusor muscle will overcome external sphincter

Bladder fills with urine  stretch receptors  sacral spinal cord stimulated  Spinal reflex stimulated

Babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

HYDROURETER

A

Dilation of the ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HYDRONEPHROSIS

A

Expansion of the kidney with urine

  • Increased pressure inside the renal capsule
  • Compartment syndrome compresses blood vessels inside kidney; renal ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

URINARY STASIS

A

Urinary Retention

  • Risk of infection
  • Stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

POSTOBSTRUCTIVE DIURESIS

A

Polyuric state in which copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CAUSES OF

KIDNEY STONES

A
  • Masses of crystals, protein or other substances that are a common cause of urinary tract infections

Saturation theory: Urine is supersaturated with stone components. Influenced by pH and temperature

  • Alkaline urine > chance of Ca+ stone formation
  • Acidic urine > of uric acid stone formation

Matrix theory: Organic materials act as a nidus for stone formation

Inhibitor theory: A deficiency of substances that inhibit stone formation

  • Unilaterally located in the kidneys, ureters, bladder
  • Renal tubules have many surfaces which attract a stone
  • Stones < 5mm have a 50% chance of spontaneous passage

Risk factors:

  • Race
  • Age
  • Gender
  • Geographic location& seasonal factors
  • Fluid intake
  • Occupation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SIGNS & SYMPTOMS OF

KIDNEY STONES

A

Flank pain (moderate to severe), may radiate to groin

If stone is obstructing, pt may experience urgency, frequent voiding

May or may not have hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

TREATMENT OF

KIDNEY STONES

A
  • Imaging needed to determine location of stone, severity of obstruction, size of stone
  • Obtain a UA to determine pH of urine
  • STRAIN urine to retrieve stone for further analysis
  • Pain management
  • Dietary modification PRN
  • Nephrolithotomy or lithotripsy to remove stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Benign Prostatic Hyperplasia

(BPH)

A
  • Non-malignant prostate enlargement due to excessive epithelial cell growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SIGNS and SYMPTOMS

Benign Prostatic Hyperplasia

(BPH)

A

S&S

  • Urinary hesitancy
  • Dysuria
  • Straining to void
  • Postvoid dribbling
  • Frequent daytime voiding
  • Nocturia
  • Poor force of stream
  • Intermittent stream
  • Feelings of incomplete emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

TREATMENT

Benign Prostatic Hyperplasia

(BPH)

A
  • Invasive treatment
  • Transurethral resection of the prostate (TURP)

Drug therapy

  • 5-Alpha Reductase Inhibitors
  • Alpha1-Adrenergic Receptors
  • Ie. Finasteride (Proscar)

Reduces prostate size, takes several months

MOA. Inhibits 5-alpha reductase enzyme that converts testosterone to dihydrotestosterone (DHT)

SE. decreased ejaculate, toxic to male fetus

  • Ie. Doxazosin (Cardura), Tamsulosin (Flomax)

MOA. Blockade of alpha1 receptors, relaxes smooth muscle in bladder neck, decreasing obstruction of urethra

SE. Hypotension, fainting, dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

URGE INCONTINENCE

(DETRUSOR OVERACTIVITY)

A

Common Causes:

  • Stroke
  • Alzheimer’s disease
  • Parkinson’s disase
  • BPH with overflow

Common Symptoms:

  • Urgency and frequency, day or night

Pharmacological Treatment

  • Anticholingergic drugs
  • Oxybutynin
  • Tolterodine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

STRESS INCONTINENCE

(OUTLET INCOMPETENCE)

A

Common Causes:

  • Urologic procedures
  • history of multiple childbirths

Common Symptoms:

  • small volumes of urnie loss with coughing, sneezing

Pharmacological Treatment:

  • Alpha agonists
  • Topical estrogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MIXED UI and SI

A

Common Causes:

See UI and SI

Common Symptoms:

Pharmacological Treatment:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

OVERFLOW INCONTINENCE

A

Common Causes:

  • BPH
  • Fecal impaction

Common Symptoms:

  • Poor stream
  • Incomplete emptying

Pharmacological Treatment:

  • Alpha-adrenergic blockers (e.g., terazosin and tamsulosin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ATONIC BLADDER

A

Common Causes:

  • Severe diabetic neuropathy, stroke

Common Symptoms:

  • Complete loss of bladder control

Pharmacological Treatment:

  • Intermittent catherizations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

FUNCTIONAL INCONTINENCE

A

Common Causes:

  • Inability to get to the bathroom
  • Change in mental status

Common Symptoms:

  • Symptoms will vary

Pharmacological Treatment:

  • Eliminate causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

NOCTURNAL ENURESIS

A
  • involuntary urination that happens at night while sleeping, after the age when a person should be able to control his or her bladder.
23
Q

NEUROGENIC BLADDER

UNINHIBITED BLADDER

A

(loss of bladder sensation)

Uninhibited bladder: reduced awareness of bladder fullness and a low capacity bladder; urinary incontinence

24
Q

NEUROGENIC BLADDER

SPASTIC (HYPERTONIC)

A
  • Spastic (hypertonic): volume is typically small, pressures increase and involuntary contractions occur; increased frequency, urine leakage
  • Lesions between the pontine micturition center and sacral spinal cord
  • Bladder contraction and external urinary sphincter relaxation are typically uncoordinated (detrusor-sphincter dyssynergia)
25
Q

NEUROGENIC BLADDER

FLACID (HYPERTONIC)

A
  • Flaccid (hypotonic): volume is large, pressure is low, and contractions are absent; overflow incontinence
  • Lesions from the sacral cord or sacral nerve root injuries
26
Q

DETRUSOR

(BLADDER WALL)

HYPERTROPHY

A

Obstructions

27
Q

OVERACTIVE BLADDER

(OA)

A

4 symptoms:

  • Urinary urgency
  • Urinary frequency
  • Nocturia
  • Urge incontinence

***Usually the result of involuntary contraction of the bladder***

28
Q

TREATMENT OF

OVERACTIVE BLADDER

A

Behavioral

  • Schedule voiding, time fluid intake, Kegel exercises, avoid caffeine

Drug

  • Anticholinergic agents which block muscarinic receptors
  • Ie. Oxybutynin (Ditropan)
  • These drugs block muscarinic receptors not only in the bladder but elsewhere…a way around this is using drugs that are selective for muscarinic receptors in the bladder (M3 receptors)
  • Even so they have a high SE profile of anticholinergic activity causing constipation (from reducing bowel motility), blurred vision and photophobia (from preventing contraction of the ciliary muscle)
29
Q

UTI

URINARY TRACT INFECTIONS

A

Bacteria usually enter through the urethra

Host defenses include:

  • Washout phenomenon
  • Protective mucin layer
  • Local immune responses and IgA
  • Phagocytic blood cells
  • Normal bacterial flora and prostate secretions

Inflammation of urinary epithelium from bacteria

Can occur in the urethra (urethritis), prostate (prostatitis), bladder (cystitis), ureter, kidney (pyelonephritis)

Subtypes: complicated and uncomplicated; upper or lower

Risks:

  • Premature newborns
  • Sexually active and pregnant women
  • Spermicide users
  • Individuals with indwelling catheters
  • DM patients
  • Neurogenic bladder patients
30
Q

ORGANISMS THAT

CAUSE UTI

A

Factors:Community associated

E.coli (80%)

Hospital associated

Klebsiella, Enterobacter, Proteus

Catheter-associated urinary tract infection (CAUTI)

31
Q

TREATMENT OF

UTI’s

A
  • Sulfonamides
  • Trimethoprim
  • Penicillins
  • Aminoglycosides
  • Cephalosporins
  • Fluoroquinolones
  • Nitrofurantoin
32
Q

ACUTE

CYSTITIS

A
  • Inflammation of the bladder, most common site of UTI in women of childbearing age
  • Bacteria: E.coli (80%)
  • S&S: urinary frequency, urgency, dysuria, suprapubic discomfort and LBP
  • Diagnosis: urinalysis (+ bacteria > 100k,+leukocyte esterase, + nitrite reductase), urine culture for species
33
Q

TREATMENT OF

ACUTE

CYSTITIS

A

Oral antibiotics

  • Treatment ranges from 1 day to 7 days
  • Drugs of choice:
  • Trimethoprim/Sulfamethoxazole (Bactrim)
  • Nitrofuratoin
  • Ciprofloxacin
34
Q

ACUTE UNCOMPLICATED

PYELONEPHRITIS

A
  • Usually women of childbearing age, kids, elderly
  • Infection in one or both urinary tracts (ureter, renal pelvis, interstitium)
  • Shorter course of treatment
  • Usually symptomatic
  • Pathogen: E.coli (90%)
  • Treatment: oral antibiotics
35
Q

TREATMENT OF

ACUTE UNCOMPLICATED

PYELONEPHRITIS

A

oral antibiotics

36
Q

COMPLICATED UTI

A
  • Males & females
  • Associated with a predisposing factor
    • Renal stones
    • Enlarged prostate
    • Indwelling catheter
    • Impediment to flow of urine
  • Longer course of treatment 3-7 days, may take as long as 14 days
  • Pathogen: E. coli
37
Q

RECURRENT UTI’s

A

Relapse or reinfection

If more than 3 infections a year, prophylaxis may be indicated:

  • Nitrofurantoin
  • Trimethoprim/sulfamethoxazole (Bactrim)
38
Q

ACUTE BACTERIAL PROSTATITIS

A
  • Causes: Indwelling catheter, instrumentation from urethral or prostate surgery
  • S&S: High fever, chills, myalgias, localized pain as well as UTI symptoms
  • Responds well to antimicrobial therapy usually a fluoroquinolone
39
Q

NITROFURANTOIN

A
  • Active against a large # of gram+ and gram- bacteria
  • MOA. Damages DNA; slowing growth rather than killing bacteria
  • Can treat lower UTIs and prophylax recurrent UTIs
  • SE. GI disturbances, dyspnea, anemias
40
Q

GLOMERULAR DISEASE

A

Refers to a group of related diseases

  • Glomerular capillaries and the Bowman capsule are both made of epithelial cells sitting on a basement membrane.
  • They are so tightly attached to each other that they share one basement membrane.
  • The epithelial cells of the Bowman capsule stand up from the basement membrane on foot processes, leaving pores between the feet for filtration.
  • Causes of injury include:
    • Immune responses
    • Toxins or Drugs
    • Vascular Disorders
41
Q

ACUTE

GLOMERULONEPHRITIS

A
  • Inflammatory damage to the glomerulus from a streptococcal infection
  • S&S. proteinuria, hematuria, significant loss of kidney function
  • Diagnosis. UA, renal biopsy, electron microscopy
  • Tx. Antibiotics, steroids, cytotoxic agents to reduce immune response
42
Q

NEPHROTIC SYNDROME

(Proteins in Urine)

A

Albumin “leads to” edema and increased free drug

  • Immunoglobulins and complement “leads to” immune suppression
  • Binding proteins “leads to” low ions and hormones
  • Clotting and anticlotting factors “leads to” thrombosis
43
Q

ACUTE KIDNEY INJURY

(AKI)

A

Sudden decline in kidney function with a decrease in the glomerular filtration and accumulation of nitrogen (Cr, BUN)

Stages:

  • Risk: 1.5-fold increase in the serum creatinine, or GFR decreased by 25%, or UO <0.5 mL/kg/hr for 6 hrs
  • Injury: 2-fold increase in the serum creatinine, or GFR decreased by 50%, or UO <0.5 mL/kg/hr for 12 hrs
  • Failure: 3-fold increase in the serum creatinine, or GFR decreased by 75%, or UO <0.3 mL/kg/hr for 24 hrs or no UO for 12 hrs
  • End-stage renal failure: Complete loss of kidney function >3 mo (requiring dialysis or transplant)
44
Q

PATHO OF

AKI

A

Extracellular volume depletion, decreased renal blood flow, toxic injury to kidney cells “leads to” alterations in renal function

Classifications:

  • Prerenal (renal hypoperfusion)
  • Intrarenal (disorders of renal parenchyma; intrinsic)
  • Postrenal (urinary tract obstructive disorders)
45
Q

PRERENAL AKI

A
  • Most common cause of AKI
  • Usually due to renal hypoperfusion (hypotension, hypovolemia, hemorrhage, low CO)
    • Shock, dehydration, vasoconstriction
  • Failure to restore blood volume (or BP) can cause cell injury and ATN (acute tubular necrosis)
46
Q

INTRARENAL (INTRINSIC)

AKI

A
  • Results from ATN, acute glomerularnephritis, vascular disease, use of nephrotoxins, interstitial disease (drug allergy, infection, tumor)
  • Kidney tubule function decreased
    • Ischemia, toxins, intratubular obstruction
47
Q

POSTRENAL

AKI

A
  • Rare
  • Caused by urinary tract obstruction, enlarged prostate, neurogenic bladder
48
Q

TREATMENT OF AKI

A
  • Prevention and early diagnosis
  • Correct fluid & electrolyte disturbances, special diet
  • Correcting cause, like low BP, etc.
  • Treat infections (if any)
  • Avoid nephrotoxic medications
49
Q

CHRONIC KIDNEY DISEASE

(CKD)

A
  • Progressive loss of renal function
    • Fewer nephrons are functioning.
    • Remaining nephrons must filter more
    • Hypertrophy
  • Defined as: GFR < 60 for 3 months
  • Associated with HTN, DM, chronic pyelonephritis, chronic glomerulonephritis
50
Q

METABOLIC CHANGES

WITH CKD

A
  • Na+/H2O is lost in the urine
  • K+ is retained
  • Metabolic acidosis develops
  • Ca & phosphorus metabolism are altered
  • Erythropoietin production is diminished
  • Proteinuria
51
Q

CLINICAL MANIFESTATIONS OF

CKD

A
  • Uremia/Azotemia: increased levels of serum creatinine, urea, and other nitrogenous compounds
    • CNS, GI, immune disturbances
  • Cardiovascular complications
    • Hypertension, heart disease
  • Mineral metabolism disorders  metastatic calcifications, and bone disease
    • Hyperphosphatemia  hypocalcemia  increased PTH  calcium resorption from bone  bone loss
    • Decreased vitamin D activation  increased PTH, impaired osteoblasts
  • Decreased inflammation and immunity
  • CNS and PNS alternations
    • Peripheral neuropathy, restless leg syndrome, uremic encephalopathy
  • Sexual dysfunction
    • Impotence, hypofertility, dysmenorrhea
  • Skin disorders
  • Dryness, bruising, Terry nails
  • GI disorders
    • Anorexia, nausea, vomiting, ulceration
52
Q

CARDIOVASCULAR

COMPLICATIONS

A

Anemia: from hemolysis, bone marrow suppression, decreased erythropoietin and iron

  • Weakness, fatigue, depression, insomnia, decreased cognitive function
  • Decreased blood viscosity “leads to” increased heart rate, peripheral vasodilation
  • Angina pectoris and other ischemia

Decreased platelets “leads to” bleeding

53
Q

TREATMENT OF

CKD

A
  • Ultrasound, CT scan to visualize kidney
  • Obtain UA and serum electrolytes
  • Dialysis
  • Supportive therapy
    • Restrict phosphate, K+
    • Supplement vitamin D
  • Renal transplant

Pharmacology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions