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Vet 2 > Kidney Function And Drugs > Flashcards

Kidney Function And Drugs Flashcards

0
Q

Nephron

1) . Is the
2) It’s job is to…
3) kidney damage is so bad because…
4) consists of

A

1) basic functional unit of the kidney
2) . Job is to regulate water and soluble matter (especially electrolytes) in the body
3) because it does not generate
4) consists of the renal corpuscle (glomerulus, bowmans capsule) proximal convoluted tubules, loop of Henle, distal convoluted tubules and collecting ducts

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1
Q

Trigone of bladder

A

2 ureters

I urethra

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2
Q

Glycosaminoglycans (GAGS)

1) found
2) . What do they do
3) defects are factor in…
4) examples

A

GAGS

1) they are found covering the transitional epithelium of the urinary tract
2) they keep microorganisms and crystals from adhering to the bladder wall
3) the defects in surface GAGs are believed to be a factor in FLUTD
4) ex- cranberry juice, crab abiding makes the bladder wall slippery so bacteria doesn’t stick

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3
Q

AZODYL

Think…

A

Claims to have the potential to reduce azotemia though enteric (intestine) dialysis

Azotemia= AZODYL

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4
Q

What are used for urolith treatments?

3

A

Urinary acid fires
urinary alkalizer
xanthine oxidase inhibitors ( with diet think… Thin … Can (b) thin) oko

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5
Q

With urolith treatment we should

1) types of urolith includes
2) each type is….

A

Put on diet
1) struvite (magnesium ammonium phosphate) calcium orca late, calcium phosphate, irate, cystine, and mixed
2) each type is treated differently and may include :
dietary management as well as
drug treatment

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6
Q

What is a urolith

A

Abnormal mineral masses in urinary system (ex: kidney/bladder)

Compact sand grid= stone

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7
Q 
What's is a urinary acidified used for?
Ex: 
It Produces 
Prevents
Side effects
But since introduction of \_\_\_\_\_\_, urinary acidifiers have not been routinely prescribed
A

Used for urolith treatment
Ex: Methigel

It’s used to produce acid urine <7

It assists in dissolving and preventing formation of struvite urolith

Side effects:gi disturbances

Since introduction of urinary acidifying diets

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8
Q

Urinary alkalizer

Ex:

Used in

Difficult to

The side affects

A

Ex: potassium citrate, sodium, bicarbonate

Used in the management of ammonium acid urate, calcium oxalate crystals and Cystine urolihiasis

Difficult to dissolve calcium oxalate crystals without altering calcium metabolism in body

Side effects are possible fluid and electrolyte imbalances

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9
Q

Xanthine oxalate inhibitors

Ex:
- decreases….

1) found mostly in
2) side effects

A

Ex: Allopurinol

  • decreases the production of uric acid produced by xanthine oxidase
    1) found mostly in dalmatians and patients with gout
    2) Side effects: uncommon
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10
Q

What is ACE

A

Angiotensin Converting enzyme

used in renin-angiotensin-aldosterone system

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11
Q

Ace inhibitors cause….

A

No water retention!!

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12
Q

Renin-angiotensin-aldosterone system
Regulates

Occurs when

A

Regulates blood pressure and water (fluid) balance

When blood volume is low, kidneys secrete renin directly into circulation

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13
Q

Steps of the Renin-angiotensin-aldosterone system

A

Renin converts angiotensin I to angiotensin II by ACE (angiotensin converting enzyme)

angiotensin lI causes blood vessels to constrict which increases blood pressure and also secretes aldosterone (builds up fluid in the body)

The Aldosterone causes kidney tubules to increase reabsorption of sodium (Na) and water into the blood, which increases volume of fluid in the body and increases blood pressure

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14
Q

ACE inhibitors drop blood pressure by

A

Ace inhibitors block conversion of angiotensin I to angiotensin ll
decrease aldosterone secretion decrease peripheral arterial resistance and alleviate vasoconstriction

which all drop blood pressure

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15
Q

ACE inhibitors treat

Side effects

Examples

A

ACE inhibitors treat:
severe or non-responding hypertension,
heart failure,
protein losing glomerulonepathies

Side effects: are complications in patients with renal insufficiency

Ex: benazepril, captopril, enalapril

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16
Q

Vasodilators and calcium channel blockers

May be be substituted for or used in combination with other mess when …

Vasodilator a example:

Calcium channel blocker ex:

Side effects

A

When previous drug therapy to control hypertension fails

Vasodilator example- Dopamine
It May be used to promote diuresis in patience unresponsive to loop or osmotic diuretics

Calcium dilator example: silo tarzen, amlodipine

Side effects: hypotension
Edema 
conduction disturbances
Heart faliure 
Bradycardia
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17
Q

Vasodilator example

A

Dopamine

Maybe used to promote diuresis in patients unresponsive to loop or osmotic Diuretics

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18
Q

Calcium channel blocker example

A

Dilitazem and amlodipine

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19
Q

What is GFR?

A

Glomerular penetration rate

How fast plasma is filtered through glomerulus

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20
Q

What to hormones are responsible for the majority of urine volume regulation

A

Antidiuretic hormone (ADH)

Aldosterone

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21
Q

What does aldosterone do?

A

It increases reabsorption of sodium (Na) in DCT and collecting ducks back into the blood

This causes and osmotic imbalance which causes water to go back into the blood along with the sodium

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22
Q

Collecting ducks are the site of …

A

Anti-diuretic hormones (ADH ) which prevents dehydration

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23
Q

Antidiuretic hormones do what especially

A

Stop urination
Prevent water loss
Regulate fluid balance

It is a failsafe mechanism so that we don’t dehydrate if we have lack fluid intake

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24
Q

Increase in urine volume

A

Polyuric

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25
Q

Increase in thirst

A

Polydipsia

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26
Q

Cholinergic agonist is for

A

Expulsion

urinary incontinence

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27
Q

Anticholinergic agents are for

A

Retention

urinary incontinence

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28
Q

Aderenergic agonists are split into

A

Alpha and beta

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29
Q

With potassium sparing diuretics

Think

A

Conserve potassium
Enhance excretion of sodium and water
and reduces excretion of potassium

Hyperkalemia if given with potassium (uncommon)

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30
Q

Hypokalemia involves-

A

Hypo-k loss

Ex- loop diuretic, thiazides diuretic, carbonic anhydrase inhibitors

Hyper- k retention

Uncommon-potassium sparing diuretic

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31
Q

With loop diuretic think…

A

Lasix ( furosemide)

It inhibit reabsorption of sodium at LOOP of Henle

Promote CL, k and water

Lung fluid

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32
Q

Micturition

A

Expulsion of urine in the urinary bladder into the urethra (urinating)

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33
Q

Secretion
1) Leaves through…. Which are also…

2) secreted are … Think hon

A

1) the tubular filtrate in the DCT leaves through the collecting ducks as urine

Collecting ducts are also the site of antidiuretic hormone action which prevents dehydration

2) important substances secreted are hydrogen, potassium, and ammonia

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34
Q

Gloucosuria

Rates?

A

Renal threshold of glucose: The blood glucose level gets too high, The amounts of glucose filtered through the glomerulus exceeds the amount That
can be reabsorbed and it is lost in the urine

Rates: 180 for a dog
And 240 for a cat

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35
Q

Diuresis

A

Increasing urine flow

Think diuretic

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36
Q

Diuretic drugs…

Ex:

A

Used to remove excess extracellular fluid by increasing urine flow (diuresis) and Na excretion and reducing hypertension (sodium +water= lower blood pressure)

Ex: cplot
loop diuretic
Osmotic diuretic
Thiazide diuretic 
Potassium-sparing diuretics
Carbon anhydrase inhibitors
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37
Q

When Na is reabsorbed excessively ( maybe with Cl and water)

____ can be an issue

A

Hypokalemia
Deficiency of k
Promote k excretion

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38
Q

Whenever there is a Hypokalemia risks or loss of k we have to …

A

Give water!!!

39
Q

Hypertension

A

High blood pressure

40
Q

What help with lung fluid?

A

Loop diuretics

41
Q

What are the functions of the kidney

A

Think thbpp

Filter toxins in blood, mainly urea
Maintain homeostasis
Production of hormones
Blood volume control
Blood pressure regulation
42
Q

Homeostasis is a function of the kidney

It is maintained by

A

FFA

Filtration, reabsorption, secretion
Fluid balance regulation
Acid base balance regulation

43
Q

Filtration of kidneys

A

Glomerular capillaries have large fenstrations in capillary endothelium (single layer)

But they’re not large enough to allow blood cells or large protein to pass

High bp in glomerular capillaries force some plasma out into the space of Bowmans capsule

Glomerular filtrate rate: GFR is how fast plasma is filtered through glomerulus

44
Q

Kidneys are located

A

Retroperitoneal: outside the abdominal cavity

Right more cranial

45
Q

Urinary system…

A

2 kidneys, 2 ureters, urinary bladder, and urethra

46
Q

Hilus

A

Indented medial side of kidney where the ureters, nerves, blood and lymph vessels enter and leave

47
Q

Kidney are the most….

It….

A

Important single route of waste removal

Filters all waste products out of the bloodstream, but allow elements needed by the body to stay in

48
Q

Reabsorption

When….
______ leaves ______ and enters the

About ___ of reabsorption occurs in ____ (examples)

Then filtrate goes to _____ and then ____

A

Useful substances go back into bloodstream

Glomerular filtrate leaves Bowman’s capsule and enters that PCT
(Called tubular filtrate)

About 65% of reabsorption occurs in PCT (water, any, CL, K, CA, bicarb, 100% glucose and amino acids)

Filtrate now goes to loop of Henle and then DCT

49
Q

Secretion

_____ in the ____ leaves through the _____ ______ as _____

Important substances secreted are _____, _____, and ______

A

The tubular filtrate in the DCT leaves through the collecting ducts as urine

Important substances secreted are hydrogen, ammonia, and potassium
(Think… Hap)

50
Q

The presence of abnormal amount of protein in the urine is used as an

A

Indicator of glomerular damage

51
Q

Kidney hormones are responsible for the

A

Two hormones are responsible for the majority of urine volume regulation and how the body keeps fluid

Antidiuretic hormone (ADH) and aldosterone

52
Q

Secretion

Impaired

A

All these actions may be inhibited in cases of renal failure or dysfunction

Impaired renal excretion of biotransformation cause delayed elimination of many drugs and enhances their toxicity and duration of action

Delayed Excretion will increase the drugs half-life and therefore cause toxicity

The doctor may extend the regiment or drop the dose

53
Q

Presence of abnormal amounts of protein in the urine is used as

What is gloucosuria?

A

An indicator of glomerular damage

Renal threshold of glucose: when the blood glucose level gets too high, the amount of glucose filtered through the glomerulus exceeds the amount That can be reabsorbed and it is lost in the urine
Canine: 180 mg/Dl
Feline: 240 mg/dl

54
Q

Antidiuretic hormone (ADH)

1) Acts on_____
2) Used to ______
3) it prevent ___ and regulates_____

A

1) Acts on DCT and collecting ducts to promote water reabsorption
2) used to stop urination/ water-sodium stays
3) prevent water loss from the body, regulate fluid balance

55
Q 
Antidiuretic hormone (ADH)
When it works properly...

If ______ is not releasing adequate amounts of ADH…

So there is ____, ____

One of these factors when diagnosing _______

Ex: vasopressin

A

Antidiuretic hormone

When working properly, it’s the body’s failsafe mechanism so that we don’t dehydrate if we have lack of fluid intake

If the posterior pituitary gland is not releasing adequate amounts of ADH, water is not Reabsorbed

So there is an increase in urine volume (polyuric) and therefore an increase in thirst (polydipsia)

One of the factors when diagnosing diabetes insipidus

Ex: vasopressin

56
Q

Aldosterone

A

Increases reabsorption of sodium in DCT and collecting ducts back into the blood

This causes an osmotic imbalance which causes water to flow back into the blood along with the sodium

57
Q

What increases the reabsorption of sodium in DCT and collecting ducts back into the blood

and also causes an osmotic imbalance which causes water to go back into the blood along with the sodium

A

Aldosterone

58
Q

Collecting ducts are also the site of

A

Antidiuretic hormone (ADH) action which prevents dehydration

59
Q

Define renal dysfunction

What’s happens when waste builds up….

A

Any pathological condition that results in the inability of the urinary system to adequately remove waste materials from the blood

Waste materials built up in the blood and become toxic to the pet and the resulting condition is called uremia

60
Q

Define uremia

A resulting condition of…

Uremia increases…

contraindications

A

Abnormally high concentrations of urea, creatine, and other nitrogenous end products of protein and amino acid metabolism in the blood

Waste materials build up in the blood and become toxic to the pet and the resulting condition is called uremia

Uremia can increase the sensitivity of some tissues to certain drugs

Contraindications- xy alone and ketamine

61
Q

If it kidney’s functionality is decreased blank may not occur correctly

A

Erythropoesis

62
Q

What about erythropoietin?

A

It’s the formation of erythrocytes

And may not occur correctly with kidneys function impaired

it is a hormone secreted by a healthy kidney That communicates with the bone marrow to make a more RBC

In disease kidneys the hormone is reduced or not at all

Epogen is a last ditch effort to help the non-regenerative anemia

63
Q

What should a slide look like in diseased kidneys

A

Non-regenerative anemia, normochromic, normocytic

64
Q

how does a diseased kidney affect the RBCs?

A

Bone marrow is unable to respond to the anemia and there are no reticulocytes because it’s non regenerative

65
Q

What can be done for non-regenerative anemia? And Kidney failure

A

Sometimes injections of human recombinant erythropoietin (epogen), but this is considered a last ditch effort

PCV should be monitored on a weekly basis until improvement is reached or after the dose has been decreased

PCV you should be in the “teens” before therapies consent

66
Q

What are the types of kidney failure?

A

Prerenal uremia
Renal uremia
Post renal uremia

67
Q

What is pre-Renal uremia and how can we try to fix it

A

It’s decrease in blood flow to the kidneys

It may be caused by dehydration, CHF, or shock

In this case the kidneys are functioning properly but there isn’t enough blood reaching them, so waste material can’t be adequately removed

And try to fix it with fluids
Yes- kidney function
No- blood flow

68
Q

What is Renal uremia?

A

Inability of the kidney to adequately regulate urine production because of that incident nephrons

Examples are toxins inflammation and infection

There is adequate blood flow but not enough functional nephrons, so waste removal can’t take place properly

Yes- blood flow
No-nephrons

69
Q

What is post renal uremia?

A

And obstruction that prevents urine from being expelled from the body

Ex: tumor, blood clot or urolith (stones)

70
Q

What is used to remove access extracellular fluid by increasing urine flow or diuresis and sodium excretion and reducing hypertension?

A

Diuretic drugs

Cplot

71
Q

What are the diuretic drugs?

A

Loop, osmotic, thiazide, potassium sparing, and carbonic anhydrase inhibitors

Think cplot

72
Q

Remove extracellular fluid by….
Reduce hypertension (sodium/water and low blood pressure)
Increase urine flow (diuresis)
Increase Na excretion

A

Diuretic Drugs

73
Q

What are the diuretic drugs?

A

Loop, osmotic, thiazide, potassium sparing, and carbonic anhydrase inhibitors

Think cplot

74
Q

Hypertension

A

High blood pressure

75
Q

Loop Diuretics… must have

A

WATER!

76
Q 
Loop Diuretics...
ex: \_\_\_\_ \_\_\_\_
inhibits....
actions are .... and given....
Tremendous ....
promotes excretion of...
A

Loop
Ex: Furosemide; Lasix

Inhibits tubular reabsorption of Na at loop of henle

Actions are Quick and given IV

Tremendous diuresis

Promotes excretion of CL, K, and water

Clincal use- pulmonary edema, hypercalcemia nephropathy,

77
Q

Osmotic Diuretic
Ex:
Administered- IV to promote… by…water is draw into

glamorous filtrate, reducing its reabsorption and increasing the secretion of water

A

Ex: Glucose and mannitol

Admin. IV to promote DIURESIS by exerting high OSMOTIC PRESSURE in the kidney tubules and limiting tubular reabsorption.

78
Q

ex: Hydrochlorothiazide
Reduce edema by inhibiting reabsorption of Na, Cl, water at the renal tubules,
Duration of action is longer than looop diuretics
Cross placenta border
Clinical uses: nephrogenic diabetes insipidus and hypertension
Side effects: hypokalemia if therapy is prolonged, cardiac dysfunction

A

Thiazide DIuretic

79
Q

Drugs used to treat oliguric acute renal failure (urine production has decreased or almost stopped) and to
Reduce intracranial and intraocular pressure
Side effects are vomiting and electrolyte imbalances

A

Osmotic Diuretic

Eye and Brain trauma

80
Q

1) Eye or brain diuretic
2) Pregnant
3) Pulmonary edema
4) conjunction with aldosterone antagonists
5) Reduce intraocular pressure by reducing the production of aqueous humor- used to treat GLAUCOMA

A

1) Osmotic Diuretic
2) Thiazide DIuretic
3) Loop
4) Potassium-sparing diuretics
5) Carbon Anhydrase inhibitors

81
Q 
Ex:Spironolactone
-Weaker diuretic and antihypertensive effects, but they do conserve potassium
-usually used in conjunction with other diuretic, mainly loop
-
-a.k.a. aldosterone antagonists
Side effect: HYPERkalememia
-ENHANCES SODIUM/WATER EXCRETION
-REDUCES POTASSIUM SECRETION
A

Potassium-sparing diuretics

82
Q

ex: acetazolamide
- Block action of carbon anhydrase, which is used by the body to maintain acid-base balance
- Reduce intraocular pressure by reducing the production of aqueous humor and may be used to treat GLAUCOMA
- Side effects: Hypokalemia, metabolic acidosis (tachypnea, twitching, mouth ulcers, weight loss, muscle loss)

A

Carbon Anhydrase inhibitors

83
Q

Define Urinary Incontinence

Two types

A

The loss of voluntary control of micturition

1) Neurologic
2) non-neurolgic

84
Q

Example neurologic…

Urinary Incontinence

A

Trauma to the spinal cord, tumors of the nervous sytem

Dashond= slip disks/bladder issue

85
Q

Example of non-neurologic

Urinary Incontinence

A

neoplasia (cancer), trauma to the bladder itself, stress, hormones

86
Q

Expulsion to treat urinary incontinence is done with…

A

CHOLINERGIC AGONISTS

87
Q

Retention to treat urinary incontinence is done with…

A

ANTICHOLINERGIC AGENTS

88
Q

Anticholinergic Agents (retention)

1) their action produces muscle….
2) Used to treat….
3) Side effects…
4) they are….
5) aka…

A

1) their action produces muscle MUSCLE RELAXATION
2) Used to treat URGE incontinence by promoting the retention of urine in the urinary bladder
3) Side effects… Decreased gastric motility and delayed gastric emptying, which may decrease the absorption of other medications
4) they are…. SLOW!
5) aka… Parasympatholytic because they block Ach at receptor sites in the parasympathetic nervous system.

89
Q

What treats Urinary Incontinence

Classification based on….

A

1) Cholingeric Agonists (Expulsion)
2) Anticholinergic Agents (Retention)
3) Adrenergic Antagonists
Beta and Alpha

90
Q

Reduces internal sphincter tone when the urethral sphincter is in hypertonus (increased tension)
Side effect syncope (pass out)
SYMPATHETIC

A

Alpha Aderenergic Antagonists
(Ex: prazoin, phenoxybenzamine)

(classified by site of action)

91
Q

inhibit catecholamines
control mild to moderate hypertension associated with CRF
Decrease Cardiac output and promotion of bronchospasm

A

Beta Aderenergic Antagonists
(ex: propranolol)
(classified by site of action)

92
Q

Non-neurologic urinary disorder

1) includes….
2) what can increase urethral tone?
3) how do we treat most urinary incontinence mostly seen in spayed female dogs?

4) DES out so we use

A

1) includes stress, URGE!!!, Hormone response ectopic ureter formation, over distension
2) Alpha and Beta adrenergic agonists
3) Estrogen treats hormone responsive urinary incontinence in spayed female dogs
4) PPA

93
Q

When blood volume is low, kidney’s secrete ….

A

renin directly into blood stream

95
Q

Kidney’s secrete renin into the bloodstream when…

A

When blood volume is low

Vet 2 (10 decks)

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