Lecture 4: Excretion Flashcards

1
Q

major routes of excretion

A

-renal (primary)
-bile to feces

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2
Q

other routes of excretion

A

-pulmonary
-salivary
-mammary

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3
Q

Nephron

A

-primary functional unit of kidney
-compact

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4
Q

mechanisms of renal excretion

A

-filtration
-active tubular secretion
-tubular reabsorption
-biotransformation

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5
Q

Filtration location

A

-glomerulus

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6
Q

tubular secretion location

A

-proximal convuluted tubule

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7
Q

tubular reabsorption location

A

-distal convuluted tubule
-collecting duct

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8
Q

Glomerular filtration

A
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9
Q

Determinants of Filtration

A

-number of functional nephrons
-size (<5000)
-protein binding (permeability)
-renal blood flow (delivers drug to kidney)

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10
Q

Old people have less nephrons

A

-reduce dose
-less excretion

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11
Q

Renal Clearance vs weight graph

A

-negative slope
-increase weight decreases clearance rate

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12
Q

Renal clearance vs Creatinine Clearance

A

-positive slope
-increase together

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13
Q

Decrease creatinine clearance

A

-decrease renal clearance by filtration
= lower dose

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14
Q

Active Tubular Secretion

A

-carrier-mediated transport
-some filtration still
-susceptible to competitive interactions
-stereoselective excretion

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15
Q

carrier-mediated reactions (ATS)

A
  1. saturable
  2. competitive interactions (only certain amount of carriers available = drug interactions)
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16
Q

dose vs excretion rate

A

-positive slope for filtration
-positive slope that levels off for ATS

17
Q

Tubular Reabsorption

A

-most passive
-some carrier-mediated

18
Q

passive tubular reabsorption

A

-driven by concentration gradient
-determined by lipophilicity and pKa
-influenced by urine flow and pH

19
Q

carrier-mediated (ACTIVE) reabsorption

A

-saturable (capacity-limited)
-ascorbic acid and glucose
-what shows up in urine is reabsorbed back into blood

20
Q

saturable

A

-increase concentration saturates reabsorption

21
Q

Urine vs blood drug concentration

A

-blood more accurate
-urine reabsorption leads to higher concentration
-why we use blood glucose for diabetes

22
Q

tubular/plasma concentration

A

1=same
>1: higher in tubule (creatinine)
<1: higher in blood (glucose)

23
Q

What happens to reabsorption as urine flow is INcreased?

A

-DEcrease reabsorption

24
Q

Why do some meds require u to drink lot of water

A

-drug can precipitate out if drug concentration is too high
-kidney stones

25
Q

Ascorbic acid

A

-undergoes REabsorption
-massive increase in dose barely increases plasma level
-bc ur saturating = spills out into the urine

26
Q

Biotransformation of drugs

A

-mostly liver but some in kidney (vitamin D)

27
Q

Vitamin D

A

-must be bioactivated to active form
-liver makes active form

28
Q

What is the most important determinant of filtration of a drug?

A

molecular weight

29
Q

How do passive and active tubular reabsorption differ?

A

-saturability
-need to look at variety of doses to see effect ?

30
Q

What occurs to secretion as blood concentration increases

A

-reach maximum secretion (saturation)

31
Q

Which types of drugs will have more drug interactions? (filtered or secreted?)

A

-secretion because of carriers
-carriers=competition

32
Q
A