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nephro Flashcards

1
Q

horseshoe kidney

A

kidneys are linked and wrap around the aorta

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2
Q

how is fluid volume controlled

A

sodium

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3
Q

consequences of hyponatremia

hypernatremia

A

hypotension, cardvascular collapse, death

hypertension, pulmonary edema, death

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4
Q

proteinuria is usually = what

A

renal disease

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5
Q

how does the respiratory system regulate pH

A

by adding or taking away CO2

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6
Q

how does the renal system regulate pH

A

adding or taking away HCO3

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7
Q

respiratory compensation of acidosis

alkalosis

A

acidosis: ventilation increases, takes away CO2, shifts the equation to CO2 and H2O
alkalosis: decreases ventilation, retains CO2, shifts equation to H and HCO3

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8
Q

renal compensation of acidosis

alkalosis

A

acidosis: HCO3 is retained, H+ is excreted
alkalosis: HCO3 is secreted, H+ is retained

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9
Q

causes of metabolic acidosis

A

renal failure

ketoacidosis

ingestion of acid (aspirin overdose)

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10
Q

causes of respiratory acidosis

A

respiratory failure

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11
Q

causes of metabolic alkalosis

A

prolonged vomiting

ingestion of large amounts of bicarbonate

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12
Q

causes of respiratory alkalosis

A

hyper ventillation

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13
Q

what is the function of clinically useful diuretics

why do they work

A

causes an increased secretion of Na

water follows Na

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14
Q

regulators of sodium homeostasis

A

Hypothalamus/pituitary: ADH

Baroreceptors in the atria: Atrial natrietic peptide

sympathetic nervos system

RAAS

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15
Q

T/F use of diuretics can completely eliminate Na from the body

A

false, the body will eventually reach a new equilibrium

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16
Q

diruetic drug classes

A

carbonic anhydrase inhibitors

osmotic agents

thiaizide and thiazide-like agents

loop agents

potassium sparing

ADH antagonists

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17
Q

carbonic anhydrase

A

enzyme responsible for splitting H+ off H2CO3 or synthesizing H2O and CO2 f

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18
Q

inhibition of carbonic anhydrase causes what

A

alkaline urine

metabolic acidosis

minimal sodium loss

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19
Q

most important carbonic anhydrase inhibitor

what is this most used for

what does it do

A

acetazolamide (diamox)

acute mountain sickness

speeds acclimation process and treats symptoms

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20
Q

indications for the use of carbonic anhydrase inhibitors

A

open angle glaucoma

epilepsy

acute mountain sickness

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21
Q

functions of osmotic diuretics

A

increase tubule osmolality

increase renal ultrafiltrate

increase urine flow

preferential to water but electrolytes are also lost

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22
Q

osmotic diuretics

primary uses

complications iwth use

A

Mannitol glycerin, isosorbide

acute renal failure, increased ICP

may worse pulmonary edema, not useful for anuria

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23
Q

two instances where mannitol is particularly useful

how can you determine mannitol is a good therapy

A

acute renal failure due to hemoylsis or rhabdomyolysis

Mannitol IV increases urine flow, good response to test dose indicates it will work well

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24
Q

where is most Na reaborbed in euvolemia

expanded volume

dehydration

A

proximal tubule

less in the proximal tubule, increases Na excretion to urine

significant increase in Na reabsorption in PT

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25
what are the functions of thiazide diuretics
inhibitors of Na/Cl symport in the tubule (increases Na/Cl excretion) come inhibit carbonic anhydrase some have a direct vascular effect
26
three thiazide drugs
hydrochlorothiazide benzathiazide bendroflumethazide
27
most important thiaizide like diuretic
chlorthalidone
28
side effects of thiazide drugs
**_HYPOKALEMIA_** **postural hypotension** change in glucose tolerance hypercalcemia, uricemia hyponatremia
29
complications of hypokalemia
muscle weakness muscle soreness heart arrhytmia death
30
function of loop diuretics
blocks tubule reabsorption of Na significantly increases Na+ and Cl- venous dilation
31
T/F osmotic diuretics are useful in decreasing blood volume and Na
false
32
most important loop diuretic
furosemide (lasix)(
33
ADRs of loop diuretics
ototoxicity (deafness, vertigo, usually reversible) excessive fluid and Na loss (hypotension, postural hypotension) loss of electrolytes (K, Cl, Ca, Mg)
34
two types of potassium sparing diuretics
luminal membrane agents (triameterene) mineralcorticoid antagonist (spirolactione)
35
T/F luminal membrane postassium sparing diuretics are very effective
false, they are not very effective and are usually combined with thiazides or loops
36
luminal diuretic toxicity
GI upset increase urinary calcium hyperkalemia, especially with Ace inhibitors or NSAIDs
37
what is the function of mineralocorticoid receptor antagonists
blocks the effect of aldosterone, preventing retention of NA and water, prevents excretetion of K and H+
38
T/F mineralocorticoid rececptor agonists can prevent cardiac remodeling T/F they are typically not used as a sole medication
true, maybe true
39
toxicity related to aldosterone antagonsists
hyperkalemia antiandrogenic effects (gynecomastia, ↓hirsuitism)
40
issues with hyperkalemia
malaise palpitation muscle weakness fatal arrhytmia
41
non-selective ADH antagonists
lithium demeclocycline
42
T/F patients with pulmonary edema related to CHF will have almost immediate relief with lasix due to decreased heart workload
true, lasix will cause vasodilation
43
wht are vaptans
selective vasopressin receptor blockers
44
diuretic combinations
loop+thiazide (useful in pts who are refractory to loop diuretics) loop/thiazide + potassium sparing
45
T/F androgens are needed for BPH
true, specifically DHT
46
what is 5-alpha reductase
the enzyme that converts T to DHT
47
why are obese men at increased risk to BPH
because they have higher levels of estradiol because they have more aromatase to convery T into E
48
obstructive BPH symptoms
—Decreased force & caliber of urine stream —Difficulty initiating flow (“hesitancy”) —Sensation of incomplete emptying —Double voiding (2nd void within 2 hours) —Straining to urinate —Post-void dribbling
49
irritative symptoms of BPH
—Urgency —Frequency —Nocturnal voiding —All due to bladder pressure changes from partial outflow tract obstruction
50
treatment strategies for BPH
—Observation —Herbs, dietary —Medical treatment —Surgical treatment
51
why might BPH symptoms spontaneously remit
lifesyle changes or ↓androgens
52
dietary strategies to combat BPH
decreased fatty food intake saw palmetto
53
medical treatment of BPH
alphablockers 5-alpha reductase blockers
54
how can the autonomic influences of the destrusor muscle be modified
cholinergic drugs can cause urgency and frequency anitcholinergics will cause urinary retention
55
what type of autonomic receptor is found in the bladder sphincter
alpha receptors
56
blocking alpha 1 receptors leads to... blocking alpha 2 leads to...
relaxation of the bladder sphincter relaxation of the bladder and vascular smooth muscle, lowering BP
57
what is the advantage of Alpha 1 blockers (tamsulosin, silodosin) over alpha 1 and 2 blockers (doxazosin, terazosin)
alpha 1 blockers will only work on the prostate and bladder alpha 1 and 2 wil work on vascular smooth muscle as well
58
Most important ADR for alpha1 blockers how to prevent issue
orthostatic hypotension more common in volume/salt depleted patients educate them on what is happening and give them their first dose in the office
59
less common ADRs with alpha receptor blockers
CYP interaction ejaculatory dysfunction
60
T/F selective alpha blockers are 100% selective
false, they can still cross react
61
advantages of 5-alpha reductase inhibitors
treats BPH and male pattern baldness can also lower prostate cancer risk
62
5-alpha reductase inhibiors
dutasteride finasteride
63
side effects of 5 alpha reductase inhibitors
diminished libido erectile dysfunction gynecomastia
64
what is the time difference between symptomatic relief of BPH beteween alpha 1 blockers vs 5-alpha reductase inhibitors
7-10 days vs 6-12 months
65
possible use of aromatase inhibiors in BPH treatment
might able to improve the estrogen/test ratio in overweight men
66
why are elderly men at higher risk for UTI
atrophy of urinal muscosa BPH
67
Dx of UTI requires what
clinical suspcion + 100,000mL in voided samples or 1,000-10,000 in catheter samples
68
T/F a culture needed to treat a UTI
false, culture is useful but you can start treatment without it
69
typical UA results with UTI
cloudy or bloody increased WBCs, bacturia, RBCs casts = pyelonephtitis)
70
cystitis symptoms
irritative voiding symptoms (frequency, urgency, pain) hematura fever (commonly in kids)
71
pyelonephritis symptoms
fever, nausea, vomiting, diarrhea flank pain with or without voiding symptoms
72
what would indicate high clinical suspcion of UTI in peds
unexplained fever in female \<5
73
typical pathogens for UTI
80-85% come from coliforms 15-20% from strep or enterococcus hematogenous seeding is rare
74
typical coliforms in UTI
enterobacter escherichia klebsiella serratia
75
when would an abnormal bacteria or fungus be suspected for a UTI
indwelling catheter bed ridden immunosuppresedd
76
Treatment of UTI
fluids vitamin C/cranberry juice Abx
77
T/F abx are always needed for cystitis and pyelonephritis
false, they are usually necessary for cystitis but always for pyelonephritis
78
typical drugs for UTI
bactrim nitrofurantonin 2nd gen cephalosporins amoxicilin fluoroquinolones
79
complications of a UTI
untreated cystitis can lead to pyelonephritis poorly treated pyelonephritis can produce kidney damage
80
strategies to combat repeat UTI
◦Hydrate well ◦Empty bladder before/after intercourse (IC) ◦Antibiotic before IC ◦Apply antibiotic ointment to urethral meatus before IC ◦Long term low dose antibiotic therapy
81
symptoms of acute prostatitis
—Fever is common —Perineal, sacral, suprapubic pain/discomfort —Irritative voiding symptoms
82
PE and lab findings associated with acute prostatitis
enlarged and painful prostate leukocytosis with left shift UA with pyuria, bacturia, hematuria positive cultures for G- bacteria
83
inpt treatment of prostatitis out patient
IV ampicillina and aminoglycoside (gent) cipro or other fluoroquinolone
84
significant differences between chronic and acute prostatitis
chronic prostatitis is more common in ment between 40-60 no fever with chronic
85
causes of chronic prostatitis
very few are due to low grade infections some are due to atypical infections the majority are due to non-pecific inflammtion
86
hallmark signs of bacterial chronic prostatitis
Urine and blood culture negative with leukocytes and bacteria in prostatic secretions
87
best treatment for chronic bacterial prostatitis
bactrim for 6-12 weeks
88
causes of ED
medical disorders (vascular compromise, DM, androgen insufficiency) iatrogenic (ADRs from HTNdrugs, sequela from surgery) pysch
89
what is the function of PDE-5 inhibitors in treating ED
limits the action of phosphodiesterase, increasing duration of nitric oxide effect nitric oxide increases blood flow to corpus cavernosum
90
PDE-5 inhibitor examples
sildenafil (PRN) tadalafil (daily)
91
off label use of PDE-5 inhibitors
BPH (tadalafil) pulmonary HTN (sildenafil, tadalafil)
92
signficant ADRs with PDE-5 inhibitors most common other
priapism (contraindicates with organic nitrates) headache, flushing, nasal congestion color vison, hearing loss
93
when would prostaglandin E analog be used to treat ED example fucntion
when pts can't use PDE-5 inhibitors alprostadil by urethral suppository or injection probably relaxes corpus cavernosum smooth muscle

Pharmacotheraputics (10 decks)

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