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Pharm II- Urinary Tract Drugs Flashcards

1
Q

What type of acids & bases are actively secreted by the Proximal tubules?

A

weak acids & bases

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2
Q

Are drugs with a charge or without a charge reabsorbed by the kidneys?

A

Drugs without a charge are reabsorbed

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3
Q

Weak acids are more rapidly excreted in what type of urine?

A

Alkaline urine (like in herbivores)

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4
Q

Weak bases are more rapidly excreted in what type of urine?

A

Acidic urine (like in carnivores)

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5
Q

What drug competes with Pen for a cycle transporter & reduces the elimination rate (prolongs duration) of both drugs?

A

Probenicide

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6
Q

Which drug inhibits uric acid secretion?

A

Sulphinpyrazone

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7
Q

Passive reabsorption of a drug from the PCT depends on what 2 things?

A

pH of urine & pKa of the drug

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8
Q

Renal excretion of weak acids ____ in low urinary pH (acidic urine).

A

Decreases

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9
Q

Renal excretion of weak acids____ in high urinary pH (alkaline urine).

A

Increases

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10
Q

Renal excretion of weak bases ____ in low urinary pH. (acidic urine)

A

Increases

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11
Q

Renal excretion of weak bases ___ in high urinary pH (alkaline urine).

A

Decreases

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12
Q

An acidic drug will be ______ in carnivores?

A 
NON ionized
(can be reabsorbed & prolongs drug's effects)
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13
Q

A basic drug will be ____ in carnivores?

A

Ionized

is eliminated

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14
Q

An acidic drug will be _____ in herbivores?

A

Ionized

is eliminated

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15
Q

A basic drug will be ____ in herbivores?

A

NON-ionized

can be reabsorbed & prolongs drug’s effects

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16
Q

The half life of a basic drug is less in which type of animal?

A

Carnivores

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17
Q

The half life of an acidic drugs is less in which type of animals?

A

Herbivores

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18
Q

Herbivores have delayed elimination of drugs with a ____ pKa.

A

high pKa

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19
Q

Carnivores have a delayed elimination of drugs with a ____ pKa.

A

low pKa

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20
Q

What drug decreases reabsorption of Glucose, H2O & Amino Acids in the PCT?

A

Dopamine

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21
Q

What drug decreases the reabsorption of Na & Cl in the Ascending LoH?

A

Furosemide

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22
Q

What 2 drugs increases the reabsorption of H2O, Ca, Na & Cl in the DCT?

A

Antidiuretic Hormone

Aldosterone

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23
Q

What drug decreases the reabsorption of H2O, Ca, Na & Cl in the DCT?

A

Thiazide diurectics

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24
Q

Which 2 drugs decrease the reabsorption of H2O, Ca, Na & Cl in the Collecting Ducts?

A

Atrial Natriuretic Peptide (ANP)

Urodilation

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25
Q

Where is most H2O reabsorbed?

A

Descending LoH

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26
Q

Where in the kidneys is there variable permeability to H2O?

A

DCT & Collecting Ducts

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27
Q

Which part of the glomerulus filters molecules based on size, shape & charge?

A

basement membrane of glomerulus

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28
Q

Which part of the glomerulus may phagocytose macromolecules?

A

visceral epithelium of the glomerulus

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29
Q

The basement membrane & podocytes only allow what to pass? (2)

A

small molecules & H2O

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30
Q

Which cells relax or constrict & change the available filtration area?

A

Mesangial cells

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31
Q

What causes relaxation of the mesangial cells & enhances the available filtration area?

A

Atrial Natiuretic Peptide (ANP)

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32
Q

What causes contraction of the mesangial cells & decreases the available filtration area?

A

Sympathetic innervation

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33
Q

What causes constriction of the mesangial cells & decreases the available filtration area?

A

Angiotensin II

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34
Q

______ blockers are important in preventing proteinuria in Cats.

A

Angiotensin II blockers

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35
Q

Glomerular nephritis is a/an _______ dz.

A

Immune Mediated Dz caused by immunoglobulin complexes

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36
Q

What percentage of H2O is reabsorbed in the PCT?

A

60-70%

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37
Q

The epithelium in the PCT is _____.

A

“Leaky” = passive flow in either direction

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38
Q

Na enters the cell via what?

A

Na/H exchanger

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39
Q

Na leaves the cell and enters the interstitium via what?

A

Na/K ATPase Pump

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40
Q

What is responsible for the counter-current system of the kidney?

A

the LoH

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41
Q

How is the counter-current system established in the kidney?

A

Via H2O permeability in the Descending limb & Na permeability in the Ascending limb

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42
Q

Where does active transport of Na occur?

A

THICK Ascending LoH

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43
Q

Which cells are responsible for the secretion of H in the Collecting Ducts?

A

Intercalated cells

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44
Q

Where in the Collecting Ducts can transport of H2O & ions can be individually regulated by hormones?

A

Tight jxns in between cells

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45
Q

Sprionolactone is an Aldosterone _____. What is its effect?

A

Aldosterone receptor ANTagonist

Diuretic effect

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46
Q

Which 2 diuretics allow more Na to reach the Collecting Ducts?

A

Thiazide & Loop Diuretics

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47
Q

Which 3 drugs decrease Na reabsorption in the Collecting Ducts?

A

Amiloride
Triamterene
Spironolactone

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48
Q

Are there dissolution protocols available for Ca carbonate or Ca oxalate crystals/stones?

A

NO

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49
Q

Which type of crystals/stone can you dissolve w/ drugs?

A

Struvite crystals/stones

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50
Q

What is the primary mediator of benign prostatic hyperplasia in dogs?

A

overproduction of dihydrotestosterone (DTH)

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51
Q

How do you TX acute prostatisis?

A

W/ appropriate antibiotics

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52
Q

What are the causes of urinary incontinence in animals?

A

urge incontinence = Cystitis or bladder stones
Reactive/spastic bladder
Urethral sphincter incompetence in the bitch

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53
Q

Which nerve controls bladder contraction & opens the internal sphincter?

A

Pelvic nerve

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54
Q

Which nerve contracts the internal sphincter of the bladder & relaxes the detrusor mm of the bladder?

A

Hypogastric nerve

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55
Q

Which diuretics are the most powerful?

A

Loop Diuretics

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56
Q

What are the loop diuretics (3)?

A

Furosemide
Bumetanide
Torasemide

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57
Q

What is the MOA of Loop Diuretics?

A

Inhibits the Na/K/Cl carrier –> blocks the establishment of the chemical gradient

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58
Q

Which drugs have venodilator action through endothelin derived kinin (NO/PGI2)?

A

Loop Diuretics

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59
Q

Increased _____ conc. in the distal tubule results in increased loss of ____ & _____ ions.

A

Na

H, K

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60
Q

Loop diuretics cause increased secretion of what 2 ions?

A

Ca & Mg

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61
Q

Loop diuretics cause decreased secretion of what?

A

Uric Acid

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62
Q

D: of Loop Diuretics?

A

strongly PPP

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63
Q

Metabolism of Furosemide?

A

Glucuronidation in the liver

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64
Q

Metabolism of Bumetanide & Torasemide?

A

CYP450 pathways in the liver

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65
Q

What are the side effects of Loop Diuretics?

A

HYPOKALEMIA

Metabolic Alkalosis

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66
Q

How can one avoid hypovolemia & hypotension in patients receiving Loop Diuretics?

A

Make sure animal has enough water

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67
Q

Which diuretics act on the distal tubule?

A

Thiazide diuretics

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68
Q

MOA of thiazide diuretics?

A

Decrease active reabsorption of Na (& Cl) by binding to the CHLORIDE site of the Na/Cl symport system –> blocks active transport of Na & Cl

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69
Q

Thiazides increase the excretion of what 2 ions (driven by Na/K pump)?

A

H & K

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70
Q

Parathormone & Calcitriol increase what?

A

Ca reabsorption

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71
Q

What are the 2 thiazides used in Vet med?

A

Chlorothiazide

Hydrochlorothiazide

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72
Q

Is K loss significant with Thiazide diuretics?

A

yes

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73
Q

What are the diuretic effects of thiazides?

A

moderate

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74
Q

Thiazides decrease the excretion of what 2 things?

A

Uric acid & Ca

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75
Q

Thiazides increase the excretion of what 2 ions?

A

Mg & Na

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76
Q

What are the extra renal actions of thiazides?

A
  1. Vasodilation
  2. Hyperglycemia (possible)
  3. Decreased blood volume (result of direct action)
  4. reduce bone loss in humans
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77
Q

What effect do thiazides have in Diabetes insipidus?

A

reduce the volume of urine

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78
Q

Thiazides cause an intial ______ in urine due to decreased blood volume.

79
Q

A: of Thiazides?

A

P.O; well absorbed in GIT

80
Q

Thiazides compete with what for tubular secretion?

81
Q

Clinical uses of Thiazides?

A

Hypertension
Mild heart failure
Central of Nephrogenic Diabetes insipidus

82
Q

How do Thiazides help a patient with Diabetes insipidus?

A

diuresis –> decreased plasma volume –> decreased GFR –> Increased Na & H2O reabsorption
Counteracts excessive urine production

83
Q

What are the renal side effects of Thiazides? (3)

A

HYPOkalemia
Metabolic alkalosis
Increased plasma [uric acid]

84
Q

What are the non-renal side effects of Thiazides? (4)

A

hyperglycemia
Increased plasma cholesterol (long term use)
Male impotence
Hypersensitivity rxns

85
Q

What do principle cells of the Collecting Ducts do?

A

Reabsorb Na

Secrete K

86
Q

What do the intercalated cells of the Collecting Ducts do?

87
Q

Where can transport of H2O & ions be individually regulated by hormones?

A

Tight jxns between cells

88
Q

What hormone influences the absorption of Na & Cl?

A

Aldosterone

89
Q

Which 2 hormones influence H2O reabsorption?

A 
Antidiuretic hormone (ADH)
Vasopressin
90
Q

Aldosterone works where?

A

On the Collecting Ducts

91
Q

Aldosterone enhances reabsorption of what?

92
Q

Aldosterone promotes excretion of what?

93
Q

What is the quick effect of Aldosterone?

A

stimulation of Na/H exchanger

94
Q

What is the delayed effect of Aldosterone?

A

binding to cellular receptors–> activates Na channels

95
Q

Amiloride & Triamterene block what?

A

The binding of Aldosterone to cellular receptors

96
Q

Spironolactone is a ____ _____ ____.

A

aldosterone receptor ANTagonist

97
Q

Spironolatone has a _____ effect.

98
Q

How does ADH/Vasopressin cause a sustained increase in H2O permeability?

A

V2 receptor stimulation increases the # of aquaporins & H2O channels in the cell membrane

99
Q

[K] is controlled by what?

A

Regulation of renal K excretion

100
Q

What is the driving force for K excretion in the kidneys?

A

Negative potential difference of the lumen

101
Q

K excretion will increase in what 2 ways?

A

More Na reaches the collecting ducts

Increasing Na reabsorption in the collecting ducts

102
Q

Which 2 diuretics cause more Na to reach the collecting ducts & increase K excretion?

A

Thiazide & loop diuretics

103
Q

K excretion will decrease in what way?

A

Decreasing Na reabsorption in the Collecting duct

104
Q

What 3 drugs cause decrease Na to reach the collecting ducts & decreases K excretion?

A

Amiloride
Triamterene
Spironolactone

105
Q

What are the K sparing (Distal) diuretics?

A

Amiloride
Triamterene
Spironolactone

106
Q

MOA of Spironolactone?

A

inhibits the Na/K exchange by competing w/ Aldosterone

107
Q

MOA of Amiloride & Triameterene?

A

Inhibits Na/K exchange by directly decreasing activity of the pump

108
Q

Distal (K sparing) diuretics decrease what?

109
Q

What is the activity of distal diuretics?

A

poor

only increases when Na load or [Aldosterone] is high

110
Q

3 clinical uses of distal diuretics?

A
  1. decrease hypokalemia secondary to other diuretic use (CHF)
  2. Edema–> hepatic dz & portal hypertension
  3. Ascites –> hepatic dz & portal hypertension
111
Q

A: of Spironolactone?

A

P.O.; well absorbed

112
Q

What is the active metabolite of Spironolactone?

113
Q

Side effect of Spironolactone & Amiloride.

A

HYPERkalmia

114
Q

What are the 2 eicosanoids (prostaglandins) that effect renal fxn? (TQ)

A

PGE2 & PGI2

115
Q

What is the fxn of PGE2 & PGI2?

A

Maintain sufficient renal blood flow

116
Q

What causes production of PGE2 & PGI2? (6)

A 
Ischemia
Trauma
Circulating Angiotensin II
Catecholamines
ADH
Bradykinin
117
Q

What is the influence of PGE2 & PGI2 on hemodynamics?

A

Counteracts the Renin/Angiotensin/Aldosterone system –> Vasodilation in response to Angiotensin II & Nor Epi

118
Q

What are the impacts of PGE2 & PGI2 on renal control of NaCl & H2O?

A

increases renal blood flow & natriuresis

119
Q

What are the effects of NSAIDs on PGE2 & PGI2?

A

inhibits their production; effects renal perfusion

120
Q

MOA of Osmotic diuretics?

A

Filters molecules in the glomeruls but does not allow them to be reabsorbed –> creates an osmotic gradient –> pulls H2O from the interstitium & blood into the urinary system

121
Q

Where do osmotic diuretics act? (3)

A

Proximal tubule
Descending LoH
Collecting duct
(sites that are freely permeable to H2O)

122
Q

What is the secondary effect of osmotic diuretics?

A

decreases Na reabsorption

123
Q

What is the specific order of drugs given to manage oliguria or anuria?

A

Furosemide –> Osmotic diuretics –> Dopamine –> Fenoldopam –> Diltiazem

124
Q

Fenoldopam is a _____ agonist with similar effects to dopamine.

A

D1 agonist

125
Q

What are the 4 ways to inhibit the Renin-Angiotensin-Aldosterone System (RAAS)?

A
  1. Angiotensin-converting enzyme inhibitors
  2. Angiotensin Receptor blockers
  3. Aldosterone receptor blockers
  4. Renin inhibitors
126
Q

What are the 2 angiotensin receptor blockers?

A

Losartan

Telmisartan

127
Q

Which diuretics are the most powerful?

A

Loop Diuretics

128
Q

What are the loop diuretics (3)?

A

Furosemide
Bumetanide
Torasemide

129
Q

What is the MOA of Loop Diuretics?

A

Inhibits the Na/K/Cl carrier –> blocks the establishment of the chemical gradient

130
Q

Which drugs have venodilator action through endothelin derived kinin (NO/PGI2)?

A

Loop Diuretics

131
Q

Increased _____ conc. in the distal tubule results in increased loss of ____ & _____ ions.

132
Q

Loop diuretics cause increased secretion of what 2 ions?

133
Q

Loop diuretics cause decreased secretion of what?

134
Q

Metabolism of Furosemide?

A

Glucuronidation in the liver

135
Q

Metabolism of Bumetanide & Torasemide?

A

CYP450 pathways in the liver

136
Q

What are the side effects of Loop Diuretics?

A

HYPOKALEMIA

Metabolic Alkalosis

137
Q

Which diuretics act on the distal tubule?

A

Thiazide diuretics

138
Q

MOA of thiazide diuretics?

A

Decrease active reabsorption of Na (& Cl) by binding to the CHLORIDE site of the Na/Cl symport system –> blocks active transport of Na & Cl

139
Q

Thiazides increase the excretion of what 2 ions (driven by Na/K pump)?

140
Q

What are the 2 thiazides used in Vet med?

A

Chlorothiazide

Hydrochlorothiazide

141
Q

Is K loss significant with Thiazide diuretics?

142
Q

What are the diuretic effects of thiazides?

143
Q

Thiazides decrease the excretion of what 2 things?

A

Uric acid & Ca

144
Q

Thiazides increase the excretion of what 2 ions?

145
Q

What effect do thiazides have in Diabetes insipidus?

A

reduce the volume of urine

146
Q

Thiazides cause an intial ______ in urine due to decreased blood volume.

147
Q

Thiazides compete with what for tubular secretion?

148
Q

How do Thiazides help a patient with Diabetes insipidus?

A

Counteracts excessive urine production

149
Q

What are the renal side effects of Thiazides? (3)

A

HYPOkalemia
Metabolic alkalosis
Increased plasma [uric acid]

150
Q

What are the non-renal side effects of Thiazides? (4)

A

hyperglycemia
Increased plasma cholesterol (long term use)
Male impotence
Hypersensitivity rxns

151
Q

Where can transport of H2O & ions be individually regulated by hormones?

A

Tight jxns between cells

152
Q

Amiloride & Triamterene block what?

A

Aldosterone binding

153
Q

How does ADH/Vasopressin cause a sustained increase in H2O permeability?

A

V2 receptor stimulation increases the # of aquaporins & H2O channels in the cell membrane

154
Q

MOA of Spironolactone?

A

inhibits the Na/K exchange by competing w/ Aldosterone

155
Q

MOA of Amiloride & Triameterene?

A

Inhibits Na/K exchange by directly decreasing activity of the pump

156
Q

Distal (K sparing) are poor acting diuretics that decrease _____ only when Na/Aldosterone is high.

157
Q

What are the 2 eicosanoids (prostaglandins) that effect renal fxn? (TQ)

A

PGE2 & PGI2

158
Q

MOA of Osmotic diuretics?

A

Filters molecules in the glomeruls but does not allow them to be reabsorbed –> creates an osmotic gradient –> pulls H2O from the interstitium & blood into the urinary system

159
Q

Where do osmotic diuretics act? (3)

A

Proximal tubule
Descending LoH
Collecting duct
(sites that are freely permeable to H2O)

160
Q

Osmotic diuretics primarily prevents reabsorption of _____ & secondarily decreases reabsorption of _____.

161
Q

What hormone plays a large role in acute renal failure?

A

Angiotensin II

162
Q

Fenoldopam is a _____ agonist with similar effects to dopamine.

A

D1 agonist

163
Q

What are the 2 angiotensin receptor blockers?

A

Losartan

Telmisartan

164
Q

Which drug blocks aldosterone receptors?

A

Spironolactone

165
Q

Which drug inhibits renin?

A

Aliskirine

166
Q

What are the 2 receptor types for Angiotensin II?

167
Q

What do AT1 receptors mediate? (4)

A

VasoCONSTRICTION
Aldosterone & Vasopressin release
Na & H2O rentention
Sympathetic facilitation

168
Q

What do AT2 receptors mediate? (4)

A

VasoDILATION
Na EXCRETION
Anti-proliferative effects
Limiting detrimental effects of AT1 activation

169
Q

Telmisartan binds strongly to which Angiotensin II receptors?

170
Q

What are the effects of Telmisartan?

A

strong antihypertensive effects

171
Q

What is the PK of Telmisartan?

A

Lipophilic
Weak Acid
Binds reversibly to intracellular proteins (TQ)

172
Q

How is Telmisartan metabolized in Cats?

A

Via glucuronidation (phase 2 rxns)

173
Q

Which crystal/stone has a dissolution protocol?

A

Struvite crystals/stones

174
Q

What drug can be used to TX Benign Prostatic Hyperplasia?

A

Finasteride

175
Q

MOA of Finasteride?

A

5 alpha-reductase inhibitor–> blocks conversion of testosterone into DHT

176
Q

What type of antimicrobial drug do you want to use to TX prostate infections? (acidic or basic) Second best choice? (TQ)

A 
Basic antimicrobial (high pKa)
Lipophilic drugs
177
Q

Which 2 drugs can be used to inhibit bladder contractions?

A

Oxybutynin

Propanthelin

178
Q

What is the difference between 3ry & 4ry structures?

A 
3ry= no charge--> goes to brain --> CNS effects
4ry= Charged--> no CNS effects
179
Q

Pelvic nerve is a ___________ nerve.

A

parasympathetic

180
Q

The pelvic nerve releases what?

181
Q

ACh released by the Pelvic nerve binds to which receptors on the bladder wall?

A

M3 Receptors

182
Q

Hypogastric nerve is a ________ nerve.

A

sympathetic

183
Q

Hypogastric nerve releases what?

A

NA (Nor epi)

184
Q

NA released by the Hypogastric n. binds to what 2 receptors? Give locations.

A

Beta 2 receptors–> Bladder wall

Alpha 1 receptors–> Urethra

185
Q

The Pudendal nerve is a _______ nerve.

186
Q

The ACh released by the Pudendal nerve binds to what receptors in the External urethral sphincter?

A

Nicotinic receptors

187
Q

What are the fxns of the 4 receptors in the bladder? (TQ)

A

M3 = contracts detrusor mm.
Beta 2= relaxes detrusor mm.
Alpha 1= contracts urethra
Nicotinic = contracts external sphincter

188
Q

Which drugs work on the BLADDER to TX incontinence? (TQ)

A

Parasympathicolytics

Sympathicomimetics

189
Q

Clenbuteral is a parasympathicoltyic or sympathicomimetic drug?

A

Sympathicomimetic w/ effects on the bladder

190
Q

Which drugs work on the external sphincter to TX incontinence?

A

Sympathicomimetics & estrogens

191
Q

Which 2 sympathicomimetic drugs work on the sphincter?

A

Phenylpropanolamine

Ephedrine

192
Q

What estrogen drug is used to TX urinary incontinence?

193
Q

What drugs can be used to TX Urethral hypertonicity (detrussor-urethral dyssynergia)? (4)

A

Phenoxybenzamine, Prazosine

Diazepam, Dantorlene

Linde's Sets (16 decks)

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