Brainscape's Knowledge GenomeTM

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


See full index

Basic Pharmacology > Renal and Urinary Tract Pharmacology > Flashcards

Renal and Urinary Tract Pharmacology Flashcards

1
Q

what are the primary pharmacological interventions with the renal system and urinary tract?

A

increasing urine output
decreasing urine output (rare)
maintaining renal perfusion
control of bladder and urethral tone

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

what does water follow in its movement?

A

sodium
other osmotic agents

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

why would we want to increase urine flow?

A

achieve blood volume contraction
protect kidney function

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

what is the mechanism of action of diuretics?

A

osmotic effects of water-permeable segments
specific interactions with enzymes
interactions with specific membrane transport proteins
interactions with hormone receptors in renal epithelial cells

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

how do osmotic diuretics (mannitol) work?

A

disrupt the osmotic gradient generated by the re-absorption of sodium

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

what do you need for osmotic diuretics to be effective?

A

intact tubular wall

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

what are the clinical indications of mannitol?

A

prophylaxis or treatment of acute kidney injury
not for reducing edema
reduction of CSF (cerebral edema) or intraocular pressures (must have intact blood-brain barrier)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the efficacy and natriuresis of osmotic diuretics?

A

variable efficacy
N/A natriuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the adverse effects of mannitol?

A

acute expansion of ECF/plasma volume (cardiac decompensation, edema)

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

what are the contraindications of mannitol?

A

anuric kidney failure
marked dehydration
pulmonary congestion/edema
intracranial hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the over-all effect of carbonic anhydrase inhibitors?

A

low
compensation in the loop of henle and distal convoluted tubule
as body bicarbonate stores become depleted, diuretic effect is lost

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

what are carbonic anhydrase inhibitors used for?

A

primarily for glaucoma: topical use more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are carbonic anhydrase inhibitors contraindicated in?

A

hepatic cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the most common diuretic in veterinary medicine?

A

furosemide: all species

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what do loop diuretics do?

A

inhibit Na/K/2Cl cotransporter in the thick ascending limb of the loop of henle

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

what are the loop diuretics?

A

furosemide
torsemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what can furosemide do?

A

block majority of sodium reabsorption in loop
only small amount of Na that flows through can be reabsorbed in rest of tubule
“high ceiling diuretic”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the half-life of furosemide?

A

short: 1-1.5 hours in dogs/cats, 3 hours in horses/cattle

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

what is the oral bioavailability of furosemide?

A

good except in horse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the adverse effects of furosemide?

A

ototoxicity
do not use in those with liver failure- may precipitate coma
hypokalemic metabolic alkalosis

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

why does furosemide cause hypokalemia?

A

higher amount sodium going down the tubule, so later excretes potassium in exchange for absorbing sodium
aldosterone (increases because of decreased blood volume) enhances Na/K exchange

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

what are the clinical indications of furosemide?

A

reduce blood volume
prevent exercise-induced pulmonary hemorrhage in racehorses
acute kidney injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

why would you want to reduce blood volume?

A

heart failure
edema
decreases hydrostatic pressure and increases oncotic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why does torsemide not have as much of an effect on potassium as furosemide?

A

may also act as an aldosterone antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what do thiazide diuretics do?

A

inhibit Na/Cl cotransport in the distal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are some thiazide diuretics?

A

chlorothiazide
hydrochlorothiazide
trichlomethiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the clinical indications of thiazides?

A

edema: adjunctive if furosemide alone does not cut it
nephrogenic (ADH-resistant) diabetes insipidous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is a potassium-sparing diuretic?

A

spironolactone- aldosterone antagonist

29
Q

what does spironolactone do?

A

blocks aldosterone receptor

30
Q

when is spironolactone most effective?

A

in presence of hyperaldosteronism

31
Q

what are the adverse effects of spironolactone?

A

hyperkalemia

32
Q

what are the clinical indications of spironolactone?

A

used in conjunction with other diuretics, especially if refractory edema
may provide additional survival benefits in congestive heart failure
veterinary product sold as a combination with benazepril (angiotensin converting enzyme inhibitor)

33
Q

is spironolactone used as a sole agent?

A

rarely

34
Q

what should you treat edema due to liver disease with?

A

aldosterone antagonist

35
Q

what are some antidiuretic agents?

A

vasopressin
desmopressin

36
Q

what are some agents that affect renal hemodynamics?

A

dopamine
NSAIDs: inhibit prostaglandin production
renin angiotensin aldosterone system modifying agents

37
Q

angiotensin II I receptors are abundant in the ________________________

A

efferent arterioles

38
Q

_____________, which is regulated by angiotensin II, can promote kidney damage

A

aldosterone

39
Q

what do AT1 receptors do?

A

induce vasoconstriction
direct profibrotic and proinflammatory actions of angiotensin II, promoting kidney damage

40
Q

by ________________________, or blocking its effects (____________________), we can reduce proteinuria and hypertension

A

angiotensin II (ACE inhibitors)
AT1 blockers

41
Q

what is Telmisartan (AT1 receptor blocker) shown to do?

A

reduce systemic hypertension and proteinuria in cats
not shown to change outcomes yet

42
Q

what do we manipulate when we control bladder and urethral tone?

A

bladder: sympathetic/parasympathetic
urethral sphincter: sympathetic/parasympathetic, musculoskeletal

43
Q

why would you want to achieve blood volume contraction?

A

edema
heart failure
hypertension

44
Q

what two drugs interact with specific enzymes to produce their diuretic effects?

A

dichlorphenamide
dorzolamide

45
Q

what drugs interact with specific membrane transport proteins to diurese?

A

furosemide
thiazidees

46
Q

what drugs interact with hormone receptors in renal epithelial cells to diurese?

A

spironolactone
potassium-sparing diuretics
ACE inhibitors indirectly

47
Q

what is natriuresis?

A

sodium loss in urine

48
Q

what is the efficacy and natriuresis of thiazide diuretics?

A

moderate
5%

49
Q

what is the efficacy and natriuresis of loop diuretics?

A

high
20-25%

50
Q

do osmotic diuretics, such as mannitol, directly affect sodium movement?

A

no

51
Q

why should you monitor central venous pressure in an animal you a treating with mannitol?

A

if it goes up, you are fluid overloading

52
Q

why should you not give mannitol if a patient is dehydrated?

A

exacerbates tissue/cellular dehydration

53
Q

what is lost in urine with carbonic anhydrase inhibitors?

A

sodium bicarbonate

54
Q

why is the over-all effect of carbonic anhydrase inhibitors low?

A

compensation in the loop of henle and distal convoluted tubule
as body bicarbonate stores become depleted, diuretic effect is lost

55
Q

what is dorzolamide and what is it used for?

A

carbonic anhydrase inhibitor
topical for glaucoma

56
Q

what are the adverse effects of carbonic anhydrase inhibitors?

A

hyperchloremic metabolic acidosis
CNS toxicity with large doses
contraindicated in hepatic cirrhosis
teratogenic

57
Q

what is lost in urine with loop diuretics?

A

sodium
potassium
chloride

58
Q

with furosemide, you need to ________________________ to have an effect

A

achieve a threshold concentration

59
Q

furosemide abolishes lumen-positive voltage and thus ________________ reabsorption as well

A

calcium and magnesium

60
Q

how is torsemide cleared?

A

hepatic primarily

61
Q

what are the adverse effects of thiazides?

A

not many clinically significant
hyperglycemia
hypochloremic alkalosis

62
Q

how do ACE inhibitors work with diuresis?

A

decrease release of aldosterone
not diuretic but similar effects

63
Q

when does hyperaldosteronism often occur?

A

cardiac failure
liver disease
nephrotic syndrome

64
Q

what is the veterinary product of spironolactone sold as a combination with?

A

benazepril: angiotensin converting enzyme inhibitor

65
Q

how do NSAIDs affect renal hemodynamics?

A

inhibit prostaglandin production: renal blood flow is dependent on prostaglandins when an animal is hypotensive

66
Q

what does dopamine do with renal hemodynamics?

A

vasodilation

67
Q

what do AT1 receptors induce?

A

vasoconstriction
direct profibrotic and proinflammatory actions of angiotensin II

68
Q

what is Telmisartan?

A

AT1 receptor blocker
vasodilation in glomerular efferent arterioles, drop in blood pressure, increased renal blood flow, reduces proteinuria

Basic Pharmacology (37 decks)

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