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Pharmacology II > Renal Pharm 5 > Flashcards

Renal Pharm 5 Flashcards

1
Q

1/3 of total body water is located in the?

A

ECF

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2
Q

From the ECF, 15% is located in the?

A

Interstitium

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3
Q

From the ECF, 5% is located in the ?

A

Plasma

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4
Q

From the ECF, 40% is located in the?

A

ICF

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5
Q

From the ECF? ~1% is located in the?

A

Transcellular fluid

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6
Q

Water moves in whatever direction in which the osmotic pressure is?

A

Higher

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7
Q

What membrane is located between the plasma and IF?

A

Capillary membrane?

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8
Q

What membrane is located between the IF and ICF?

A

Cell membrane

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9
Q

Osmoreceptors, located in the __________, detect significant
changes in ___ composition or volume and trigger _______ responses.

What hormones are controlled in this process?

What are the responses to this process?

A

hypothalamus, ECF, endocrine

B/c they control hormone release from the pituitary gland and then ADH is released. ADH is critical for maintaining water balance.

ADH, aldosterone, ANGII, ANP

Urinary excretion of water
Dietary absorption of water

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10
Q

Many electrolytes are necessary for normal cell metabolism and contribute to body structures (2?).

Electrolytes, specifically _________, facilitates the osmotic movement of water between body compartments.

__________, _____, _______/_______ pump (kidney) Help maintain the hydrogen ion concentration (acid-base balance) required for normal cellular function.

Crucial to the production and maintenance of __________ potentials and _______ potentials.

A

Many electrolytes are necessary for normal cell metabolism and contribute to body structures (Ca, phosphorous).

Electrolytes, specifically sodium, facilitates the osmotic movement of water between body compartments.

Bicarbonate, Cl, Hydrogen/Phosphate pump (kidney) Help maintain the hydrogen ion concentration (acid-base balance) required for normal cellular function.

Crucial to the production and maintenance of membrane potentials and action potentials

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11
Q

The total number of cations and anions are?

A

The same

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12
Q

What is the difference in cations located in the EC vs IC spaces?

A
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13
Q

Any changes in the Na concentration will effect the?

A

Osmolality

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14
Q

What is the plasma osmolality concentration?

A

Plasma osmolality calculation (glucose, Na and BUN concentration):
Plasma osmolality = 2[Na] + Glucose/18 + BUN/2.8

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15
Q

What is the unit of measure of Na when calculating osmolality?

A

Na = mmol/L

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16
Q

What is the osmolality of the plasma?

A

295/296-300 = renal cortex and plasma

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17
Q

What is the unit of measure of Glucose and BUN when calculating osmolality?

A

Glucose and BUN = mg/dL

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18
Q

What is the unit of measure of total Osmolality?

A

Osmolality = mOsm/kg water)

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19
Q

List the causes of Hypernatremia?

A
  1. Excessive loss of water with inadequate replacement
  2. Diseases: Diabetes insipidus, fever, diarrhea, vomiting
  3. Iatrogenic: (administration of hypertonic saline or sodium bicarbonate)
  4. Accidental: Heat stroke, salt poisoning (sea water ingestion)
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20
Q

Hypervolemic Hypernatremia
- Impermeable solute _______
- Signs of fluid ________ possible
- ________ urine

A
  • Impermeable solute gains
  • Signs of fluid overload possible
  • Hypertonic urine
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21
Q

List the causes of Hypervolemic Hypernatremia.

A
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22
Q

Treatment for Hypervolemic Hypernatremia

A

Diuretics
5% dextrose solution

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23
Q

Define Isovolemic Hypernatremia
- Pure water _____
- Absent to minimal ___________
- ________ or _______ (diabetes insipidus) urine

A
  • Pure water loss
  • Absent to minimal dehydration
  • Normal or hypotonic (diabetes insipidus) urine
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24
Q

Causes of Isovolemic Hypernatremia

A
  1. Diabetes insipidus
  2. Fever
  3. Heat stroke
  4. Inadequate water intake (access limited, primary hypodipsia as seen in miniature schnauzers, infirmity)
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25
Q

Treatment of Isovolemic Hypernatremia

A

5% dextrose solution
Water deficit
Vasopressin for diabetes insipidus

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26
Q

Define Hypovolemic Hypernatremia

A
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27
Q

Causes of Hypovolemic Hypernatremia

A
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28
Q

Treatment of Hypovolemic Hypernatremia

A
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29
Q

List the causes of Hyponatremia

A
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30
Q

Define Hyperosmolar Hyponatremia.

A
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31
Q

List the causes of hyperosmolar hyponatremia.

A
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32
Q

Treatment for hyperosmolar hyponatremia.

A

See below

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33
Q

Define normosmolar hyponatremia

A
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34
Q

List the causes of normosmolar hyponatremia.

A

amount of lipids in sample you took will displace sodium ions and proteins, but patient is not necessarily hyponatremic.

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35
Q

Treatment of normosmolar hyponatremia

A
36
Q

Define Hypoosmolar hyponatremia

A
37
Q

List the causes of hyposmolar hyponatremia

A
38
Q

How do you treat hyposmolar hyponatremia?

A
39
Q

Which electrolytes maintain acid-base balance?

A

H+
HCO3-
CO2

40
Q

pH = ?

A

50% dissociated, 50% non-dissociated

41
Q

Buffer substances bring the pH back to normal. Changes in either direction will alter cell metabolism and physiology

A
42
Q

Respiratory acidosis

CO2 __ –> pH ___ –> acidosis

A

increase, decrease

43
Q

Respiratory alkalosis

CO2 __ –> pH ___ –> alkalosis

A

decrease, increase

44
Q

Metabolic acidosis

HCO3 __ –> pH ___ –> acidosis

A

decrease, decrease

45
Q

Metabolic alkalosis

HCO3 __ –> pH ___ –> alkalosis

A

increase, increase

46
Q

Before administering the fluid, you need to assess acid base status, so you need the pH of the blood. pH of the blood (measured at 37 degrees C and temp. corrected = body of animal –> all in the lab)

A
47
Q

The parameters used for analyzing acid-base status:
1. ____
2. ______ (both 37 degrees and temp. corrected)
3. standard __________ (SB; measured concentration in _____ standardized to a pCO2 of ___ mmHg and _____ body temperature)
4. _____ excess (the amount ____ or _____ needed to return the blood to the normal pH; BE are all bases over the normal)

A

pH, pCO2, pCO2, bicarbonate, blood, 40, normal, base, acid, alkali

48
Q

The anion gap is _____ precise than the blood gas analyzer but still useful to evaluate acid-base disorders (when a gas analyzer not available)

Use of electrolytes that are normally measured in a blood biochemistry exam (4?)

Law of electroneutrality: the concentrations of anions and cations in plasma must be ______ (under normal conditions there is ____ anion gap)

Important when managing ?

A

Less precise than the blood gas analyzer but still useful to evaluate acid-base disorders (when a gas analyzer not available)

Use of electrolytes that are normally measured in a blood biochemistry exam (Na+, K+, Cl-, and HCO3-)

Law of electroneutrality: the concentrations of anions and cations in plasma must be equal (under normal conditions there is no anion gap)

Other not normally measured cations = Ca++ and Mg++
Anions = sulfates, phosphates, proteinates, organic acids

Important when managing chronic illness

49
Q

How do you calculate the anion gap?

A

Sodium predominates
plasma proteins make up a decent amount of anions

50
Q

Some common disorders that promote acid-base disturbances
in veterinary medicine
Respiratory alkalosis

A

HODE

Overzealous mechanical ventilation during anesthesia
High altitude
Damage to the respiratory centers
Emotional excitement

51
Q

Some common disorders that promote acid-base disturbances
in veterinary medicine

Metabolic alkalosis:

A

Vomiting
Torsion of the abomasum in ruminants
Hypokalemia
Hypoparathyroidism (low PTH levels and PTH inhibits HCO3-
reabsorption in the kidney)

52
Q

Metabolic acidosis (very common):

A

See this mostly in practice

Renal failure
Hyperkalemia
Hyperparathyroidism
Diarrhea
Fistulas (pancreatic duct fistula)
During mineralization of bones; during infusion of CaCl2
Lactate formation (anaerobic glycolysis, severe physical
exercise, tumors)
Starvation, diabetes mellitus, increased fat mobilization
A protein-rich diet
Rumen acidosis

53
Q

For fluids and electrolytes

Main questions:
1) When should fluid therapy be instituted?
2) What kind of solutions?
3) How much?
4) How fast?
5) What route of administration?
6) How to evaluate?

Main purpose: to correct fluid, electrolyte, or acid-base imbalances
Other purposes: parenteral nourishment, stimulation of organ function,
administration of certain drugs, etc

A
54
Q

How do you calculate fluid replacement volume?

A

Replacement volume (l) = body weight (kg) x % dehydration
+ maintenance fluid needs: 40-65 ml/kg/24 h (mature animals)
130 ml/kg/24 h (immature animals)

55
Q

Measuring % fluid lost is, for the most part, ________.

A

subjective

56
Q

Fluids lost in a case of:

Loss of skin elasticity

A

5%

57
Q

Fluids lost in a case of:

Oral mucous membranes becoming tacky

A

6-7%

58
Q

Fluids lost in a case of:

Prolonged capillary refill time

A

6-8%

59
Q

Fluids lost in a case of:

Prolonged capillary refill time

A

6-8%

60
Q

Fluids lost in a case of:

Skin tenting that persists

A

8-10%

61
Q

Fluids lost in a case of:

Eyes sunken back into orbits

A

10%

62
Q

Fluids lost in a case of:

Cool extremities, early shock

A

10-12%

63
Q

There are ways to measure specific fluid compartments in the body, but it takes a long time and need a marker substance to be injected that remain in the compartment you want to measure

A
64
Q

Is PO used for fluid administration?

A

PO (or nasogastric). Easy, safe

65
Q

Is Per-rectum used for fluid administration?

A

Useful for very young animals (good absorption of water, K+, Na+, Cl-

66
Q

Is IV used for fluid administration?

A

check osmolality and rate of administration. Maintenance of asepsis is
critical. Location of vein on very small or severely ill patients may be difficult

67
Q

Is SC used for fluid administration?

A

convenient for correcting mild to moderate deficits in small animals (only for isotonic solution!)induce fluid shift in the local tissue

68
Q

Is IP used for fluid administration?

A

good for electrolyte and water absorption

69
Q

Is Intraosseous used for fluid administration?

A

administration via catheter into bone
Mainly for very small animals when you can’t find the vein

70
Q

What makes a solution hypertonic? Alkalinizing? Hypotonic? etc.

A
71
Q

How is LRS is alkalinizing if lactate is an acid?

A

Anaerobic metabolism
Where does lactate come from in the body? Skeletal muscle during anaerobic metabolism. When there is no oxygen, pyruvate is converted into lactic acid (anaerobic glycolysis). Lactic acid is reconverted into pyrvuate by using protons. Pyruvate then converted to glucose or can enter the krebs cycle as acetyl coa

Lactate removes protons. Plain and simple

72
Q

Norm R contains acetate. How does it alkalinize the pH?

A

ss

73
Q

Most fluids are ________ (high in ____, low in ____)

A

isotonic, Na+, K+

74
Q

Alkalinizing solutions (e.g., _________ _______ solution) are __________:
Use: _________ _______! (Other examples?)
Alkalinizing agents:
________ → metabolized in the liver
________ → metabolized in muscle
________ → metabolized in various tissues

A

lactated Ringer’s, Crystalloids, metabolic acidosis

diarrhea, renal disease, pre- and postsurgical
support, trauma, shock

lactate, acetate, gluconate

75
Q

Acidifying (e.g., ______, _______ solution) are _____________:
Use: _______ ________ ( ________ percentage compared to metabolic acidosis)

A

Acidifying (e.g., saline, Ringer’s solution) are Crystalloids:
Use: metabolic alkalosis (small percentage compared to metabolic acidosis)

76
Q

Colloids are composed of ________ particles that are retained ________ the vascular space more readily than crystalloids → ________ colloid osmotic pressure (________ pressure,
_______-________ effect)

A

Composed of large particles that are retained within the vascular space more
readily than crystalloids → increase colloid osmotic pressure (oncotic pressure,
Gibbs-Donnan effect)

77
Q

List some examples of natural colloids.

A
  • Natural: whole blood, plasma, albumin
78
Q

List some examples of synthetic colloids.

A
  • Synthetic: dextran 40, dextran 70, hetastarch, pentastarch, oxypolygelatin
79
Q

What are colloids used for?

A

SIR Colloid has Perfusion Deficits, and Hypooncotic states deficient in blood components.

Uses: perfusion deficits, hypooncotic states, deficiency of blood components,
systemic inflammatory response syndrome (SIRS)

80
Q

Colloids are contraindicated in?

A

Contraindicated in oliguric or anuric renal failure (rapid volume expansion)

81
Q

List the possible adverse reactions when using colloids

A

Possible adverse reactions: anaphylaxis, impairment of coagulation (dilution effect)

82
Q

Hypertonic solutions are used traditionally for ____________ (rapid plasma volume ___________) Increase cardiac _______, release of __________, ______ delivery to the heart

A

Hypertonic solutions are used traditionally for resuscitation (rapid plasma volume expansion) Increase cardiac output, release of catecholamines, oxygen delivery to the heart

83
Q

List some examples of what hypertonic saline is used for?

A

Hypertonic saline solution (5%, 7%, 7.7%)
Uses: shock associated with hemorrhage, trauma, gastric-dilatation volvulus, acute
pancreatitis, sepsis, head injury (mannitol effect)

84
Q

The effects of hypertonic solutions are transient → combination with colloids (e.g., 7% HSS in 6% dextran 70)

A
85
Q

The use of hypertonic saline is contraindicated in __________.

A

The use of hypertonic saline is contraindicated in hypernatremia

Pharmacology II (27 decks)

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