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PPT > RENAL, UROLOGY AND HAEMATOLOGY > Flashcards

RENAL, UROLOGY AND HAEMATOLOGY Flashcards

1
Q

Why is furosemide given to patients assymetrically?

A

You don’t want take it too late in the day as it would cause diuresis during the night - onsets within 5 minutes but can last up to 8 hours

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2
Q

What does postural drop, prolonged cap refill and tachycardia all suggest?

A

Hypovolaemia

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3
Q

How do diuretics usually affect potassium levels?

A

They cause hypokalaemia - unless potassium sparing

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4
Q

What fluid do you use for fluid resuscitation after an AKI?

A

0.9% sodium chloride or hartmanns but be aware hartmanns has potassium in it so is contraindicated if the patient is hyperkalaemic

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5
Q

How do you prescribe appropriately in AKI?

A

DAMN
Diuretics, ACEi/ARB, metformin, NSAIDs

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6
Q

Why should you not give metformin in an AKI?

A

It’s not nephrotoxic but is 90% excreted by the kidneys and so accumulates in AKI and causes lactic acidosis

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7
Q

Outline why ACEi/ARB and NSAIDs are nephrotoxic especially when used together?

A

ACEi/ARBs block the effects of angiotensin 2 causing efferent arterioles dilation which reduces the pressure in the glomerulus
NSAIDs block the vasodilators effects of prostaglandins in the afferent arterioles so it cannot compensate for the efferent dilation and GFR reduces more

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8
Q

What drugs need close monitoring in AKI?

A

Warfarin
Aminoglycosides
Lithium

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9
Q

What drugs require dose reduction in AKI?

A

Meds that are metabolised and excreted by the kidneys should be dose adjusted for an assumed eGFR of <10
LMWH, opiates, penicillins, sulfonylureas, aciclovir and metformin

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10
Q

What drugs can aggravate hyperkalaemia?

A

Trimethoprim
Spironolactone
Amiloride

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11
Q

What’s the most common cause of acquired nephrogenic diabetes insipidus

A
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12
Q

When do we use creatinine clearance instead of using eGFR?

A

For very toxic drugs, very elderly patients and those of extreme muscle mass (if in doubt use CrCl)

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13
Q

Why is creatinine clearance more accurate than eGFR?

A

Because it includes adjustment for weight
Creatinine is used as a substrate for insulin so is nearly as accurate as an insulin measurement

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14
Q

Why do extremes of muscle mass affect eGFR measurements? And how do we fix this?

A

EGFR uses average surface area of an adult so if you have a BMI <18 or >40 then you should adjust your eGFR for increased accuracy

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15
Q

What can you do if there is impaired renal excretion and the half life has increased?

A

You can reduce the dose or extend the dosing interval

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16
Q

What’s the problem with gentamicin? And why do we still use it regardless?

A

It has a narrow therapeutic index, ototoxic, vestibulotoxic and nephrotoxic
Because its the least likely antibiotic to cause clostridium difficil diarrhoea

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17
Q

How is gentamicin given?

A

IV or IM as its not readily absorbed from the GIT

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18
Q

How do you calculate an appropriate dose for gentamicin?

A

Consider the patients lean mass (mass without excess fat) because the total body water of everyone is very similar and is hardly affected by body mass
Do use ideal body weight for the patients height

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19
Q

Outline why we say gentamicin follows first order kinetics?

A

It’s excreted unmodified buy the kidneys - drug is cleared from the blood at a rate proportional to its concentration

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20
Q

What are the 2 regimens used in the UK to give gentamicin?

A

Pharmacokinetic
Extended interval

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21
Q

What is extended interval dosing regimen?

A

Aka Hartford dosing
It’s the regimen that maximises bacterial killing whilst minimising toxicity
Give first infusion and then take a blood sample between 6 and 14 hours after. Instead of changing the dose you change the time between giving. The next dose

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22
Q

What is urgency urinary incontinence?

A

When you feel a sudden/intense need to pass urine and your unable to delay going to the toilet - there are usually only a few seconds between the need to urinate and the release of urine. It’s often associated with overactive bladder syndrome

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23
Q

What is stress urinary incontinence?

A

When urine leaks out with sudden pressure on the bladder and urethra, causing the sphincter muscles to open briefly eg. Sneezing laughing or coughing

24
Q

What is mixed urinary incontinence?

A

Stress and urgency urinary incontinence

25
Q

What is overflow urinary incontinence?

A

Continuous urine leakage resulting from a hypotonic bladder or bladder outlet obstruction producing urinary retention

26
Q

What’s stinylates the bladder?

A

Hypogastric nerve (sympathetic) - NA acts on beta 3 receptor to relax bladder and acts on alpha receptor to contract internal urethral sphincter
Pelvic nerve (parasympathetic) - ACh acts on M3 receptor to contract bladder
Pudendal nerve (somatic) - ACh acts on nicotinic except or to contract external urethral sphincter

27
Q

What drugs are available for overactive bladder syndrome?

A

Muscarinic receptor antagonists e.g. oxybutinin and tolterodine
Beta 3 adrenoreceptor agonist e.g. mirabegron

Both - relax bladder

28
Q

What side effects do anticholinergic have?

A

BCDU
Blurred vision
Constipation
Dry mouth
Urinary retention

29
Q

How is stress incontinence managed?

A

Pelvic floor exercises for at least 3 months
Surgery e.g. urinary sling
Vaginal oestrogens in peri-menopausal women
Duloxetine in those averse to surgery

30
Q

Who is most likely to experience stress incontinence?

A

Women after childbirth due to damaged pelvic floor

31
Q

Why do vaginal oestrogens help stress incontinence?

A

Because the vaginal mucosa will become atrophied after a lack of oestrogen in perimenopausal periods which can make stress incontinence worse

32
Q

How do you assess the severity of BPH?

A

Using international prostate severity score
0-7 mildly symptomatic
8-19 moderately symptomatic
20-35 severely symptomatic

33
Q

How do you manage LUTS in men?

A

Conservative measures e.g. pads, bladder training, urethral milking, catheterisation,
Drugs - alpha blockers for moderate to severe LUTS, anticholinergic for overactive bladder, 5-alpha reductive inhibitor to men with PSA >1.4, diuretics
Surgery

34
Q

What’s the first line treatment for BPH LUTS symptoms?

A

Alpha blockers e.g. tamsulosin

35
Q

What are the adverse effects of alpha blockers?

A

Othrostatic hypotension
Headache
Dizziness
Oedema
Erectile dysfunction
Rhinitis

36
Q

What are the contraindications for alpha blockers?

A

History of postural hypotension
History of micturition syncope

37
Q

Which drugs do alpha blockers reac with?

A

Other hypotensive agents
PDE5 inhibitors as can cause significant hypotension

38
Q

What’s second line drug treatment for BPH?

A

5 alpha reductase inhibitors

39
Q

What are the adverse side effect of 5 alpha reductase inhibitors?

A

Sexual dysfunction
Depression
Breast enlargement, breast tenderness impotence - affects testosterone levels

40
Q

Which drugs do 5 alpha reductase inhibitors interact with?

A

Calcium channel blockers

41
Q

What’s a contraindication of 5 alpha reductase inhibitors

A

Pregnanct women shouldn’t even expose themselves to them as it may cause abnormal development of the external genitalia

42
Q

How do we manage prostate cancer?

A

Radiotherapy
Surgical prostatectomy
Anti androgens
GnRH analogues e.g. goserelin

43
Q

How do GnRH analogues work for prostate cancer?

A

They cause an initial increase in LH and FSH but chronic administration results in the sustained suppression of pituitary gonadotropins so serum testosterone levels fall

44
Q

What’s the treatment of choice for bladder cancer

A

Cisplatin based combination chemotherapy

45
Q

How do we treat renal cell carcinomas?

A

Tyrosine kinase inhibitors e.g. sorafenib and sunitinib
Or mTOR inhibitor

46
Q

Where do renal cell carcinomas metastasise to and why?

A

Lungs because they tend to grow down the renal vein which runs directly to the heart - can cause cannon ball tumours in lungs

47
Q

What are the 2 ways in which iron salts can be given for iron deficient anaemia?

A

Oral and parenteral but only when oral therapy is unsuccessful or intolerable

48
Q

What are examples of oral iron salts?

A

Ferrous sulphate
Ferrous fumarate
Ferrous gluconate

49
Q

Why is iron from meat better than iron from plants?

A

Because iron from meat is heme iron which is Fe2+ and can be used directly whereas non-heme iron from plants is Fe3+ is oxygenation status need to change before being absorbed

50
Q

What are the main adverse drug efefcts of iron

A

constipation
Black stools
Diarrhoea
Epigastric pain
GI irritation
Nausea

51
Q

What drugs does iron react with and how?

A

Levothyroxine
Bisphosphonates
Ciprofloxacin
Tetracyclines
Calcium and zinc salts
They work by reducing gut absorption so should be taken at least 2 hours before oral iron

52
Q

Why should you take iron with vitamin C?

A

It helps absorb it because it cotransports with iron

53
Q

What’s the recommended duration of iron treatment?

A

Take it until Hb levels are normal and then continue for 3 months as you need to replenish bone marrow stores too

54
Q

What drugs can be used for transplant immunosuppression?

A

Calcineurin inhibitors e,g, Ciclosporin and tacrolimus
Anti-proliferative agents e.g. azathioprine and cyclophosphamide

55
Q

What’s the MOA of calcineurin inhibitors?

A

Inhibit calcineurin which is a key protein allowing transcription of IL-2 which inhibits T lymphocytes activation

PPT (6 decks)

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