Renal (year 2) Flashcards
what is the only licensed angiotensin receptor antagonist?
telmisartan
what are the effects of angiotensin receptor antagonists?
inhibits effects of angiotensin (such as vasoconstriction, aldosterone synthesis, sodium/water retention)
what are the adverse effects of telmisartan?
rare (GI upset)
what is potassium supplementation used for?
correct hypokalaemia
how can potassium supplements be administered?
IV
oral
what is the IV form of potassium supplementation?
KCl
what oral formulations can be used for potassium supplementation? (2)
potassium gluconate
potassium citrate
as well as potassium supplementation, what other effect does potassium citrate have?
treat metabolic acidosis
what are the adverse effects of potassium supplementation?
hyperkalaemia (muscle weakness, cardiac arrhythmia, cardiac arrest)
how do phosphate binders work?
bind phosphate in the GI tract to prevent absorption (must give with food)
how are phosphate binders excreted?
in faeces
what is an example of a phosphate binders?
calcium acetate
what are the adverse effects of phosphate binders?
hypophosphataemia
GI problems
hypercalcaemia (if its a calcium salt)
what is sodium bicarbonate given to treat?
manage metabolic acidosis
alkalinise urine
hypercalcaemia
hyperkalaemia
how is sodium bicarbonate administered?
oral
IV
what are the adverse effects of sodium bicarbonate?
alkalise stomach
metabolic alkalosis
what is erythropoietin replacement used to treat?
anaemia associated with CKD
what are treatments aiming to do when treating incontinence?
increase urethral sphincter activity
decrease detrusor muscle activity
what drug groups can be used to increase urethral sphincter activity? (2)
alpha adrenoreceptor agonist
increase adrenoreceptor sensitivity
what drug group can be used to decrease detrusor muscle activity?
muscarinic antagonist
what effect do alpha adrenoreceptor agonists have to treat urinary incontinence?
increase urethral outflow resistance
peripheral vasoconstriction
what are the adverse effects of using alpha adrenoreceptor agonists to treat urinary incontinence?
increased blood pressure
irritability
restlessness
what are the adverse effects of using muscarinic antagonists to treat urinary incontinence?
constipation tachycardia mydriasis increase intraocular pressure drying of bronchial secretions
what drug group can be used to treat urinary incontinence in spayed bitches?
oestrogen receptor agonist
how do oestrogen receptor agonists treat urinary incontinence?
increase muscle tone of urethral sphincter (increases sensitivity of adrenoreceptors)
what needs to be effected to treat urinary retention?
increase detrusor muscle activity
what drug group can be used to increase detrusor muscle activity?
muscarinic agonist
what are the side effects of using muscarinic agonists to treat urinary retention?
GI cramping
vomiting/diarrhoea
salivation
bradycardia
what drug group can be used to treat urinary retention by relaxing the urethral sphincter?
alpha adrenoreceptor antagonists
what are the adverse effects of using alpha adrenoreceptor antagonists to treat urinary retention?
hypotension
miosis
tachycardia
nasal congestion
what is the name of the drug that can be used to treat urinary retention due to the external urethral sphincter (skeletal)?
dantrolene (ryanodine receptor antagonist)
how does dantrolene work?
inhibits calcium release from the sarcoplasmic reticulum of skeletal muscle
what are the adverse effects of using dantrolene to treat urinary retention?
muscle weakness (including respiratory muscle)
what can sedatives be used for treating in the urinary system?
treat urinary retention due to external urethral sphincter
what type of sedative is used to treat urinary retention?
benzodiazepine
what are the side effects of using benzodiazepines to treat urinary retention?
sedation
muscle weakness
ataxia
why would urinary pH need to be modified?
dissolve urinary stones
what drug can be used as a urinary acidifier?
methionine
what are the adverse effects of urinary acidifiers?
metabolic acidosis
what drug can be used as a urinary alkaliniser?
potassium citrate
what are the adverse effects of urinary alkanisers?
hyperkalaemia (if its a potassium salt)
what are oral rehydration fluids based around?
equimolar sodium and glucose
why do oral rehydration fluids have equimolar sodium and glucose?
they target the sodium-glucose cotransporter
what does a first generation oral fluid contain?
enough sodium and equimolar glucose to correct dehydration
what does a second generation oral fluid contain?
enough sodium and equimolar glucose to correct dehydration
bicarbonate (alkalising agents)
why do secondary oral fluids contain alkalising agents?
correct metabolic acidosis
what does a third generation oral fluid contain?
sodium and high glucose concentrations to address nutritional demand (neonate)
what does a fourth generation oral fluid contain?
enough sodium and equimolar glucose to correct dehydration
glutamine
why do fourth generation oral fluids contain glutamine?
promote villus repair/regeneration
what is a crystalloid fluid?
salt solutions that freely cross capillary walls
how long do crystalloids stay in the vascular space?
short period of time (quickly leak into ECF)
what is a colloid fluid?
large molecules diluted in a crystalloid
what % sodium chloride is isotonic to plasma?
0.9%
what features does a crystalloid fluid have? (2)
buffered
balance
what is meant by a buffered crystalloid?
contain a source of bicarbonate
what is meant by a balanced crystalloid?
contain sodium, chloride, potassium, calcium, magnesium (similar to plasma)
what is meant by an isotonic crystalloid?
some electrolyte concentration as plasma so are isosmotic to plasma
what is an example of a hypertonic crystalloid?
7.2% NaCl
what do hypertonic crystalloid cause?
plasma expansion
what is an example of a hypotonic crystalloid?
5% dextrose
when would a hypotonic fluid be used?
if animal cannot drink (doesn’t need plasma expanding)
what effect do colloids have on plasma?
plasma expanders
what are the substances found in natural colloids?
whole blood
plasma
albumen
what are the sunsbstances found in synthetic colloids?
starches
gelatins
dextrans
what are some adverse effects of colloid use?
anaphylactic reactions
coagulopathies
oedema
how do diuretics work?
increase excretion of sodium (and water)
where in the nephron do the best working diuretics act?
on earlier parts of the nephron
what are the groups of diuretics, in the order they act on the nephron? (5)
osmotic carbonic anhydrase inhibitors loop thiazides potassium sparing
what is the main osmotic diuretic?
mannitol
what is the mode of action of osmotic diuretics?
filtered but not reabsobed (maintain osmotic pressure in filtrate)
where do osmotic diuretics have their main effect?
water permeable parts of nephron
what effect do osmotic diuretics have on blood flow?
increase kidney medullary blood flow (maintain osmotic gradient)
how are osmotic diuretics administered?
IV
when may osmotic diuretics be used?
forced diuresis (poisoning)
acute kidney injury
oedema/glaucoma
what is the main adverse effect of osmotic diuretics?
initial increase in ECF (worsen oedema)
where is high carbonic anhydrase concentration found in the body? (3)
eye
RBC
PCT of kidney
what are carbonic anhydrase inhibitors used to treat?
glaucoma
metabolic alkalosis
(not used as diuretic)
where in the kidney do carbonic anhydrase inhibitors work?
PCT
what is the mechanism of action of carbonic anhydrase inhibitors?
reduce hydrogen production and hence sodium/hydrogen exchange
reduced bicarbonate reabsorption in PCT leading to diuresis
what ion is retained when using carbonic anhydrase to maintain ionic balance?
chloride
how are carbonic anhydrase inhibitors administered?
oral
what are some adverse effects of carbonic anhydrase inhibitors?
metabolic acidosis
ammonium not excreted
what is the most powerful diuretic group?
loop diuretic
what is the mechanism of action of loop diuretics?
secreted into PCT
inhibit sodium/potassium cotransporter in LOH
increase sodium delivery to DCT
how are loop diuretics administers?
oral
parenteral
what are loop diuretics used to treat?
oedema
congestive heart failure management
what are some adverse effects of loop diuretics?
hypokalaemia
ECF disturbances
dehydration/hypovolaemia
where do thiazides work in the nephron?
DCT
what is the mechanism of action of thiazide?
inhibit sodium/chloride cotransporter
increase sodium, magnesium, potassium excretion
why are thiazides weaker diuretics that loop diuretics?
act after most sodium has been reabsorbed
what effect do thiazides have on calcium?
reduce excretion of calcium
how are thiazides administered?
oral
what are thiazides used for?
treat oedema
dissolution of Ca containing kidney stones
what are some adverse effects of thiazides?
dehydration/hypovolaemia
hypokalaemia
hyperglycaemia
ECF disturbances
when are potassium sparing diuretics usually used?
in combination with loop and thiazide diuretics (reduce side effects)
where do potassium sparing diuretics work?
principal cells of DCT/collecting duct
what are the mechanisms of action of potassium sparing diuretics? (2)
competitive inhibitor of aldosterone
inhibit sodium reabsorption (sodium/potassium ATPase)
how are potassium sparing diuretics administered?
oral
what are the adverse effects of potassium sparing diuretics?
hyperkalaemia
metabolic acidosis
diabetes mellitus
