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Pharmacology > Renal (year 2) > Flashcards

Renal (year 2) Flashcards

1
Q

what is the only licensed angiotensin receptor antagonist?

A

telmisartan

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2
Q

what are the effects of angiotensin receptor antagonists?

A

inhibits effects of angiotensin (such as vasoconstriction, aldosterone synthesis, sodium/water retention)

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3
Q

what are the adverse effects of telmisartan?

A

rare (GI upset)

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4
Q

what is potassium supplementation used for?

A

correct hypokalaemia

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5
Q

how can potassium supplements be administered?

A

IV

oral

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6
Q

what is the IV form of potassium supplementation?

A

KCl

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7
Q

what oral formulations can be used for potassium supplementation? (2)

A

potassium gluconate

potassium citrate

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8
Q

as well as potassium supplementation, what other effect does potassium citrate have?

A

treat metabolic acidosis

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9
Q

what are the adverse effects of potassium supplementation?

A

hyperkalaemia (muscle weakness, cardiac arrhythmia, cardiac arrest)

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10
Q

how do phosphate binders work?

A

bind phosphate in the GI tract to prevent absorption (must give with food)

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11
Q

how are phosphate binders excreted?

A

in faeces

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12
Q

what is an example of a phosphate binders?

A

calcium acetate

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13
Q

what are the adverse effects of phosphate binders?

A

hypophosphataemia
GI problems
hypercalcaemia (if its a calcium salt)

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14
Q

what is sodium bicarbonate given to treat?

A

manage metabolic acidosis
alkalinise urine
hypercalcaemia
hyperkalaemia

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15
Q

how is sodium bicarbonate administered?

A

oral

IV

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16
Q

what are the adverse effects of sodium bicarbonate?

A

alkalise stomach

metabolic alkalosis

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17
Q

what is erythropoietin replacement used to treat?

A

anaemia associated with CKD

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18
Q

what are treatments aiming to do when treating incontinence?

A

increase urethral sphincter activity

decrease detrusor muscle activity

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19
Q

what drug groups can be used to increase urethral sphincter activity? (2)

A

alpha adrenoreceptor agonist

increase adrenoreceptor sensitivity

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20
Q

what drug group can be used to decrease detrusor muscle activity?

A

muscarinic antagonist

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21
Q

what effect do alpha adrenoreceptor agonists have to treat urinary incontinence?

A

increase urethral outflow resistance

peripheral vasoconstriction

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22
Q

what are the adverse effects of using alpha adrenoreceptor agonists to treat urinary incontinence?

A

increased blood pressure
irritability
restlessness

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23
Q

what are the adverse effects of using muscarinic antagonists to treat urinary incontinence?

A 
constipation
tachycardia
mydriasis
increase intraocular pressure
drying of bronchial secretions
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24
Q

what drug group can be used to treat urinary incontinence in spayed bitches?

A

oestrogen receptor agonist

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25
Q

how do oestrogen receptor agonists treat urinary incontinence?

A

increase muscle tone of urethral sphincter (increases sensitivity of adrenoreceptors)

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26
Q

what needs to be effected to treat urinary retention?

A

increase detrusor muscle activity

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27
Q

what drug group can be used to increase detrusor muscle activity?

A

muscarinic agonist

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28
Q

what are the side effects of using muscarinic agonists to treat urinary retention?

A

GI cramping
vomiting/diarrhoea
salivation
bradycardia

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29
Q

what drug group can be used to treat urinary retention by relaxing the urethral sphincter?

A

alpha adrenoreceptor antagonists

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30
Q

what are the adverse effects of using alpha adrenoreceptor antagonists to treat urinary retention?

A

hypotension
miosis
tachycardia
nasal congestion

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31
Q

what is the name of the drug that can be used to treat urinary retention due to the external urethral sphincter (skeletal)?

A

dantrolene (ryanodine receptor antagonist)

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32
Q

how does dantrolene work?

A

inhibits calcium release from the sarcoplasmic reticulum of skeletal muscle

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33
Q

what are the adverse effects of using dantrolene to treat urinary retention?

A

muscle weakness (including respiratory muscle)

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34
Q

what can sedatives be used for treating in the urinary system?

A

treat urinary retention due to external urethral sphincter

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35
Q

what type of sedative is used to treat urinary retention?

A

benzodiazepine

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36
Q

what are the side effects of using benzodiazepines to treat urinary retention?

A

sedation
muscle weakness
ataxia

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37
Q

why would urinary pH need to be modified?

A

dissolve urinary stones

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38
Q

what drug can be used as a urinary acidifier?

A

methionine

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39
Q

what are the adverse effects of urinary acidifiers?

A

metabolic acidosis

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40
Q

what drug can be used as a urinary alkaliniser?

A

potassium citrate

41
Q

what are the adverse effects of urinary alkanisers?

A

hyperkalaemia (if its a potassium salt)

42
Q

what are oral rehydration fluids based around?

A

equimolar sodium and glucose

43
Q

why do oral rehydration fluids have equimolar sodium and glucose?

A

they target the sodium-glucose cotransporter

44
Q

what does a first generation oral fluid contain?

A

enough sodium and equimolar glucose to correct dehydration

45
Q

what does a second generation oral fluid contain?

A

enough sodium and equimolar glucose to correct dehydration

bicarbonate (alkalising agents)

46
Q

why do secondary oral fluids contain alkalising agents?

A

correct metabolic acidosis

47
Q

what does a third generation oral fluid contain?

A

sodium and high glucose concentrations to address nutritional demand (neonate)

48
Q

what does a fourth generation oral fluid contain?

A

enough sodium and equimolar glucose to correct dehydration

glutamine

49
Q

why do fourth generation oral fluids contain glutamine?

A

promote villus repair/regeneration

50
Q

what is a crystalloid fluid?

A

salt solutions that freely cross capillary walls

51
Q

how long do crystalloids stay in the vascular space?

A

short period of time (quickly leak into ECF)

52
Q

what is a colloid fluid?

A

large molecules diluted in a crystalloid

53
Q

what % sodium chloride is isotonic to plasma?

A

0.9%

54
Q

what features does a crystalloid fluid have? (2)

A

buffered

balance

55
Q

what is meant by a buffered crystalloid?

A

contain a source of bicarbonate

56
Q

what is meant by a balanced crystalloid?

A

contain sodium, chloride, potassium, calcium, magnesium (similar to plasma)

57
Q

what is meant by an isotonic crystalloid?

A

some electrolyte concentration as plasma so are isosmotic to plasma

58
Q

what is an example of a hypertonic crystalloid?

A

7.2% NaCl

59
Q

what do hypertonic crystalloid cause?

A

plasma expansion

60
Q

what is an example of a hypotonic crystalloid?

A

5% dextrose

61
Q

when would a hypotonic fluid be used?

A

if animal cannot drink (doesn’t need plasma expanding)

62
Q

what effect do colloids have on plasma?

A

plasma expanders

63
Q

what are the substances found in natural colloids?

A

whole blood
plasma
albumen

64
Q

what are the sunsbstances found in synthetic colloids?

A

starches
gelatins
dextrans

65
Q

what are some adverse effects of colloid use?

A

anaphylactic reactions
coagulopathies
oedema

66
Q

how do diuretics work?

A

increase excretion of sodium (and water)

67
Q

where in the nephron do the best working diuretics act?

A

on earlier parts of the nephron

68
Q

what are the groups of diuretics, in the order they act on the nephron? (5)

A 
osmotic
carbonic anhydrase inhibitors
loop
thiazides
potassium sparing
69
Q

what is the main osmotic diuretic?

A

mannitol

70
Q

what is the mode of action of osmotic diuretics?

A

filtered but not reabsobed (maintain osmotic pressure in filtrate)

71
Q

where do osmotic diuretics have their main effect?

A

water permeable parts of nephron

72
Q

what effect do osmotic diuretics have on blood flow?

A

increase kidney medullary blood flow (maintain osmotic gradient)

73
Q

how are osmotic diuretics administered?

A

IV

74
Q

when may osmotic diuretics be used?

A

forced diuresis (poisoning)
acute kidney injury
oedema/glaucoma

75
Q

what is the main adverse effect of osmotic diuretics?

A

initial increase in ECF (worsen oedema)

76
Q

where is high carbonic anhydrase concentration found in the body? (3)

A

eye
RBC
PCT of kidney

77
Q

what are carbonic anhydrase inhibitors used to treat?

A

glaucoma
metabolic alkalosis
(not used as diuretic)

78
Q

where in the kidney do carbonic anhydrase inhibitors work?

A

PCT

79
Q

what is the mechanism of action of carbonic anhydrase inhibitors?

A

reduce hydrogen production and hence sodium/hydrogen exchange
reduced bicarbonate reabsorption in PCT leading to diuresis

80
Q

what ion is retained when using carbonic anhydrase to maintain ionic balance?

A

chloride

81
Q

how are carbonic anhydrase inhibitors administered?

A

oral

82
Q

what are some adverse effects of carbonic anhydrase inhibitors?

A

metabolic acidosis

ammonium not excreted

83
Q

what is the most powerful diuretic group?

A

loop diuretic

84
Q

what is the mechanism of action of loop diuretics?

A

secreted into PCT
inhibit sodium/potassium cotransporter in LOH
increase sodium delivery to DCT

85
Q

how are loop diuretics administers?

A

oral

parenteral

86
Q

what are loop diuretics used to treat?

A

oedema

congestive heart failure management

87
Q

what are some adverse effects of loop diuretics?

A

hypokalaemia
ECF disturbances
dehydration/hypovolaemia

88
Q

where do thiazides work in the nephron?

A

DCT

89
Q

what is the mechanism of action of thiazide?

A

inhibit sodium/chloride cotransporter

increase sodium, magnesium, potassium excretion

90
Q

why are thiazides weaker diuretics that loop diuretics?

A

act after most sodium has been reabsorbed

91
Q

what effect do thiazides have on calcium?

A

reduce excretion of calcium

92
Q

how are thiazides administered?

A

oral

93
Q

what are thiazides used for?

A

treat oedema

dissolution of Ca containing kidney stones

94
Q

what are some adverse effects of thiazides?

A

dehydration/hypovolaemia
hypokalaemia
hyperglycaemia
ECF disturbances

95
Q

when are potassium sparing diuretics usually used?

A

in combination with loop and thiazide diuretics (reduce side effects)

96
Q

where do potassium sparing diuretics work?

A

principal cells of DCT/collecting duct

97
Q

what are the mechanisms of action of potassium sparing diuretics? (2)

A

competitive inhibitor of aldosterone

inhibit sodium reabsorption (sodium/potassium ATPase)

98
Q

how are potassium sparing diuretics administered?

A

oral

99
Q

what are the adverse effects of potassium sparing diuretics?

A

hyperkalaemia
metabolic acidosis
diabetes mellitus

Pharmacology (25 decks)

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