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Year 2 > Urinary > Flashcards

Urinary Flashcards

0
Q

What do diuretics do?

How do they do this?

A

Increase output of urine, by reducing sodium and water retention

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1
Q

LIst the 5 types of diuretics

A 
Osmotic diuretics 
Carbonic anhydrase inhibitors
Loop diuretics 
Thiazides
Potassium-sparing diuretics
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2
Q

Which hormone stimulates the principal cells in the collecting ducts to reabsorb more Na+ and Cl- and secrete more K+?

A

Aldosterone

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3
Q

What stimulates aldosterone secretion?

A

Decreased blood pressure and increased potassium

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4
Q

What is reabsorbed and secreted in the DCT and collecting duct?

A

Reabsorbed: Na+, Cl-
Secreted: K+
(principal cells)

Intercalated cells: H+ secretion

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5
Q

How would you increase the action of the urethral sphincter muscle?

A

Alpha or beta agonists, eg phenylpropanolamine
Increased adrenoreceptor sensitivity.
Increased noradrenaline release and activity

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6
Q

How would you decrease the activity of the detrusor muscle (of bladder wall)?

A

Anticholinergics/muscarinic antagonists eg Propantheline

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7
Q

How would you fix urinary incontinence?

A

Increase action of the urethral sphincter

Decrease activity of the detrusor (bladder wall) muscle

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8
Q

How does hyper phosphataemia lead to increased parathyroid hormone?

A

Phosphate inhibits formation of vitamin D3. As vitamin D3 exerts negative feedback on PTH, hyper phosphataemia leads to increased PTH.

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9
Q

Which part of the nephron do osmotic diuretics act in?

A

Proximal convoluted tubule

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10
Q

Give an example of an osmotic diuretic

A

Mannitol

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11
Q

Give an example of a carbonic anhydrase inhibitor (diuretic)

Where do they act?

A

Acetazolamide
Dichlofenamide
(All are sulphonamides)
Act in PCT

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12
Q

Give an example of a loop diuretic

What do they do?

A

Furosemide

Inhibition of Na+/K+/Cl- co-transporter

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13
Q

Where do thiazides act?

A

DCT

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14
Q

What do thiazides do?

A

Inhibit Na+/Cl- co-transport (before aldosterone-stimulated Na+/K+ exchange)
Increase Na+, Cl-, Mg2+ and K+ excretion
Decrease Ca2+ excretion
Decrease urine output in some nephrogenic diabetes insipidus
Inhibits conversion of pro-insulin to insulin

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15
Q

What do carbonic anhydrase inhibitors do?

A

Reversibly inhibit carbonic anhydrase enzyme, predominantly in PCT.
Causes decreased H+ secretion, and reduced Na+/H+ exchange
Decreased CO2 reabsorption
Increased NaHCO3 excretion
Alkaline urine

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16
Q

What do osmotic diuretics do?

A

Increase kidney medullary blood flow which reduces interstitial osmotic gradient
Filtered but not reabsorbed, so maintain osmotic pressure within filtrate

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17
Q

What are the key features of principle cells (epithelial cells) in the DCT and collecting duct?

A

Na+/K+ pump on basolateral membrane

Na+ and K+ leak channels on apical membrane

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18
Q

How is Na+ reabsorption and K+ secretion increased in the principle cells of the renal collecting duct?

A

Acutely: increased activity of existing channels and pumps

Long-term: synthesis of new channels and pumps

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19
Q

What do potassium-sparing diuretics do?

A

Do not secrete potassium into urine
Triamterine and amiloride are organic bases, and inhibit active Na+ reabsorption, which decreases Na+/K+ ATPase activity
Spironolactone is a steroid and competitive inhibitor of aldosterone (which reabsorbs Na+ and secretes K+)

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20
Q

Carbonic anhydrase inhibitors cause initial diuresis, but what is their primary function?

A

To treat glaucoma

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21
Q

What is the most common side effect of using diuretics (except K+-sparing)?

A

Hypokalaemia (increased K+ loss)

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22
Q

Give an example of a diuretic treatment (i.e. combination of two)

A

Potassium sparing e.g. amiloride with a loop or thiazide diuretic e.g. hydrochlorothiazide

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23
Q

When using α-agonists to treat urinary incontinence, what can we also use to increase α-adreno-receptor sensitivity?
When might this be contraindicated, why?

A

A natural, short-acting oestrogen i.e. Estriol
Contraindicated in entire bitches.
Adverse effects: swollen vulva and mammary glands, attracts males

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24
Q

What are the adverse effects of using anticholinergics or muscarinic antagonists?

A

Increased heart rate, dilated pupils and photophobia, dry mouth, constipation

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25
Q

How do we treat urinary retention?

A

We want to increase activity of detrusor muscle (muscarinic agonists eg Bethanecol)
Want to decrease activity of urethral sphincter (alpha or beta antagonist)

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26
Q

Give an example of an a-antagonist drug used to decrease activity of the urinary sphincter (in urinary retention)

A

Phenoxybenzamine

Prazosin

27
Q

Which 2 drugs can we use to relax the external urinary sphincter?

A

Central inhibition: Diazepam
Peripheral inhibition: Dantrolene
Adverse effect of general muscle weakness with overdose of Dantrolene

28
Q

What drug could we give to treat cystine uroliths? How does it work? What form of preparation is it given as?

A

Penicillamine
Binds to cystine to make a complex that is more soluble than cystine
Oral preparation

29
Q

What drug could we give to treat urate uroliths? How does it work? What form of preparation is it given as?

A

Allopurinol
Inhibits xanthine oxidase and decreases formation of Uric acid
Oral preparation

30
Q

How can you acidify urine pH?

A

Methionine

Ammonium chloride/sulphate

31
Q

How can you alkalinise urine pH?

A

NaHCO3

Sodium/potassium citrate

32
Q

What are the common clinical signs of renal failure?

A 
Azotaemia (increased blood urea and creatinine)
Polyuria and polydipsia
Anorexia
Metabolic acidosis
High blood pressure
Anaemia 
Hyperphosphataemia  
Hypokalaemia
33
Q

When managing renal failure, diet should contain increased and decreased what?

A

Increased potassium

Decreased phosphorus

34
Q

Name 3 phosphate binders used to bind phosphate in the GI tract

A

Calcium acetate
Lanthanum carbonate octahydrate
Sevelamer

35
Q

What is cystitis?

A

Inflammation (not necessarily infection) of the bladder

36
Q

If we want to treat a bacterial bladder infection, what sort of drug should we select?
What might we need to manipulate?

A

One that is excreted, unchanged, in the urine
E.g. amoxicillin, trimethoprim, fluoroquinalones
May need to manipulate urine pH, as different antibiotics work best at different pHs (e.g. penicillins=5.5)

37
Q

Give an example of a urinary antiseptic

What are its adverse effects?

A

Methanamine (hexamine). Hydrolysed in urine to release formaldehyde
Bladder irritation

38
Q

What is a crystalloid?

A

A water-based solution with small-molecular-weight particles, freely permeable to the capillary ‘membranes’

39
Q

What do buffered crystalloids contain?

A

HCO3- or, more often, contain molecules (e.g. acetate, lactate, gluconate) which are metabolised in the liver to produce HCO3-

40
Q

What do balanced crystalloids contain?

Give an example of one and state its pH

A

Contain electrolytes in addition to Na+ and Cl- (such as K+ Ca2+ Mg2+ ), making them similar to plasma
Lactated Ringer’s (pH 6.7)

41
Q

What is the pH of normal saline solution?

A

5.7

42
Q

What is a colloid?

A

A water-based solution with a molecular-weight too large to freely pass across capillary ‘membranes’
Intravascular volume-replacement solution

43
Q

Give some examples of natural and synthetic colloids

A

Natural: albumen, plasma, whole blood
Synthetic: gelatines, starches, dextrans

44
Q

What is the priority when doing fluid therapy?

A

Restoration of circulating volume

45
Q

For each litre of ECF volume replacer given, how much remains in the intravascular space?

A

250mls

46
Q

Why is it not always appropriate to give fluid replacers with high Na solutions?

A

Sodium may accumulate over time

47
Q

How do colloids work

A

Large molecules thus can’t pass through healthy vascular endothelium.
They therefore increase osmotic pressure of the plasma and ‘pull’ water from the interstitial space.
Plasma volume expanders.

48
Q

Why should ECF replacers be used concurrently or soon after colloids?

A

To replace the fluid taken from the interstitial space

49
Q

How does hypertonic saline work?

A

7.2% NaCl. Increases blood pressure.
Draws water in by osmosis from the interstitial space. Plasma expanders.
Any effect is transient, so must be followed by administration of isotonic crystalloids

50
Q

What is the optimum Na concentration of an oral fluid required to achieve optimum rehydration?

A

120-130mmol/L

51
Q

What is urine specific gravity?

What do we use to measure it?

A

Ratio of density of urine compared with density of a reference (water=1)
Refractometer

52
Q

What is the specific gravity of protein-free plasma?

A

1.008-1.012

53
Q

Which values for specific gravity are classed as an ‘inadequate concentration’ in cats and dogs?

A

Cats

54
Q

What does isosthenuria refer to?

What does it suggest?

A

The excretion of urine whose specific gravity is within the range of protein-free plasma, typically 1.008-1.012.
Suggests that the kidneys have not altered the glomerular filtrate. It is likely that the animal has kidney failure

55
Q

How can you distinguish between renal and pre-renal azotaemia?

A

Renal-unable to concentrate urine

56
Q

When might you see ketones in urine?

A 
Not normally
Might see them in:
-starvation
-ketosis in ruminants
-poorly controlled diabetes mellitus
57
Q

What kind of problem do you have if you have glucosuria, but plasma glucose is normal?

A

PCT problem

58
Q

How much protein is normally in urine?

A

None

59
Q

What is the normal pH range for dogs and cats?

A

5-9

60
Q

What percentage of urea is reabsorbed in the kidneys?

A

50%

61
Q

What can we measure to estimate GFR?

A

Creatinine

62
Q

What are the differences between urea and creatinine?

A 
Urea= nitrogenous waste product, made in liver from ammonia from catabolised proteins. Filtered by glomerulus. Some reabsorbed in PCT
Creatinine= Produced constantly by muscles. Filtered by glomerulus. Not reabsorbed in PCT
63
Q

Why might a patient have high urea in their urine? (7)

A 
High protein diet 
Decreased GFR
Recent meal
Catabolism (fever)
Blocked/ruptured lower urinary tract
GI haemorrhage
Dehydration
64
Q

Why might a patient have low urea in their urine? (3)

A

Low protein diet
Severe liver disease
Aggressive fluid therapy

65
Q

How do you evaluate kidney function?

A 
Urinalysis (analysis of volume, physical, chemical, and microscopic properties of urine)
Blood tests (urea & creatinine, serum electrolytes)
66
Q

What waste products are found in urine?

A

Na+, K+, urea, creatinine

Year 2 (10 decks)

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