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Year 2 NSF > Urinary Pharmacology > Flashcards

Urinary Pharmacology Flashcards

1
Q

What % of body weight is water in adults and neonates?

A

60% of adult

80% of neonate

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2
Q

What proportion of body water is intracellular and extracellular fluid?

A

1/3 is extracellular

2/3 is intracellular

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3
Q

What is the major cation of extra and intracellular fluid?

A

Na+ is extracellular

K+ is intracellular

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4
Q

What % of ECF is blood plasma?

A

25%

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5
Q

What does dehydration trigger?

A

Decrease in blood volume then blood pressure activating the baroreceptor and activates RAAS

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6
Q

How can fluid be given enterally and parenterally?

A

Enteral- oral, tube

Parenteral- IV, Intra-osseous, intra-peritoneal, sub-cutaneous

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7
Q

When should oral rehydration therapy be used?

A

When the GI tract is functional with mild/moderate fluid volume disturbances

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8
Q

What is in oral fluids and what was added from 1st gen to 4th gen?

A

1st generation- enough sodium and equimolar glucose to correct dehydration

2nd generation- addition of bicarbonate which is lost in diarrhoea

3rd generation- high glucose- adresses nutritional demands

4th generation- contains glutamine- promoting villus repair and regeneration

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9
Q

How should an oral fluid be chosen?

A

Rehydration ability
Ability to correct acidosis
How much glucose
Nutritional ability and prevention of villus atrophy (glutamine)

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10
Q

What are crystalloids?

A

Salt solutions that freely cross capillary walls- quickly pass into extracellular fluid compartment

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11
Q

What are colloids?

A

Non-crystalline substances consisting of large molecules diluted in a crystalloid- capillary impermeable to these large molecules

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12
Q

Is 0.9% sodium chloride as colloid or crystalloid?

A

Crystalloid- has similar tonicity to plasma but is not physiological

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13
Q

What do physiological crystalloid contain?

A

HCO3- for buffer or acetate/gluconate/lactate which are metabolised by the liver with net production of HCO3-

Balanced with electrolytes of Na, Cl, K, Mg, Ca

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14
Q

What concentration of solution can crystalloids be?

A

Isotonic
Hypertonic
Hypotonic

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15
Q

Why are isotonic crystalloids poor plasma expanders?

A

Water freely moves by osmosis between blood plasma and interstitial fluid

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16
Q

Why are hypertonic crystalloids considered plasma expanders?

A

Their tonicity causes water to move from interstitial and intracellular to intravascular
e.g 7.2% NaCl solution

17
Q

What is an example of a hypotonic crystalloid and what happens when administered into circulation?

A

5% dextrose in water
Lower concentration of electrolytes but isosmotic when administered- dextrose enters cells and is metabolised, therefore hypotonic as effectively water

18
Q

What is used for maintenance solution and why?

A

4% glucose and 0.18% NaCl

ICF contains less Na and more K, can’t put high K into ECF

19
Q

What is the result of isotonic, hypotonic and hypertonic crystalloids?

A

Isotonic- within 1 hour 75% of isotonic moves into ECF
Hypotonic- result in fluid accumulation in intracellular space
Hypertonic- draws fluid into the intravascular space

20
Q

What is the effect of colloids?

A

Plasma volume expanders- increase colloidal osmotic pressure of the plasma and ‘pull’ water from the interstitial space

21
Q

When are colloids used?

A

When it is difficult to administer sufficient volume of fluids rapidly enough to resuscitate a patient
When decreases oncotic pressure is suspected

22
Q

What are used as colloids?

A

Natural- whole blood, plasma, albumen

Synthetic- starches, gelatins, dextrans

23
Q

What are the potential adverse effects of colloids?

A

Anaphylactic reactions, coagulopathies, oedema

24
Q

What are the 5 types of diuretics?

A 
Osmotic 
Carbonic anhydrase inhibitors 
Loop 
Thiazides
Potassium sparing
25
Q

Why are diuretics classed as cardiovascular drugs?

A

Used to reduce sodium and water retention (oedema) and are therefore usually classified as cardiovascular

26
Q

What is an example of a osmotic diuretic and what are their mechanisms of action?

A

Mannitol
MOA- filtered but not reabsorbed so excreted unchanged by the kidney and maintain osmotic pressure within filtrate
Mainly effects permeable parts of nephron
Increased filtrate in PCT also decreases Na+ reabsorption

27
Q

How are osmotic diuretics administered, what are they used for and their adverse effects?

A

Admin- IV (fast acting)
Use- forced diuresis- poisoning, oliguric renal failure to stimulate urine output, cerebral oedema and glaucoma
Adverse effects- initial increase in ECF so may worsen pulmonary oedema or CHF

28
Q

What is the mechanism of action of carbonic anhydrase inhibitors?

A

Distributed to tissues with high carbonic anhydrase activity (eye, kidney, RBCs)
Reversible inhibit CA enzyme leading to less H+ production and reduced Na/H exchange
Bicarbonate reabsorption from PCT is decreases and excretion increases
Results in diuresis and alkaline urine, Cl is therefore maintained for balance

29
Q

How is carbonic anhydrase inhibitors administered, what are they used to treat and what are their adverse effects?

A

Oral administered- acetazolamide
Treat- glaucoma, metabolic alkalosis, weak diuretics
Adverse- hypercholraemic metabolic acidosis, liver disease means NH4 not lost in urine, PUPD for glaucoma

30
Q

What is the MOA of loop diuretics?

A

Secreted into the PCT
Inhibit the NaKCl2 transported in LOH
Increase delivery of NA to the DCT
Increased excretion of K, H, Mg, Ca

31
Q

Name an example of a loop diuretic, administration, use and adverse effects?

A

Feurosemide
Oral or parenteral administation
Treatment of oedema- udder, essential in management of CHF
Adverse- Excessive Na and water can cause dehydration and hypovolaemia, hypokalaemia

32
Q

What is the mechanism of action of thiazides?

A

Secreted into PCT
Increase Na, Cl, Mg, K excretion
Decrease calcium excretion

33
Q

What is an example of thiazides, how are they administered, what are they used to treat and what are there adverse effects?

A

Hydrochlorothiazide
Orally administered
Used for treatement of oedema and dissolution of Ca containing kidney stones
Adverse- dehydration and hypovolaemia, hypokalaemia

34
Q

What is the mechanism of action of potassium sparing diuretics?

A

Act on principal cells of DCT and CD
Competitive inhibitors of aldosterone
Inhibition of Na reabsorption therefore NaKATPase activity

35
Q

How are potassium sparing diuretics administered, used and what are there adverse effects?

A

Orally administered
Treatment of oedema, prevention of hypokalaemia
Adverse effects- hyperkalaemia, don’t use two different, don’t use with renal impairment

36
Q

What are the most powerful and used diuretics?

A

Loop diuretics

Year 2 NSF (16 decks)

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