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Clinical Urology > Urology Therapeutics > Flashcards

Urology Therapeutics Flashcards

1
Q

What is the purpose of Diuretics?

How does it achieve this purpose?

A

To treat any condition where there is hypervolemia, or tissue edema that is NOT caused by hypoproteinemia
It does this by increasing urinary excretion of Na+ and water, resulting in a net decrease in extracellular fluid volume

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2
Q

What are 5 examples of when diuretics are indicated?

A
  • Congestive heart failure, leading to pulmonary edema
  • Increased intracranial and interocular pressure
  • Mammary edema
  • Lymphoedema
  • Exercise-induced pulmonary hemorrhage
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3
Q

What is the most commonly used Osmotic diuretic?

A

Mannitol

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4
Q

How does Mannitol work?

A

It is freely filtered at the glomerulus, but poorly reabsorbed, and thus water retains in the nephron instead of being reabsorbed

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5
Q

When is Mannitol indicated for use?

A
  • Oliguric renal failure
  • Acute glaucoma
  • Cerebral edema
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6
Q

What is a potential side effect of IV Mannitol?

A

While in the bloodstream, it causes water to move out of the cells and into vessels, this can cause an acute circulatory overload, which can result in worsening of signs such as hypertension

Take BP measurements as you give Mannitol

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7
Q

What is an example of a Carbonic Anhydrase Inhibitor?

A

Acetazolamide

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8
Q

What are the effects of Carbonic Anhydrase Inhibitors?

A

They inhibit the enzyme Carbonic Anhydrase in the proximal tubules, resulting in a decrease in resorption of water

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9
Q

When are Carbonic Anhydrase Inhibitors indicated for use?

A
  • Decrease intraocular pressure in glaucoma (used as an eye drop)

They are not routinely used as a diuretic!

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10
Q

What are the effects of Thiazide diuretics?

A

They block Na+, K+ and Mg++ reabsorption in the distal tubule,
They will increase Ca++ reabsorption

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11
Q

Are the Thiazide diuretics considered to be weak or potent diuretics?

A

Weak Diuretics

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12
Q

When are the Thiazide diuretics indicated for use?

A
  • Treat udder edema

- Congestive Heart Failure

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13
Q

What is the most commonly used loop diuretic?

A

Furosemide

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14
Q

How do the loop diuretics work?

A

Inhibit Na+ and Cl- resorption from the thick ascending loop of Henle
While also increasing the excretion of Ca++, Mg++ and K+

note: Loop diuretics are the most potent diuretics

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15
Q

When are loop diuretics indicated for use?

A
  • Pulmonary edema due to CHF or Exercise-Induced Pulmonary Hemorrhage
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16
Q

What are the potential adverse effects of loop diuretics?

A
  • Volume depletion
  • Hypokalemia
  • Metabolic alkalosis: an excess of bicarb
  • May potentiate the ototoxicity of aminoglycosides
    caution: cats are particularly sensitive to adverse effects
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17
Q

What are the effects of Spironolactone?

A

Spironolactone is an aldosterone antagonist, it works by blocking the aldosterone-mediated Na+ resorption, and K+ and H+ excretion from the distal tubule
Thus it is a “potassium-sparing diuretic”

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18
Q

When is Spironolactone indicated for use?

A
  • As an addition to Furosemide to treat CHF
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19
Q

What are the potential side effects of Spironolactone?

A
  • Hyperkalemia

- GIT disturbance

20
Q

What are the 3 approaches to the treatment of chronic renal failure?

A
  • Medication: ACE inhibitors or Angiotensin receptor blockers, +/- erythropoietin
  • Diet: low protein, low phosphorus, low Na+ diets, omega-3 PUFA’s, Vitamin B12 supplements
  • Supportive therapies: phosphate binders (e.g. Chitosan and Calcium carbonate)
21
Q

What medications might be recommended in a chronic renal failure patient, and why?

A

1) Angiotensin Converting Enzyme (ACE) inhibitors (e.g. benazepril)
or alternatively,
- Angiotensin receptor blockers (e.g. Telmisartan)

These are used when proteinuria is detected. They work to reduce the proteinuria by reducing glomerular capillary pressure by dilating the efferent renal arteriole

2) Anabolic steroids (e.g. laurabolin): this reduces protein loss from the muscles, but is rarely reccommended
3) Erythropoietin: to counteract the anemia

22
Q

What is the first-line choice for a urinary infection in cats and dogs?

A

Amoxycillin
- it achieves high urine concentrations if dosed q8 hours instead of q12 hours

note: Fluoroquinolones are also excreted in an active form in the urine, but should not be used as a first-line therapy

23
Q

What is the first-line choice for a urinary infection in cattle and horses?

A

Penicillin G
- achieves high urine concentrations if dosed q8 hours instead of q12 hours

note: Fluoroquinolones are also excreted in an active form in the urine, but should not be used as a first-line therapy

24
Q

When are fluoroquinolone antibiotics indicated for use in UTI’s?

A
  • If a UTI involving Gram-negative bacteria has been identified, especially for the treatment against Pseudomonas spp
  • For pyelonephritis
  • Prostatitis: good prostate penetration
25
Q

Bladder contraction and thus urination is primarily under the control of Parasymp or Symp nervous system?

A

Parasympathetic NS

26
Q

If a patient suffers from hypocontractility of the bladder (and thus cannot sustain urination), what drug can be given?

A

Parasympathomimetic agents, such as Bethanechol (aka Urecholine)

27
Q

What are the potential adverse effects of using Bethanechol?

A

Muscarinic effects: salivation, defecation, abdominal cramping

28
Q

What is the antidote for the treatment of the side effects of using Bethanechol?

A

Atropine

29
Q

When is Bethanechol contraindicated for use?

A

Patients with bronchial or gastrointestinal disease

30
Q

If a patient suffers from hypercontractility of the bladder (and thus cannot retain urine), what drug can be given?

A

Anticholinergics (parasympatholytic drugs), such as Propantheline

31
Q

What are the potential adverse effects of using Propantheline?

A
  • Decrease GI motility
32
Q

When is Propantheline contraindicated for use?

A

Patients with GI infections, or with hepatic, renal, endocrine or cardiac disease

33
Q

What drug can be used in a patient with a Hypotonic urethra (resulting in a lack of urethral constriction and thus urine dribbling)?

A

Sympathomimetics, such as Phenylpropanolamine (e.g. Propalin)

34
Q

What are the potential adverse effects of using Phenylpropanolamine?

A
  • Restlessness and aggressiveness
35
Q

What drug can be used in a patient with a Hypertonic urethra (resulting in an inability to pee or difficulty peeing)?

A

Alpha-adrenergic antagonists, such as Prazosin

36
Q

What are the potential side effects of using Prazosin?

A
  • Hypotension
  • CNS effects (lethargy and dizziness)
  • GI effects
37
Q

When is prazosin contraindicated for use?

A
  • Patients with chronic kidney disease, or with pre-existing hypotensive conditions
38
Q

What drug can be used to treat hormonal responsive incontinence in spayed females?

A

Estriol (incurin)

This is a short-acting estrogen, and thus should not be used in intact females as it will mimic estrus

39
Q

What are the potential adverse effects of using Estriol?

A

Estrogenic effects, such as a swollen vulva, mammry glands +/- attractiveness to males
+/- vomiting

40
Q

What drug can be used to treat functional urethral obstructions?

A
  • Prazosin: alpha-adrenergic antagonist
  • Dantrolene: direct muscle relaxant by inhibiting Ca++ movement from the sarcoplasmic reticulum

The effect of Dantrolene is enhanced by the use of Prazosin

41
Q

What are the potential adverse effects of using Dantrolene?

A

Sedation, weakness, GI upset, increased urinary frequency

42
Q

What is the drug that can be used to medically treat urate uroliths?
How does it work?

A
  • Allopurinol (this is a human drug): it is a xanthine oxidase inhibitor
  • It blocks the action of Xanthine Oxidase, which is the enzyme responsible for the formation of urate uroliths
43
Q

What urolith is more likely to form in an alkaline urine sample?

A

Struvite (triple phosphate crystals)

44
Q

What urolith is more likely to form in an acidic urine sample?

A
  • Calcium oxalate

- Urate uroliths

45
Q

How can alkaline urine be managed to make it more acidic?

A
  • Urine Acidifiers
  • Urine specific diets that have added urine acidifiers

note: never give these both at the same time, as you will double the effects of the acidification

46
Q

How can acidic urine be managed, to treat calcium oxalate and urate crystals and even fungal urinary infections, to make it more alkaline?

A
  • Potassium citrate

Clinical Urology (8 decks)

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