week 3 content - exam 2 Flashcards
Kidney stones pharmacology
Acute pain
- NASAIDS or morphine
- IV fluids
Preventative meds
- _______stones = HTZT diuretics
- _______stones = abx
- ________stones = allopurinol (gout related)
Kidney stones pharmacology
Acute pain
- NASAIDS or morphine
- IV fluids
Preventative meds
- Calcium stones = HTZT diuretics
- Struvite stones = abx
- Urate stones = allopurinol (gout related)
patho
_______ blocks some light from passing through the eyeball lens and scatters light, preventing all of it from reaching retina and thus preventing allowance of vision to be crisp and clear
cataracts
Acute glomerulonephritis
Patho
1. Trigger
2. Type II or type III – direct attack or immune complexes form
3. _________ (inflammation) activated
4. Mediators are released
5. Tissue injury
6. ______turia, ________uria, ___creased GFR
Patho
1. Trigger
2. Type II or type III – direct attack or immune complexes form
3. Complement (inflammation) activated
4. Mediators are released
5. Tissue injury
6. Hematuria, proteinuria, decreased GFR
_________ angle glaucoma
- Abnormal angle between the iris and the cornea
- Outflow is blocked when the pupil is dilated
-
__________ angle glaucoma
- Abnormal/blockage of trabecular meshwork
- Reduced/slowed drainage of aqueous humor (eye ball juice)
- Imbalance between inflow and outflow
- Increased IOP and results in vision problems
Closed - AKA Acute angle closure glaucoma or narrow angle glaucoma
Open
2 types of _________________:
1. Dry – non-exudative (most common)
-Yellow deposits in the retinal pigment epithelium
2. Wet – exudative
-Growth of new leaky blood vessels in an abnormal location of the retina
Macular degeneration
MOA
- Blocks conversion of testosterone to DHT (alpha 1 receptors)
- Decreased epithelial tissue in prostate
Indications
- Mechanical obstruction of urethra
- Works on enlarged prostate only
s/e
- Impotence
- Decreased libido
- Gynecomastia – abnormal growth breast tissue
Other notes
- Results 6-12 mos
- Take it for life
- Lowers DHT, doesn’t lower testosterone
- Males can’t donate blood while taking this med
- Decreases prostate specific antigen (PSA) levels
o measure PSA before starting drug and 6 mos after starting drug
o If PSA isn’t low = eval for prostate cancer
- Also used to treat male pattern baldness – increases hair growth
- Females caution in handling – tetragenic for preg. Women, may cause birth defect in male fetus
Class: 5 alpha reductase inhibitors
Drug: finasteride
for BPH
Prostate or testicular cancer?
Most common cancer in males in US
- Highest = black men
- Lowest = Asians and native American men
- Increases after age 50
Risk factors
- Increased age
- Familial tendency
- High fat diet
prostate
____________
High blood sugar causes poor blood flow to retina and damaged blood vessels in retina
____________
High BP creates blockages in retinal blood vessels
Diabetic retinopathy
High blood sugar causes poor blood flow to retina and damaged blood vessels in retina
Hypertensive retinopathy
High BP creates blockages in retinal blood vessels
CKD or AKI s/s?
- Anxiety/depression
- HTN
- Heart failure
- CAD
- Pericarditis
- PAD
- n/v
- anorexia
- GI bleed
- Gastritis
- Fatigue
- h/a
- sleep disturbance
- encephalopathy
- pulmonary edema!! Severe s/s and indicator for dialysis
- pruritus
- ecchymosis
- dry, scaly skin
CKD
AKI =
- Oliguria (goal is >30ml/hr or <400ml/24hr)
- begins 1 day after hypotensive event and lasts 1-3 weeks
- FVE
- Metabolic acidosis and waste product accumulation (azotemia/uremia) – no excretion, build up of waste
- Hyponatremia – no excretion, dilution issue
- Hyperkalemia – no excretion, accumulation issue
- Neurologic disorders – r/t hyponatremia
- AKI can develop into CKD if pt doesn’t recover
Treatment of AKI or CKD
- Find cause
- Monitor labs
- Treat manifestations
- Avoid nephrotoxic drugs
- Monitor for CKD problems
AKI
Manifestations
- Spontaneous, sudden
- Unilateral vision loss
- Painless
- Floaters
- Flashes of light
- Curtain coming down effect – black line at top and bottom of vision field
Retinal detachment
The glomerulus
Capillary membranes have 3 layers
1. Endothelium
2. _________ (where a lot of issues occur)
3. Podocytes – special epithelial cells
The glomerulus
Capillary membranes have 3 layers
1. Endothelium
2. GBM – glomerulus basement membrane (where a lot of issues occur)
3. Podocytes – special epithelial cells
BPH or testicular cancer?
s/s
testicle enlargement doesn’t correlate with severity of s/s
similar to UTI
- Frequency
- Urgency
- Delay
- Reduction in force
- Increased urination time
- Dribbling
LUTS
lower urinary tract symptoms
BPH
Drug: __________
MOA
- Blocks alpha 1 receptors – relaxes smooth muscle cells in bladder, neck, prostate, and urethra
- Selective for alpha receptors in prostate – will not have systemic effects
Indications
- Dynamic obstruction of urethra
Quick results, take life long
s/e
- Well tolerated
- Abnormal ejaculation – doesn’t decrease PSA
Class: Alpha 1 adrenergic antagonists
Drug: tamsulosin
for BPH
CKD pharmacotherapy
Drugs use to
_______________
o Reduce BP <140/90
o Treat hyperlipidemia – cholesterol <200
______________
o FVE
o Hyperkalemia
o Metabolic acidosis
o Hyperphosphatemia
o Renal osteodystrophy
o Anemia
CKD pharmacotherapy
Drugs use to
- Slow rate of progression
o Reduce BP <140/90
o Treat hyperlipidemia – cholesterol <200
- Treat complications
o FVE
o Hyperkalemia
o Metabolic acidosis
o Hyperphosphatemia
o Renal osteodystrophy
o Anemia
Risk factors
- Age
- Family hx
- Race/ethnicity
BPH or testicular cancer?
BPH
testicular cancer =
- Family hx
- White
- Cryptorchidism
- HIV infection
_________ functions
- Maintain F&E balance (which helps with BP and third spacing)
- Rids the body of water-soluble wastes via urine (non-soluble waste is through stool)
- Endocrine functions
o Produce erythropoietin (which stimulates RBC production)
o Activates vitamin D (important for calcium absorption and bone health)
o Produces renin (helps regulate BP)
kidney
Nephrotic syndrome
Patho
1. Increased glomerular permeability
2. _________uria
3. _______albuminemia – _______ occurs bc low albumin causes fluid shifting
Patho
1. Increased glomerular permeability
2. Proteinuria
3. Hypoalbuminemia – third spacing occurs bc low albumin causes fluid shifting
Glomerulonephritis Etiology
2 types of injury
1. Type ____ – antibodies attach to antigens of the glomerular basement membrane “anti-GBM antibodies”
2. Type _____ – antibodies react with circulating antigens and are deposited as immune complexes in the GBM – most common
-
Both forms
- Accumulate antigens, antibodies, and complement (inflammatory process)
- Complement activation = ____________ injury
- Type II – antibodies attach to antigens of the glomerular basement membrane “anti-GBM antibodies”
- Type III – antibodies react with circulating antigens and are deposited as immune complexes in the GBM – most common
Both forms
- Accumulate antigens, antibodies, and complement (inflammatory process)
- Complement activation = tissue injury
3 AKI classifications (based on where injury occurs)
_________– r/t volume loss, most common
o Causes – blood loss, dehydrated
-
________ – directly hurting kidney
o Causes - acute tubular necrosis, chemicals or toxins, kidney cell death, drug OD, acute glomerulonephritis vascular disease, DM, HTN
-
__________ – not as common
o Causes - obstruction causing cell death, blockage, tumor
-
post renal, pre renal, intra renal
3 AKI classifications (based on where injury occurs)
- Pre-renal – r/t volume loss, most common
o Causes – blood loss, dehydrated
-
- Intrarenal – directly hurting kidney
o Causes - acute tubular necrosis, chemicals or toxins, kidney cell death, drug OD, acute glomerulonephritis vascular disease, DM, HTN
-
- Post renal – not as common
o Causes - obstruction causing cell death, blockage, tumor
___________
Elevated intraocular pressure (IOP) + Vision changes
OR
Elevated intraocular pressure (IOP) + optic nerve damage
Glaucoma
dozolamide
carbonic anhydrase inhibitor
May be combined with timolol = cosopt
MOA
- decreased production of aqueous humor
s/e
- stinging
- bitter taste
- allergic reactions – conjunctiva or lid reactions
1st line or 2nd line treatment for open angle glaucoma?
2nd line
______________
Prostate (glands surrounding the urethra) which Produces seminal fluid, have noncancerous/nonmalignant enlargement
3 cells involved
Benign prostatic hyperplasia BPH
- Epithelial cells
- Smooth muscle cells
- Stromal cells
Diabetic retinopathy: Non-proliferative retinopathy vs proliferative retinopathy?
which one has
- Advanced retinopathy
- Growth of New blood vessels – abnormal, fragile and leaky
proliferative retinopathy
kidney stone Crystal formation enhanced by
o pH changes – ex: ______
o excessive concentrations of insoluble salts in the urine – ex: ________
o urinary stasis – ex: _________
o pH changes – ex: UTI
o excessive concentrations of insoluble salts in the urine – ex: dehydration, bone disease, gout, renal disease
o urinary stasis – immobility, sedentary lifestyle – like wheel chair bound
Complications _________
- Obstruction – urine cant get out
- UTI – urine stasis
- Renal problems – problems travel further up into kidneys
BPH
CKD
Decreased production of __________ = Anemia
Decreased production of erythropoietin =
- Anemia
Manifestations
- Look and feel sick
- Sudden onset fever, chills, CVA tenderness
- dysuria, hematuria, frequency, urgency
- n/v
- anorexia
upper or lower UTI?
upper - Pyelonephritis
Manifestations
- Look and feel sick (Upper UTI = systemic response)
- Sudden onset fever, chills, CVA tenderness
- Lower UTI s/s – dysuria, hematuria, frequency, urgency
- n/v
- anorexia
___________
Cloudy lens
____________
Curtain coming down effect – black line at top and bottom of vision field
__________
Tunnel vision
____________
Blind spots = scotomas
glaucoma, macular degeneration, Cataracts, retinal detachment
Cataracts
Cloudy lens
retinal detachment
Curtain coming down effect – black line at top and bottom of vision field
glaucoma
Tunnel vision
macular degeneration
Blind spots = scotomas
Prognosis
- Stage dependent
- Early diagnosis
- Severity depends on
o Gleason score (higher = worse)
Looks at biopsy and predicts cancer outcome
o Tumor volume
PSA level (higher and rapid rise = worse)
# of cores positive (more = worse)
o How was cancer detected – PSA vs DRE (digital rectal exam)
PSA detects it much earlier than DRE
Consider risk factors
High risk factors = consider PSA
Lower risk factors = consider DRE
prostate or testicular cancer?
prostate
Germ cell tumors = __________ cancer
Germ cell – sperm forming cells w/in ________
Germ cell tumors – cancer
Germ cell tumors = testicular cancer
Germ cell – sperm forming cells w/in testicles
Germ cell tumors – cancer
risk factors for __________
- pregnancy
- recurrent lower UTI
- abx resistant strain
complications for ________
- CKD
- Sepsis/urosepsis
o More likely in elderly
o Severe systemic response
o High mortality rates
Pyelonephritis
2 types of __________:
- Open angle
- Closed angle
which one most common?
glaucoma
- Open angle
treatment
-abx
o Bactrim (trimethoprim/sulfamethoxazole)
o Ciprofloxacin
upper - Pyelonephritis
CKD
Decreased activation of _________ =
- Renal osteodystrophy, weakened bones from low Calcium
Decreased activation of vitamin D =
- Renal osteodystrophy, weakened bones from low Calcium
1st line treatment for __________ =
Latanoprost
Prostaglandin analogs
MOA
- Increases outflow drainage of aqueous humor
Indications
- ______________
- Ocular HTN
s/e
- Well tolerated
open angle glaucoma
why are there LOTS of manifestations with CKD?
Biggest concern = _______
with CKD waste products are in our blood and our blood goes everywhere so that would effect every system in the body!
and also increases inflammation
Biggest concern = fluid overload in lungs
causes of Meniere’s disease - T/F
- high salt diet
- caffeine
- alcohol
- stress
- smoking
- MSG
- Allergies
treatment of Meniere’s disease is only symptomatic?
- high salt diet
- caffeine
- alcohol
- stress
X- smoking - MSG
- Allergies
true
Complications of kidney stones Urinary obstruction
- Stasis of urine – _______ more likely
- Back up of pressure – damages __________
o Hydroureter - ureter becomes swollen due to obstruction.
o Hydronephrosis - kidney becomes swollen due to obstruction.
o postrenal acute kidney injury - type of kidney damage caused by an obstruction in the urinary tract.
- Statis of urine – infection more likely
- Back up of pressure – damages kidneys
Kidney stones manifestations
Pain of acute renal colic
- location of pain = _________
- Radiates to lower abd and groin
- __________ of pain lasting 20-60 mins
- Intermittent – ureter spasms
- _______ pain – calculi scrape ureter wall
Other s/s
- n/v
- dyuria
- chills, fever – only if UTI is present
- hematuria
- foul smelling urine
- diaphoresis
Kidney stones manifestations
Pain of acute renal colic
- Flank pain
- Radiates to lower abd and groin
- Colicky/spasms/waves of pain lasting 20-60 mins
- Intermittent – ureter spasms
- Sharp pain – calculi scrape ureter wall
Other s/s
- n/v
- dyuria
- chills, fever – only if UTI is present
- hematuria
- foul smelling urine
- diaphoresis
which cancer has controversy around screening - prostate or testicular cancer?
prostate
- Most prostate cancer grows so slowly that men die of other causes before prostate cancer becomes deadly, making them clinically irrelevant
- PSA antigen screening helps diagnosis
- Benefits of PSA
o Some survival benefit
o Drop in prostate cancer death in US - Harms of PSA
o Takes 48 diagnoses to prevent 1 death
o 1 in 3 men with a positive PSA will have prostate cancer
o Many unnecessary biopsies
o s/e of unnecessary treatment – erectile dysfunction, urinary incontinence, bowel problems
optic topical beta blockers
_________ – nonselective beta blockers
__________– selective Beta blocker (beta 1 )
betaxolol
timolol
timolol – nonselective beta blockers
betaxolol – selective Beta blocker (beta 1 )
Risk factors for CKD
- Family hx
- Aging >60
- Male
- Black
- HTN
- DM
- Smoking
- Overweight/obese
which 2 are the biggest risk factors?
Risk factors
- Family hx
- Aging >60
- Male
- Black
- HTN!!
- DM!!
- Smoking
- Overweight/obese
Complications of glomerulopathy (is a general term that refers to any disease or condition that affects the glomeruli)
________________
- Thickening of GBM – can’t filter particles and fluid effectively, decreased urine output and increased toxins in body
- Leads to ESRD
_____________________
- Decreased renal perfusion – sclerotic/scarring glomerular changes
- High BP = glomerulus scarring = decreased perfusion to kidneys and damaged glomerulus
Complications
-Diabetic neuropathy
- Thickening of GBM – can’t filter particles and fluid effectively, decreased urine output and increased toxins in body
- Leads to ESRD
-
-Hypertensive glomerular disease
- Decreased renal perfusion – sclerotic/scarring glomerular changes
- High BP = glomerulus scarring = decreased perfusion to kidneys and damaged glomerulus
2 types of
Diabetic retinopathy
-
____________ retinopathy
- Capillary microaneurysms
- Retinal swelling
- Hard exudate
- Macular edema – plasma leaks from macular blood vessels
- Capillaries rupture leading to “dot or blot” hemorrhaging
-
_____________ retinopathy
- Capillary microaneurysms
- Retinal swelling
- Hard exudate
- Macular edema – plasma leaks from macular blood vessels
- Capillaries rupture leading to “dot or blot” hemorrhaging
PLUS
- Advanced retinopathy
- Growth of New blood vessels – abnormal, fragile and leaky
Non-proliferative retinopathy
- Capillary microaneurysms
- Retinal swelling
- Hard exudate
- Macular edema – plasma leaks from macular blood vessels
- Capillaries rupture leading to “dot or blot” hemorrhaging
-
Proliferative retinopathy
- Capillary microaneurysms
- Retinal swelling
- Hard exudate
- Macular edema – plasma leaks from macular blood vessels
- Capillaries rupture leading to “dot or blot” hemorrhaging
PLUS
- Advanced retinopathy
- Growth of New blood vessels – abnormal, fragile and leaky
do kidney stones commonly cause urinary obstruction/urine back up?
yes!
Manifestations of CKD or AKI
- Oliguria (goal is >30ml/hr or <400ml/24hr)
- begins 1 day after hypotensive event and lasts 1-3 weeks
- FVE
- Metabolic acidosis and waste product accumulation (azotemia/uremia) – no excretion, build up of waste
- Hyponatremia – no excretion, dilution issue
- Hyperkalemia – no excretion, accumulation issue
- Neurologic disorders – r/t hyponatremia
can AKI develop into CKD?
AKI
yes
AKI
obstruction causing cell death, blockage, tumor
post renal, pre renal, intra renal?
post-renal
is a general term that refers to any disease or condition that affects the glomeruli
Glomerulopathy
bladder cancer vs kidney cancer?
Treatment
- Resistant to chemo
- Surgery to remove ________ likely
Treatment
- Chemo – depends on stage
- Stage 1 = intravascular chemo (BCG vaccine: intravesical therapy)
- Advanced stages = systemic chemo
kidney
Treatment
- Resistant to chemo
- Surgery to remove kidney likely
bladder
Treatment
- Chemo – depends on stage
- Stage 1 = intravascular chemo (BCG vaccine: intravesical therapy)
- Advanced stages = systemic chemo
Manifestations
- Gradual onset of painless blurry vision
- Uni or bilateral vision changes
- Halo around lights
- Altered color perception
- Glare issues at night
- Decreased accommodation – response to light
- cloudy lens
Cataracts
BPH or testicular cancer?
Early s/s
- Enlargement of testicles
- Painless mass or discomfort:
o Ache in groin
o Sensation of heaviness
Late s/s
- Frank pain
- Signs based on metastatic spread
o Cough – lungs
o Hemoptysis
o Swelling of LE
o Back pain
o Dizziness
testicular cancer
______________
Irreversible vision loss caused by retinal aging
Macular degeneration
Non-proliferative retinopathy and proliferative retinopathy
associated with Diabetic retinopathy or Hypertensive retinopathy
Diabetic retinopathy
Risk factors _________
- OA
- Eye trauma
- Congenital risk
- DM
- Corticosteroid use
- Smoking and alcohol
cataracts
2 types of _________ cancer
Seminomas
- Arise from immature germ cells
- Slow growing
- Nonaggressive
- Easily cured with radiation
Non-seminomas
- Arise from mature germ cells
- More aggressive
- Usually treated with surgery
testicular
Stage ___
- Asymptomatic
- >90
Stage ___
- Asymptomatic, maybe HTN
- 60-89
Stage ___
- HTN
- 45-59
Stage ___
- HTN
- 30-44
Stage ___
- Manifestations are becoming apparent
- Diagnosis often occurs here
- 15-29
Stage ___ (kidney failure)
- Uremic – urea in the blood
- More manifestations apparent
- <15 or dialysis
Stage 1
- Asymptomatic
- >90
Stage 2
- Asymptomatic, maybe HTN
- 60-89
Stage 3A
- HTN
- 45-59
Stage 3B
- HTN
- 30-44
Stage 4
- Manifestations are becoming apparent
- Diagnosis often occurs here
- 15-29
Stage 5 (kidney failure)
- Uremic – urea in the blood
- More manifestations apparent
- <15 or dialysis
Patho
- Urine (solution) = water (solvent) + particles (solute)
- Problem occurs when particles (solute) are supersaturated - This means that there is a higher concentration of these substances in the urine than the urine can hold. When this happens, the substances can crystallize and form ______ in the ______
Patho
- Urine (solution) = water (solvent) + particles (solute)
- Problem occurs when particles (solute) are supersaturated - This means that there is a higher concentration of these substances in the urine than the urine can hold. When this happens, the substances can crystallize and form stones in the kidney/nephron
Nephrolithiasis
brimonidine
alpha-adrenergic agonist
MOA
- decreases aqueous humor production
- may also increase drainage of aqueous humor
indications
- 1st line treatment for __________________
- increased IOP
s/e
- burn/sting
- dry mouth
- fatigue
- h/a
- blurry vision
- hypotension
open angle glaucoma
______________ disorders
Alterations in glomerular capillary
Glomerular disorders
Alterations in glomerular capillary
o 5 alpha reductase inhibitors
o Alpha 1 adrenergic antagonists
for moderate __________
BPH
1st line treatment for __________ = optic topical beta blockers
timolol – nonselective beta blockers
betaxolol – selective Beta blocker (beta 1 )
open angle glaucoma
types of __________
o Calcium oxalate or calcium phosphate – most common
o Uric acid
o Cystine
o Struvite – magnesium ammonium phosphate
kidney stones
_________ – measures kidney function and how they are working, how much blood is filtered through kidney per min
o Lower value = the worse off the kidney are
o Normal >90
o ~25 is renal insufficiency
- GFR (glomerular filtration rate)
Glomerulus
Afferent arteriole – takes blood _______ the kidneys
Efferent arteriole – takes blood _______ the kidneys (higher pressure)
Pressure gradient – helps__________
Afferent arteriole – takes blood into the kidneys
Efferent arteriole – takes blood away from the kidneys (higher pressure)
Pressure gradient – helps push toxins out to go to urine
Nephrotic syndrome Manifestations
- _________ – low albumin = fluid leaks out of vessel and into tissue
- ___________ – compensatory mechanism – kidneys want more blood volume for perfusion
- ________ problems – spilling protein and losing fluid
- ______lipidemia
- ______coagulation – DVT risk
- _______ of antithrombin III and plasminogen – DVT risk
Manifestations
- Edema – low albumin = fluid leaks out of vessel and into tissue
- Hypertension – compensatory mechanism – kidneys want more blood volume for perfusion
- Liver problems – spilling protein and losing fluid
- Hyperlipidemia
- Hypercoagulation – DVT risk
- Loss of antithrombin III and plasminogen – DVT risk
Etiology of secondary ED:
_________ cause – r/t blood flow, meds, body causes
- PVD
o Arterial insufficiency
o Excessive venous drainage
o Sedentary lifestyle – risk factor
- Meds
o Antidepressants
o Antihypertensives
- Endocrine problems
o Low testosterone
- Trauma, surgery (radical prostatectomy)
__________ cause – mental problems
- Depression
- Low desire
- Performance anxiety
- Strained relationship
Etiology of secondary ED
Organic cause – r/t blood flow, meds, body causes
- PVD
o Arterial insufficiency
o Excessive venous drainage
o Sedentary lifestyle – risk factor
- Meds
o Antidepressants
o Antihypertensives
- Endocrine problems
o Low testosterone
- Trauma, surgery (radical prostatectomy)
Psychogenic cause – mental problems
- Depression
- Low desire
- Performance anxiety
- Strained relationship
Testicular cancer
- Effects younger or older adults more?
Risk factors
- Family hx
- White
- _____________- undescended testicles.
- HIV infection
Testicular cancer
- Effects younger aged male more than older adults
Risk factors
- Family hx
- White
- Cryptorchidism
- HIV infection
_________________
Tums
Treats hyperphosphatemia
MOA
- Binds to phosphate
Introducing calcium, lowers phosphate, b/c inverse relationship
Goals
- Keep normal phosphate levels
- Decrease mortality
Takes with meals
Monitor calcium levels
s/e
- Hypercalcemia
Calcium carbonate
GFR
lower or higher value = the worse off the kidney are?
o Normal >____
o around _____ is renal insufficiency
o Lower value = the worse off the kidney are
o Normal >90
o ~25 is renal insufficiency
Urinary obstruction locations
T/F
- Renal pelvis
- Ureter
- Bladder or urethra
- Anywhere in urinary tract
all true
- Renal pelvis – renal calculi/stones
- Ureter - renal calculi/stones, pregnancy, tumors
- Bladder or urethra – bladder cancer, neurogenic bladder, BPH, prostate cancer, urethral strictures
- Anywhere in urinary tract
Upper UTI, kidney infection
Inflammation of kidneys
Inflammatory response = kidney tissue damage
Abscess and necrosis can develop impairing renal function
Pyelonephritis
AKI or CKD
- Usually result of ischemic injury r/t loss of volume and decreased perfusion to kidneys
- Toxins or sepsis common cause too
AKI
“chill out drugs”
MOA
- block SNS stimulation of beta receptors
- decreases aqueous humor production
indications
- open angle glaucoma - maintenance treatment
s/e
- transient burning and discomfort
- systemic effects if drops are not kept local
________ contraindications
- same as oral beta blockers
- asthma
- COPD
- Sinus bradycardia
- Heart failure
Patient teaching
- Must take, or it will progress to blindness
- Apply nasolacrimal pressure with instillation
optic topical beta blockers
timolol – nonselective beta blockers
betaxolol – selective Beta blocker (beta 1 )
timolol
AKI
T/F
- Sudden and rapidly progressive
- irreversible
- Usually result of ischemic injury r/t loss of volume and decreased perfusion to kidneys
- Toxins or sepsis common cause too
- When body sense kidney injury it sends inflammatory response (meant to be helpful) but often causes more problems
- Can be mildly affected to severe
- Sudden and rapidly progressive
X - reversible - Usually result of ischemic injury r/t loss of volume and decreased perfusion to kidneys
- Toxins or sepsis common cause too
- When body sense kidney injury it sends inflammatory response (meant to be helpful) but often causes more problems
- Can be mildly affected to severe
Characterized by HARP
- Hematuria
- Azotemia – build-up of waste products
- Retention – Na and water retention + oliguria = edema and high BP
- Proteinuria
glomerulonephritis
type II and type III immune complexes
_________________
- reactions occur on the cell surface, antibodies attack the cell
- result in direct cell death or malfunction
- ex: hemolytic
-
_______________
- Immune complexes are deposited into tissue
- Result in inflammation that destroys tissue
- Ex: autoimmune issue, Glomerulonephritis
type II and type III immune complexes
- Type II
- reactions occur on the cell surface, antibodies attack the cell
- result in direct cell death or malfunction
- ex: hemolytic
- Type III
- Immune complexes are deposited into tissue
- Result in inflammation that destroys tissue
- Ex: autoimmune issue, Glomerulonephritis
AKI
Causes – blood loss, dehydrated
post renal, pre renal, intra renal?
pre-renal
Risk factors ________
- Myopia – near sidedness
- > 40
- Trauma to head
-Eye tumors
-Complications or hx of cataract surgery
Retinal detachment
MOA
- Stimulates inflammatory response in bladder
- Goal is for immune system to recognize cancerous cells and attack
s/e
- Bladder irritation
- Systemic infection
- UTI type s/s
Pt instructions
1. Empty bladder
2. Instill BCG vaccine into bladder – dwell time 2 hours
3. Change position q 15 mins
Disinfect urine for 6 hours post treatment
watch for infection
Take weekly for 6-12 weeks
Live vaccine – don’t give to compromised immunity
BCG vaccine: intravesical therapy
Treats bladder cancer
Urothelial carcinoma
lining of the bladder cancer
risk factors for ____________
- men
- 20s-30s
- White
- Family hx
- Congenital defect
- Weather – hot = dehydration risk
- Obesity – immobility/sedentary lifestyle
Nephrolithiasis - kidney stones
___________ pharmacology
Acute pain
- NASAIDS or morphine
- IV fluids
Preventative meds
- Calcium stones = HTZT diuretics
- Struvite stones = abx
- Urate stones = allopurinol (gout related)
Kidney stones
bladder vs kidney cancer?
Risk factors
- smoking!!
- Obesity
- Age
- Male
- Genetics
Risk factors
- Smoking!!
- Male
- Occupations with exposure to toxins – rubber, paint
- Low fluid intake – toxins don’t get flushed out
kidney
bladder
Manifestations of ___________
depends on
- site
- cause – stones, BPH, etc.
- speed of onset = acute or chronic worse?
severity of pain
depends on
- size
- blockage
- location
Urinary obstruction
-speed of onset
-acute = high pain
-chronic/insidious = low pain (bc the body can build a tolerance to it)
Glomerulonephritis
kidney inflammation
Retinopathy
Treatment
- Treat disease causing retinopathy (______ or _______)
Retinopathy
Treatment
- Treat disease causing retinopathy (DM, HTN)
- Depression
- Low desire
- Performance anxiety
- Strained relationship
causing ED
would be primary, secondary organic, or secondary psychogenic?
secondary – ED in someone with a hx of normal erection
Psychogenic cause – mental problems
Open angle vs Closed angle glaucoma?
Manifestations
- Typically Unilateral
- Severe eye pain
- n/s
- blurry
- halos
- red eyes
- dilated pupil – nonreactive to light
- cloudy cornea
Manifestations
- None
- Progressive loss of sight
- Vague eye pain
- Halos around lights – r/t pressure
- Tunnel vision
closed
open
Chronic glomerulonephritis vs Acute glomerulonephritis?
Triggers
- Post infectious
- Poststreptococcal infection
- Non-streptococcal infection – bacterial, viral, parasitic
- Primary disease
- Berger disease
- Multisystem disease
- Goodpasture syndrome
- Systemic lupus erythematosus (SLE)
- Vasculitis
Acute glomerulonephritis
Physiology of a normal erection
1. Sexual arousal
2. Increase______and nitric oxide release
3. Activation of ________
4. Engorgement and erection
5. Increased inflow and reduced outflow
6. Relaxation of arteries and smooth muscles
Physiology of a normal erection
1. Sexual arousal
2. Increase PNS and nitric oxide release
3. Activation of cGMP
4. Engorgement and erection
5. Increased inflow and reduced outflow
6. Relaxation of arteries and smooth muscles
Anti-GBM antibodies
- Kidney GBM and______ GBM are very similar
- So both areas can be attacked = respiratory and renal issues
- If anti-GBM antibodies are present = type _____
Anti-GBM antibodies
- Kidney GBM and lung GBM are very similar
- So both areas can be attacked = respiratory and renal issues
- If anti-GBM antibodies are present = type II
CKD drugs
1 goal is
Slowing progression
BP control
- _______ or _______ drug
- Other BP meds PRN
- Goal is SBP 110-130, max ________
Lipid control
- _________ drugs PRN
- Diet control
BP control
ACE - lisinopril and captopril
ARB - losartan
other BP meds - hydralazine, nicardipine, nifedipine, aliskiren, diuretics, ___lol drugs, doxazosin, clonidine
lipid control
statins
ezetimibe
- PVD
o Arterial insufficiency
o Excessive venous drainage
o Sedentary lifestyle – risk factor - Meds
o Antidepressants
o Antihypertensives - Endocrine problems
o Low testosterone - Trauma, surgery (radical prostatectomy)
causing ED
would be primary, secondary organic, or secondary psychogenic?
secondary – ED in someone with a hx of normal erection
Organic cause – r/t blood flow, meds, body causes
1st line treatment for open angle glaucoma =
____________
- keep them ________ by putting nasolacrimal pressure with instillation of drops (corner of eye closest to nose)
- hold pressure for __ mins
- helps prevent _________ effects
1st line treatment
Eye drops
- keep them localized by putting nasolacrimal pressure with instillation of drops (corner of eye closest to nose)
- hold pressure for 2 mins
- helps prevent systemic effects
kidney cancer Prognosis
depends on _______
- Bones
- Lungs
metastasis
manifestations
- Initially no vision changes
- Sustained severe HTN – sudden visual loss r/t swelling of optic disc and nerve
- Treat HTN = Normal vision is restored
Hypertensive retinopathy
High BP creates blockages in retinal blood vessels
Renal cell carcinoma
kidney cancer
MOA
- Inhibits PDE5 (PDE5 removes cGMP which is a key part of the erection process)
- Increases and preserves cGMP levels
- Only enhances the normal response to sexual stimuli (so if no stimuli, no erection)
Indications
- Relief of ED
- Pulmonary arterial HTN
- BPH
Onset – 30-60 mins
- Take up to 4 hours before sex
s/e
- h/a
- flushing
- dyspepsia
contraindication
- preexisting CV disease
- on nitrate
- hypotension
safety teaching
- don’t take with nitrates – will pass out b/c of drop in BP
- chest pain or signs of heart attack during sex = call 911
- sudden loss of vision in eye(s) or hearing
- don’t take more than 1 per day
- priapism – erection is painful or lasts >4 hours = medical emergency
Class: PDE 5 inhibitors
Drug: sildenafil (Viagra)
AKI
Causes -
acute tubular necrosis
chemicals or toxins
kidney cell death
drug OD
acute glomerulonephritis vascular disease
DM
HTN
post renal, pre renal, intra renal?
intra-renal
Risk factors
- Family hx
- Genetics
- UV light
- Hyperopia – far sidedness
- Smoking
- Light colored eyes
Treatment
- Limited, bc vision loss is irreversible
- Meds are injected in eye
Macular degeneration - retinal aging
Types of stones
- _______ or ________
Specific risks
- Family hx
- Idiopathic
- Diet high in calcemia and oxaluria (protein)
- ___________
Specific risks
- Urinary tract infection
- __________
Specific risks
- Gout
Types of stones
- Calcium oxalate or calcium phosphate – most common
Specific risks
- Family hx
- Idiopathic
- Diet high in calcemia and oxaluria (protein)
- Struvite “staghorn”
Specific risks
- Urinary tract infection
- Uric acid
Specific risks
- Gout
Chronic glomerulonephritis vs Acute glomerulonephritis?
Abrupt onset of glomerulonephritis
Long term inflammation of the glomerulus = scar tissue develops (can’t filter or produce urine effectively)
Acute glomerulonephritis
Abrupt onset of glomerulonephritis
Chronic glomerulonephritis
Long term inflammation of the glomerulus = scar tissue develops (can’t filter or produce urine effectively)
which stage of CKD is kidney failure?
which stage of CKD is dialysis?
which stage of CKD do Manifestations become apparent?
Which stage of CKD does Diagnosis often occur?
which stage of CKD do symptoms start?
stage 5
stage 5
stage 4
stage 4
stage 2 maybe HTN, stage 3a
Manifestations
Early
- None
Late
- Blurry
- Darkened vision
- Blind spots = scotomas
- Distorted vision = metamorphopsia
Macular degeneration - retinal aging
6 stages of CKD
________ is how we monitor function and know what stage someone is in
GFR
_______ cancer manifestations
early
- none
late
- CVA tenderness
- Hematuria – cola color b/c blood is coming from ___________
- Abdominal mass on palpation
- Bone pain – spread to bone
- Dyspnea, cough – spread to lungs
kidney cancer
dark blood coming from further away
compared to bladder cancer - blood is lighter bc bladder is closer to urethra
CKD drugs
1 goal is
Treat complications
___________
- Loop diuretic – furosemide
- Use with low salt diet
___________kalemia
- Multiple drugs used, ex: diuretic
- Addressed with hemodialysis in ESRD (end stage renal disease)
_____________
- Sodium bicarbonate
- An alkaline agent
___________phosphatemia
- Calcium carbonate
- Phosphate binder
_____________
- Calcitriol
- Activated vitamin D
____________
- Erythropoietin
- Black box warning
- Know how to use
Treat complications
FVE
- Loop diuretic – furosemide
- Use with low salt diet
Hyperkalemia
- Multiple drugs used, ex: diuretic
- Addressed with hemodialysis in ESRD (end stage renal disease)
Metabolic acidosis
- Sodium bicarbonate
- An alkaline agent
Hyperphosphatemia
- Calcium carbonate
- Phosphate binder
Renal osteodystrophy
- Calcitriol
- Activated vitamin D
Anemia
- Erythropoietin
- Black box warning
- Know how to use
Chronic glomerulonephritis vs Acute glomerulonephritis?
Increased scar tissue = decreased kidney function
Chronic glomerulonephritis
manifestations
- recurring episodes of vertigo
- n/v
- hearing loss
- ringing in ears
- feeling of fullness
Meniere’s disease
Variety of conditions that cause inflammation of glomeruli
- Focal –
- Diffuse –
- Primarily an immune process
Variety of conditions that cause inflammation of glomeruli
- Focal – specific location
- Diffuse – both kidneys, and all areas of glomeruli
- Primarily an immune process
Patho
- Increased pressure in eyes
- Decreased blood flow to eyes
- Nerve fiber death = blindness
Glaucoma
______________
Used to treat renal osteodystrophy
MOA
- Activated form of vitamin D
- Stimulate intestinal absorption of calcium/phosphate and bone mineralization
s/e
- Hypercalcemia – know s/s
- Hyperphosphatemia
Calcitriol
hypercalcemia - sedative
Open angle vs Closed angle glaucoma?
Risk factors
- Elevated IOP
- OA
- Black
- Family hx
- Myopia
- DM
- HTN
- Migraines
Risk factors
- Asian
- Female
- Hyperopia
- Family hx
- OA
open
closed
renal calculi/kidney stones
- Clumps of crystals in the urinary tract
- Size – ranges from grain of sand – golf ball
- Shape – smooth or jagged
- Commonly causes obstruction
Nephrolithiasis
Open angle vs Closed angle glaucoma?
- Outcome based on time from onset to treatment?
- an emergency!
- Triggered by Anticholinergic drugs?
all closed
Impotence
Inability to achieve or sustain erection sufficient for satisfactory sexual intercourse
Erectile dysfunction
Manifestations of disease or condition that affects the liver or kidney?
- Hematuria
- Oliguria
- Fluid retention – increased BP
- Increased BUN/Cr ratio – indicates poor kidney function
- Proteinuria – protein leaking in glomerulus
- Low albumin/hypoproteinemia – protein leaking in glomerulus
Glomerulopathy
is a general term that refers to any disease or condition that affects the glomeruli
2 types Macular degeneration:
___________ (most common)
- Yellow deposits in the retinal pigment epithelium
____________
- Growth of new leaky blood vessels in an abnormal location of the retina
Dry – non-exudative (most common)
- Yellow deposits in the retinal pigment epithelium
Wet – exudative
- Growth of new leaky blood vessels in an abnormal location of the retina
________________
Glomerulus is too permeable to plasma proteins
Etiology of _____________
- Glomerulonephritis – effects GBM
- DM – effects GBM
Nephrotic syndrome
Glomerulus is too permeable to plasma proteins
Cataracts
Cloudy lens
If left untreated = ________
Treatment = ________
blindness
surgery
________ angle glaucoma
- avoid triggers
- surgical intervention
_________ angle glaucoma
- drugs that decrease aqueous humor production
- drugs that increase aqueous humor drainage
- both
closed
open
_________ cancer Manifestations
Early
- Hematuria – pink/red b/c from ________
Late
- UTI s/s – frequency, urgency, dysuria
bladder
kidney cancer - dark, cola colored urine
CKD - Complications of drug therapy
- Many drugs are excreted through__________
- ____________ - drug doses and frequency may be adjusted when kidney function/drug elimination is decreased
Drugs of concern - T/F
- Digoxin
- Tylenol
- Diabetic agents – glyburide, metformin
- Abx – vancomycin
- Opioids – morphine
Complications of drug therapy
- Many drugs are excreted through kidneys
- Renal dosing - drug doses and frequency may be adjusted when kidney function/drug elimination is decreased
Drugs of concern
- Digoxin
X - Tylenol
- Diabetic agents – glyburide, metformin
- Abx – vancomycin
- Opioids – morphine
Glomerulonephritis
Damage occurs in the
_________ - delicate network of arterioles w/in the bowman’s capsule
- all the blood in our body goes through this
________ – massive consumer of oxygen
- Kidneys use a lot of O2 to be able to filter toxins
- BP has to be high enough to perfuse kidneys in order for everything to work
- Glomerulus
- Tubules
Pyelonephritis Etiology
- __________ infection – starts as lower UTI and infection ascends up the urinary tract
- ___________infection – from pathogens commonly E. coli
- ascending infection – starts as lower UTI and infection ascends up the urinary tract
- blood stream infection – from pathogens commonly E. coli
Prostate or testicular cancer?
s/s
- Early – asymptomatic
- Later – symptomatic when advances and metastasized
o UTI type s/s
o Other s/s based on where it has spread
Bone pain – bones
Cough, sputum – lungs
prostate
testicular=
Early s/s
- Enlargement of testicles
- Painless mass or
- Discomfort
o Ache in groin
o Sensation of heaviness
Late s/s
- Frank pain
- Signs based on metastatic spread
o Cough – lungs
o Hemoptysis
o Swelling of LE
o Back pain
o Dizziness
Treatment _________
Mild s/s
- Monitor
Moderate s/s
- Drug therapy
o 5 alpha reductase inhibitors
o Alpha 1 adrenergic antagonists
Severe symptoms
- Invasive options
BPH
Patho of CKD is a _________ problem that occurs
Important to monitor
- ______
- ______
2 of the biggest culprits AND indicators of worsening CKD
- ________uria
- ________ – vasoconstrictor
Patho of CKD is a cyclical problem that occurs
Important to monitor
- BP
- Urine
2 of the biggest culprits AND indicators of worsening CKD
- Proteinuria
- Angiotensin II – vasoconstrictor
2 types of
Diabetic retinopathy
High blood sugar causes poor blood flow to retina and damaged blood vessels in retina
Non-proliferative retinopathy and proliferative retinopathy
Etiology ___________
- Hormone imbalance – estrogen and testosterone
- DHT accumulation – increased levels of DHT = activate growth factors
o Acts on skin – acne
o Acts on hair follicles – chest, not scalp
o Stimulates growth of prostate cells
BPH
CKD
No longer maintains F&E balance =
- Edema
- _______kalemia!!!
- ______phosphatemia
- ________magnesemia
- Metabolic acidosis – accumulate acidic waste products
No longer maintains F&E balance =
- Edema
- Hyperkalemia!!!
- Hyperphosphatemia
- Hypermagnesemia
- Metabolic acidosis – accumulate acidic waste products
Glomerulus is too permeable to plasma proteins
- Elimination of >3 grams of protein/day
Nephrotic syndrome
________________
Occurs when retina has a tear or leak
Vitreous humor (eye ball juice) flows behind retina (not supposed to be there, supposed to be in eye ball)
Rapid and progressive detachment from the choroid
Retinal detachment
2 types: of testicular cancer
______________
- Arise from immature germ cells
- Slow growing
- Nonaggressive
- Easily cured with radiation
_______________
- Arise from mature germ cells
- More aggressive
- Usually treated with surgery
Non-seminomas, Seminomas
2 types:
Seminomas
- Arise from immature germ cells
- Slow growing
- Nonaggressive
- Easily cured with radiation
Non-seminomas
- Arise from mature germ cells
- More aggressive
- Usually treated with surgery
Drug: _______
MOA
- Blocks conversion of testosterone to DHT – alpha 1 and 2 receptors
- Decrease epithelial tissue in prostate
s/e
- Impotence
- Decreased libido
- Gynecomastia – abnormal growth breast tissue
Class: Alpha 1 adrenergic antagonists
Drug: dutasteride
for BPH
CKD
No longer rids the body of wastes via urine =
- __________ – no appetite
- Malnutrition
- Itching
- _________ – waste crosses BBB
- __________ – accumulate acidic waste products
No longer rids the body of wastes via urine =
- Anorexia – no appetite
- Malnutrition
- Itching
- CNS changes – waste crosses BBB
- Metabolic acidosis – accumulate acidic waste products
________________
Treats metabolic acidosis
Goals
- Slow progression of CKD
- Prevent bone loss
- Improve nutritional status
- Increase bicarb
Route
- PO
Indicated
- When HCO3 (bicarbonate) is < 15 mEq/mL
s/e
- Bloating
Sodium bicarbonate
Meniere’s disease
Endolymphatic hydrops
- episodic disorder of the middle ear, unilateral or bilateral
- _________ (excessive endolymph) fills ear and pressure messes with ________ and _________ function
Meniere’s disease
Endolymphatic hydrops
- episodic disorder of the middle ear, unilateral or bilateral
- fluid (excessive endolymph) fills ear and pressure messes with balance and hearing function
ED Classification
_________ – rare
- lifelong inability to have a normal erection
o severe psychiatric problems
o early vascular trauma
__________– most common
- ED in someone with a hx of normal erection
Classification
Primary – rare
- lifelong inability to have a normal erection
o severe psychiatric problems
o early vascular trauma
secondary – most common
- ED in someone with a hx of normal erection
