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sav NUR 326 > week 3 content - exam 2 > Flashcards

week 3 content - exam 2 Flashcards

1
Q

Kidney stones pharmacology
Acute pain
- NASAIDS or morphine
- IV fluids
Preventative meds
- _______stones = HTZT diuretics
- _______stones = abx
- ________stones = allopurinol (gout related)

A

Kidney stones pharmacology
Acute pain
- NASAIDS or morphine
- IV fluids
Preventative meds
- Calcium stones = HTZT diuretics
- Struvite stones = abx
- Urate stones = allopurinol (gout related)

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2
Q

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

A

cataracts

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3
Q

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

A

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

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4
Q

_________ 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

A

Closed - AKA Acute angle closure glaucoma or narrow angle glaucoma

Open

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5
Q

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

A

Macular degeneration

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6
Q

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

A

Class: 5 alpha reductase inhibitors

Drug: finasteride

for BPH

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7
Q

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

A

prostate

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8
Q

____________
High blood sugar causes poor blood flow to retina and damaged blood vessels in retina

____________
High BP creates blockages in retinal blood vessels

A

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

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9
Q

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
A

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

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10
Q

Treatment of AKI or CKD
- Find cause
- Monitor labs
- Treat manifestations
- Avoid nephrotoxic drugs
- Monitor for CKD problems

A

AKI

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11
Q

Manifestations
- Spontaneous, sudden
- Unilateral vision loss
- Painless
- Floaters
- Flashes of light
- Curtain coming down effect – black line at top and bottom of vision field

A

Retinal detachment

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12
Q

The glomerulus
Capillary membranes have 3 layers
1. Endothelium
2. _________ (where a lot of issues occur)
3. Podocytes – special epithelial cells

A

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

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13
Q

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

A

BPH

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14
Q

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

A

Class: Alpha 1 adrenergic antagonists
Drug: tamsulosin

for BPH

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15
Q

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

A

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

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16
Q

Risk factors
- Age
- Family hx
- Race/ethnicity

BPH or testicular cancer?

A

BPH

testicular cancer =
- Family hx
- White
- Cryptorchidism
- HIV infection

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17
Q

_________ 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)

A

kidney

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18
Q

Nephrotic syndrome
Patho
1. Increased glomerular permeability
2. _________uria
3. _______albuminemia – _______ occurs bc low albumin causes fluid shifting

A

Patho
1. Increased glomerular permeability
2. Proteinuria
3. Hypoalbuminemia – third spacing occurs bc low albumin causes fluid shifting

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19
Q

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

A
  1. Type II – antibodies attach to antigens of the glomerular basement membrane “anti-GBM antibodies”
  2. 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
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20
Q

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

A

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

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21
Q

___________
Elevated intraocular pressure (IOP) + Vision changes
OR
Elevated intraocular pressure (IOP) + optic nerve damage

A

Glaucoma

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22
Q

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?

A

2nd line

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23
Q

______________
Prostate (glands surrounding the urethra) which Produces seminal fluid, have noncancerous/nonmalignant enlargement

3 cells involved

A

Benign prostatic hyperplasia BPH

  • Epithelial cells
  • Smooth muscle cells
  • Stromal cells
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24
Q

Diabetic retinopathy: Non-proliferative retinopathy vs proliferative retinopathy?

which one has
- Advanced retinopathy
- Growth of New blood vessels – abnormal, fragile and leaky

A

proliferative retinopathy

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25
Q

kidney stone Crystal formation enhanced by
o pH changes – ex: ______
o excessive concentrations of insoluble salts in the urine – ex: ________
o urinary stasis – ex: _________

A

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

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26
Q

Complications _________
- Obstruction – urine cant get out
- UTI – urine stasis
- Renal problems – problems travel further up into kidneys

A

BPH

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27
Q

CKD

Decreased production of __________ = Anemia

A

Decreased production of erythropoietin =
- Anemia

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28
Q

Manifestations
- Look and feel sick
- Sudden onset fever, chills, CVA tenderness
- dysuria, hematuria, frequency, urgency
- n/v
- anorexia

upper or lower UTI?

A

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

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29
Q

___________
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

A

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

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30
Q

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?

A

prostate

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31
Q

Germ cell tumors = __________ cancer

Germ cell – sperm forming cells w/in ________
Germ cell tumors – cancer

A

Germ cell tumors = testicular cancer
Germ cell – sperm forming cells w/in testicles
Germ cell tumors – cancer

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32
Q

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

A

Pyelonephritis

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33
Q

2 types of __________:
- Open angle
- Closed angle

which one most common?

A

glaucoma

  • Open angle
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34
Q

treatment
-abx
o Bactrim (trimethoprim/sulfamethoxazole)
o Ciprofloxacin

A

upper - Pyelonephritis

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35
Q

CKD

Decreased activation of _________ =
- Renal osteodystrophy, weakened bones from low Calcium

A

Decreased activation of vitamin D =
- Renal osteodystrophy, weakened bones from low Calcium

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36
Q

1st line treatment for __________ =

Latanoprost
Prostaglandin analogs

MOA
- Increases outflow drainage of aqueous humor

Indications
- ______________
- Ocular HTN

s/e
- Well tolerated

A

open angle glaucoma

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37
Q

why are there LOTS of manifestations with CKD?

Biggest concern = _______

A

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

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38
Q

causes of Meniere’s disease - T/F
- high salt diet
- caffeine
- alcohol
- stress
- smoking
- MSG
- Allergies

treatment of Meniere’s disease is only symptomatic?

A
  • high salt diet
  • caffeine
  • alcohol
  • stress
    X- smoking
  • MSG
  • Allergies

true

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39
Q

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.

A
  • Statis of urine – infection more likely
  • Back up of pressure – damages kidneys
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40
Q

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

A

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

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41
Q

which cancer has controversy around screening - prostate or testicular cancer?

A

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
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42
Q

optic topical beta blockers
_________ – nonselective beta blockers
__________– selective Beta blocker (beta 1 )

betaxolol
timolol

A

timolol – nonselective beta blockers
betaxolol – selective Beta blocker (beta 1 )

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43
Q

Risk factors for CKD
- Family hx
- Aging >60
- Male
- Black
- HTN
- DM
- Smoking
- Overweight/obese

which 2 are the biggest risk factors?

A

Risk factors
- Family hx
- Aging >60
- Male
- Black
- HTN!!
- DM!!
- Smoking
- Overweight/obese

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44
Q

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

A

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

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45
Q

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

A

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

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46
Q

do kidney stones commonly cause urinary obstruction/urine back up?

A

yes!

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47
Q

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?

A

AKI

yes

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48
Q

AKI

obstruction causing cell death, blockage, tumor

post renal, pre renal, intra renal?

A

post-renal

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49
Q

is a general term that refers to any disease or condition that affects the glomeruli

A

Glomerulopathy

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50
Q

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

A

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

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51
Q

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

A

Cataracts

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52
Q

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

A

testicular cancer

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53
Q

______________
Irreversible vision loss caused by retinal aging

A

Macular degeneration

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54
Q

Non-proliferative retinopathy and proliferative retinopathy

associated with Diabetic retinopathy or Hypertensive retinopathy

A

Diabetic retinopathy

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55
Q

Risk factors _________
- OA
- Eye trauma
- Congenital risk
- DM
- Corticosteroid use
- Smoking and alcohol

A

cataracts

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56
Q

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

A

testicular

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57
Q

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

A

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

58
Q

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 ______

A

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

59
Q

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

A

open angle glaucoma

60
Q

______________ disorders
Alterations in glomerular capillary

A

Glomerular disorders
Alterations in glomerular capillary

61
Q

o 5 alpha reductase inhibitors
o Alpha 1 adrenergic antagonists
for moderate __________

A

BPH

62
Q

1st line treatment for __________ = optic topical beta blockers
timolol – nonselective beta blockers
betaxolol – selective Beta blocker (beta 1 )

A

open angle glaucoma

63
Q

types of __________
o Calcium oxalate or calcium phosphate – most common
o Uric acid
o Cystine
o Struvite – magnesium ammonium phosphate

A

kidney stones

64
Q

_________ – 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

A
  • GFR (glomerular filtration rate)
65
Q

Glomerulus

Afferent arteriole – takes blood _______ the kidneys
Efferent arteriole – takes blood _______ the kidneys (higher pressure)
Pressure gradient – helps__________

A

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

66
Q

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

A

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

67
Q

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

A

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

68
Q

Testicular cancer
- Effects younger or older adults more?

Risk factors
- Family hx
- White
- _____________- undescended testicles.
- HIV infection

A

Testicular cancer
- Effects younger aged male more than older adults

Risk factors
- Family hx
- White
- Cryptorchidism
- HIV infection

69
Q

_________________
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

A

Calcium carbonate

70
Q

GFR

lower or higher value = the worse off the kidney are?

o Normal >____
o around _____ is renal insufficiency

A

o Lower value = the worse off the kidney are
o Normal >90
o ~25 is renal insufficiency

71
Q

Urinary obstruction locations
T/F

  • Renal pelvis
  • Ureter
  • Bladder or urethra
  • Anywhere in urinary tract
A

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
72
Q

Upper UTI, kidney infection
Inflammation of kidneys
Inflammatory response = kidney tissue damage
Abscess and necrosis can develop impairing renal function

A

Pyelonephritis

73
Q

AKI or CKD

  • Usually result of ischemic injury r/t loss of volume and decreased perfusion to kidneys
  • Toxins or sepsis common cause too
A

AKI

74
Q

“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

A

optic topical beta blockers
timolol – nonselective beta blockers
betaxolol – selective Beta blocker (beta 1 )

timolol

75
Q

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
A
  • 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
76
Q

Characterized by HARP
- Hematuria
- Azotemia – build-up of waste products
- Retention – Na and water retention + oliguria = edema and high BP
- Proteinuria

A

glomerulonephritis

77
Q

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

A

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

78
Q

AKI

Causes – blood loss, dehydrated

post renal, pre renal, intra renal?

A

pre-renal

79
Q

Risk factors ________
- Myopia – near sidedness
- > 40
- Trauma to head
-Eye tumors
-Complications or hx of cataract surgery

A

Retinal detachment

80
Q

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

A

BCG vaccine: intravesical therapy
Treats bladder cancer

81
Q

Urothelial carcinoma

A

lining of the bladder cancer

82
Q

risk factors for ____________
- men
- 20s-30s
- White
- Family hx
- Congenital defect
- Weather – hot = dehydration risk
- Obesity – immobility/sedentary lifestyle

A

Nephrolithiasis - kidney stones

83
Q

___________ pharmacology
Acute pain
- NASAIDS or morphine
- IV fluids
Preventative meds
- Calcium stones = HTZT diuretics
- Struvite stones = abx
- Urate stones = allopurinol (gout related)

A

Kidney stones

84
Q

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

A

kidney

bladder

85
Q

Manifestations of ___________
depends on
- site
- cause – stones, BPH, etc.
- speed of onset = acute or chronic worse?

severity of pain
depends on
- size
- blockage
- location

A

Urinary obstruction

-speed of onset
-acute = high pain
-chronic/insidious = low pain (bc the body can build a tolerance to it)

86
Q

Glomerulonephritis

A

kidney inflammation

87
Q

Retinopathy
Treatment
- Treat disease causing retinopathy (______ or _______)

A

Retinopathy
Treatment
- Treat disease causing retinopathy (DM, HTN)

88
Q
  • Depression
  • Low desire
  • Performance anxiety
  • Strained relationship

causing ED

would be primary, secondary organic, or secondary psychogenic?

A

secondary – ED in someone with a hx of normal erection
Psychogenic cause – mental problems

89
Q

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

A

closed

open

90
Q

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

A

Acute glomerulonephritis

91
Q

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

A

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

92
Q

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 _____

A

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

93
Q

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

A

BP control
ACE - lisinopril and captopril
ARB - losartan
other BP meds - hydralazine, nicardipine, nifedipine, aliskiren, diuretics, ___lol drugs, doxazosin, clonidine

lipid control
statins
ezetimibe

94
Q
  • 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?

A

secondary – ED in someone with a hx of normal erection
Organic cause – r/t blood flow, meds, body causes

95
Q

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

A

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

96
Q

kidney cancer Prognosis
depends on _______
- Bones
- Lungs

A

metastasis

97
Q

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

A

Hypertensive retinopathy
High BP creates blockages in retinal blood vessels

98
Q

Renal cell carcinoma

A

kidney cancer

99
Q

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

A

Class: PDE 5 inhibitors
Drug: sildenafil (Viagra)

100
Q

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?

A

intra-renal

101
Q

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

A

Macular degeneration - retinal aging

102
Q

Types of stones

  1. _______ or ________

Specific risks
- Family hx
- Idiopathic
- Diet high in calcemia and oxaluria (protein)

  1. ___________

Specific risks
- Urinary tract infection

  1. __________

Specific risks
- Gout

A

Types of stones

  1. Calcium oxalate or calcium phosphate – most common

Specific risks
- Family hx
- Idiopathic
- Diet high in calcemia and oxaluria (protein)

  1. Struvite “staghorn”

Specific risks
- Urinary tract infection

  1. Uric acid

Specific risks
- Gout

103
Q

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)

A

Acute glomerulonephritis
Abrupt onset of glomerulonephritis

Chronic glomerulonephritis
Long term inflammation of the glomerulus = scar tissue develops (can’t filter or produce urine effectively)

104
Q

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?

A

stage 5

stage 5

stage 4

stage 4

stage 2 maybe HTN, stage 3a

105
Q

Manifestations
Early
- None
Late
- Blurry
- Darkened vision
- Blind spots = scotomas
- Distorted vision = metamorphopsia

A

Macular degeneration - retinal aging

106
Q

6 stages of CKD
________ is how we monitor function and know what stage someone is in

A

GFR

107
Q

_______ 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

A

kidney cancer
dark blood coming from further away

compared to bladder cancer - blood is lighter bc bladder is closer to urethra

108
Q

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

A

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

109
Q

Chronic glomerulonephritis vs Acute glomerulonephritis?

Increased scar tissue = decreased kidney function

A

Chronic glomerulonephritis

110
Q

manifestations
- recurring episodes of vertigo
- n/v
- hearing loss
- ringing in ears
- feeling of fullness

A

Meniere’s disease

111
Q

Variety of conditions that cause inflammation of glomeruli
- Focal –
- Diffuse –
- Primarily an immune process

A

Variety of conditions that cause inflammation of glomeruli
- Focal – specific location
- Diffuse – both kidneys, and all areas of glomeruli
- Primarily an immune process

112
Q

Patho
- Increased pressure in eyes
- Decreased blood flow to eyes
- Nerve fiber death = blindness

A

Glaucoma

113
Q

______________
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

A

Calcitriol

hypercalcemia - sedative

114
Q

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

A

open

closed

115
Q

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

A

Nephrolithiasis

116
Q

Open angle vs Closed angle glaucoma?

  1. Outcome based on time from onset to treatment?
  2. an emergency!
  3. Triggered by Anticholinergic drugs?
A

all closed

117
Q

Impotence
Inability to achieve or sustain erection sufficient for satisfactory sexual intercourse

A

Erectile dysfunction

118
Q

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

A

Glomerulopathy
is a general term that refers to any disease or condition that affects the glomeruli

119
Q

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

A

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

120
Q

________________
Glomerulus is too permeable to plasma proteins
Etiology of _____________
- Glomerulonephritis – effects GBM
- DM – effects GBM

A

Nephrotic syndrome
Glomerulus is too permeable to plasma proteins

121
Q

Cataracts
Cloudy lens
If left untreated = ________

Treatment = ________

A

blindness

surgery

122
Q

________ angle glaucoma
- avoid triggers
- surgical intervention

_________ angle glaucoma
- drugs that decrease aqueous humor production
- drugs that increase aqueous humor drainage
- both

A

closed

open

123
Q

_________ cancer Manifestations
Early
- Hematuria – pink/red b/c from ________
Late
- UTI s/s – frequency, urgency, dysuria

A

bladder

kidney cancer - dark, cola colored urine

124
Q

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

A

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

125
Q

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

A
  • Glomerulus
  • Tubules
126
Q

Pyelonephritis Etiology
- __________ infection – starts as lower UTI and infection ascends up the urinary tract
- ___________infection – from pathogens commonly E. coli

A
  • ascending infection – starts as lower UTI and infection ascends up the urinary tract
  • blood stream infection – from pathogens commonly E. coli
127
Q

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

A

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

128
Q

Treatment _________
Mild s/s
- Monitor

Moderate s/s
- Drug therapy
o 5 alpha reductase inhibitors
o Alpha 1 adrenergic antagonists

Severe symptoms
- Invasive options

A

BPH

129
Q

Patho of CKD is a _________ problem that occurs

Important to monitor
- ______
- ______

2 of the biggest culprits AND indicators of worsening CKD
- ________uria
- ________ – vasoconstrictor

A

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

130
Q

2 types of
Diabetic retinopathy
High blood sugar causes poor blood flow to retina and damaged blood vessels in retina

A

Non-proliferative retinopathy and proliferative retinopathy

131
Q

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

A

BPH

132
Q

CKD
No longer maintains F&E balance =
- Edema
- _______kalemia!!!
- ______phosphatemia
- ________magnesemia
- Metabolic acidosis – accumulate acidic waste products

A

No longer maintains F&E balance =
- Edema
- Hyperkalemia!!!
- Hyperphosphatemia
- Hypermagnesemia
- Metabolic acidosis – accumulate acidic waste products

133
Q

Glomerulus is too permeable to plasma proteins
- Elimination of >3 grams of protein/day

A

Nephrotic syndrome

134
Q

________________
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

A

Retinal detachment

135
Q

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

A

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

136
Q

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

A

Class: Alpha 1 adrenergic antagonists
Drug: dutasteride

for BPH

137
Q

CKD

No longer rids the body of wastes via urine =
- __________ – no appetite
- Malnutrition
- Itching
- _________ – waste crosses BBB
- __________ – accumulate acidic waste products

A

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

138
Q

________________
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

A

Sodium bicarbonate

139
Q

Meniere’s disease
Endolymphatic hydrops
- episodic disorder of the middle ear, unilateral or bilateral
- _________ (excessive endolymph) fills ear and pressure messes with ________ and _________ function

A

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

140
Q

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

A

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

sav NUR 326 (19 decks)

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