Exam 2 Embryo/Anatomy/Pharm Flashcards
(35 cards)
What drains urine before kidneys form?
external glomerulus, connects to body cavity
What does mesonephric duct before?
males-vas deferens
females-regresses/Gardner’s cyst of broad ligament
What is the allantois?
precursor to bladder
becomes median umbilical ligament
Accessory renal artery problem
can compress renal pelvis, cause backup
no collateral circulation to kidney it supplies (cannot just ligate artery)
Cause of horseshoe kidney
IMA blocking ascent
Line of Broedel on kidneys
segments kidney blood supply
SMA compression of renal vein
causes SMA syndrome compresses duodenum (vomiting) or L renal vein (varicocele)
Differentiating pyelonephritis from cystitis
cystitis does not have a fever
Differentiating cystitis from urethritis
cystitis has hematuria and bacteriuria
Reasons to tx uncomplication UTI’s
pregnancy
GU procedure
within 48hrs of cath removal
Tx for acute uncomplication cystitis
TMP-SMX (also good for systemic)
nitrofurantoin (avoid in elderly)
fosfomycin
Nitrofurantoin characteristics
alters ribosomal proteins
is reduced by bacterial flavoproteins (to active)
no resistance
filtered by kidneys only (does not work systemically)
TMP-SMX characteristics
PABA analog (inhibits folate synthesis)
has resistance
can cause megaloblastic anemia/kernicterus
do not use in pregnancy
Fosfomycin characteristics
blocks NAM synthesis via MurA stops cell wall synthesis analog of phosphoenolpyruvate transported via G6P system safe in pregnancy
Tx for acute pyelonephritis
TMP-SMX
cipro/levofloxacin if less than 10% resistance
IV ceftriaxone/aminoglycosides if more
Tx for asymptomatic bacteriuria in pregnancy
amoxicillin
cephalexin
fosfomycin
nitrofurantoin (can cause hemolytic anemia/birth defects)
Drugs not to use with UTI in pregnancy
fluoroquinolones (cartilage damage)
aminoglycosides (ototoxicity)
tetracyclines (change in bone formation)
Drugs only to use in 2nd trimester of pregnancy for UTI’s
nitrofurantoin-can cause cardiac defects
TMP-SMX (neural tube defects in 1st trimester/kernicterus in 3rd)
Tx for acute pyelonephritis in pregnancy
Beta lactams (3rd gen ie ceftriaxone) carbapenems for resistant strains
Prophylaxis tx for UTI’s by demographic
pregnancy-cephalexin/nitrofurantoin
sexually active-TMP-SMX/nitrofurantoin/cephalexin
post menopausal-estrogen replacement
Cranberry juice benefit for UTI’s prevention
A proanthocyanidins attach to fimbriae
When do you start meds for CKD?
GFR around 50-60ml/min
Changes in volume distribution
more acidic-displaced from albumin in uremia
high protein binding-more free in liver problems
small vol of distribution-increased change in conc
Metabolism by kidney for adjustment need
if over 30% excreted by kidney, needs adjustment in CKD
