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Kidney Function And Drugs Flashcards

0
Q

Nephron

1) . Is the
2) It’s job is to…
3) kidney damage is so bad because…
4) consists of

A

1) basic functional unit of the kidney
2) . Job is to regulate water and soluble matter (especially electrolytes) in the body
3) because it does not generate
4) consists of the renal corpuscle (glomerulus, bowmans capsule) proximal convoluted tubules, loop of Henle, distal convoluted tubules and collecting ducts

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1
Q

Trigone of bladder

A

2 ureters

I urethra

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2
Q

Glycosaminoglycans (GAGS)

1) found
2) . What do they do
3) defects are factor in…
4) examples

A

GAGS

1) they are found covering the transitional epithelium of the urinary tract
2) they keep microorganisms and crystals from adhering to the bladder wall
3) the defects in surface GAGs are believed to be a factor in FLUTD
4) ex- cranberry juice, crab abiding makes the bladder wall slippery so bacteria doesn’t stick

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3
Q

AZODYL

Think…

A

Claims to have the potential to reduce azotemia though enteric (intestine) dialysis

Azotemia= AZODYL

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4
Q

What are used for urolith treatments?

3

A

Urinary acid fires
urinary alkalizer
xanthine oxidase inhibitors ( with diet think… Thin … Can (b) thin) oko

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5
Q

With urolith treatment we should

1) types of urolith includes
2) each type is….

A

Put on diet
1) struvite (magnesium ammonium phosphate) calcium orca late, calcium phosphate, irate, cystine, and mixed
2) each type is treated differently and may include :
dietary management as well as
drug treatment

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6
Q

What is a urolith

A

Abnormal mineral masses in urinary system (ex: kidney/bladder)

Compact sand grid= stone

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7
Q 
What's is a urinary acidified used for?
Ex: 
It Produces 
Prevents
Side effects
But since introduction of \_\_\_\_\_\_, urinary acidifiers have not been routinely prescribed
A

Used for urolith treatment
Ex: Methigel

It’s used to produce acid urine <7

It assists in dissolving and preventing formation of struvite urolith

Side effects:gi disturbances

Since introduction of urinary acidifying diets

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8
Q

Urinary alkalizer

Ex:

Used in

Difficult to

The side affects

A

Ex: potassium citrate, sodium, bicarbonate

Used in the management of ammonium acid urate, calcium oxalate crystals and Cystine urolihiasis

Difficult to dissolve calcium oxalate crystals without altering calcium metabolism in body

Side effects are possible fluid and electrolyte imbalances

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9
Q

Xanthine oxalate inhibitors

Ex:
- decreases….

1) found mostly in
2) side effects

A

Ex: Allopurinol

  • decreases the production of uric acid produced by xanthine oxidase
    1) found mostly in dalmatians and patients with gout
    2) Side effects: uncommon
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10
Q

What is ACE

A

Angiotensin Converting enzyme

used in renin-angiotensin-aldosterone system

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11
Q

Ace inhibitors cause….

A

No water retention!!

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12
Q

Renin-angiotensin-aldosterone system
Regulates

Occurs when

A

Regulates blood pressure and water (fluid) balance

When blood volume is low, kidneys secrete renin directly into circulation

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13
Q

Steps of the Renin-angiotensin-aldosterone system

A

Renin converts angiotensin I to angiotensin II by ACE (angiotensin converting enzyme)

angiotensin lI causes blood vessels to constrict which increases blood pressure and also secretes aldosterone (builds up fluid in the body)

The Aldosterone causes kidney tubules to increase reabsorption of sodium (Na) and water into the blood, which increases volume of fluid in the body and increases blood pressure

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14
Q

ACE inhibitors drop blood pressure by

A

Ace inhibitors block conversion of angiotensin I to angiotensin ll
decrease aldosterone secretion decrease peripheral arterial resistance and alleviate vasoconstriction

which all drop blood pressure

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15
Q

ACE inhibitors treat

Side effects

Examples

A

ACE inhibitors treat:
severe or non-responding hypertension,
heart failure,
protein losing glomerulonepathies

Side effects: are complications in patients with renal insufficiency

Ex: benazepril, captopril, enalapril

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16
Q

Vasodilators and calcium channel blockers

May be be substituted for or used in combination with other mess when …

Vasodilator a example:

Calcium channel blocker ex:

Side effects

A

When previous drug therapy to control hypertension fails

Vasodilator example- Dopamine
It May be used to promote diuresis in patience unresponsive to loop or osmotic diuretics

Calcium dilator example: silo tarzen, amlodipine

Side effects: hypotension
Edema 
conduction disturbances
Heart faliure 
Bradycardia
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17
Q

Vasodilator example

A

Dopamine

Maybe used to promote diuresis in patients unresponsive to loop or osmotic Diuretics

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18
Q

Calcium channel blocker example

A

Dilitazem and amlodipine

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19
Q

What is GFR?

A

Glomerular penetration rate

How fast plasma is filtered through glomerulus

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20
Q

What to hormones are responsible for the majority of urine volume regulation

A

Antidiuretic hormone (ADH)

Aldosterone

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21
Q

What does aldosterone do?

A

It increases reabsorption of sodium (Na) in DCT and collecting ducks back into the blood

This causes and osmotic imbalance which causes water to go back into the blood along with the sodium

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22
Q

Collecting ducks are the site of …

A

Anti-diuretic hormones (ADH ) which prevents dehydration

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23
Q

Antidiuretic hormones do what especially

A

Stop urination
Prevent water loss
Regulate fluid balance

It is a failsafe mechanism so that we don’t dehydrate if we have lack fluid intake

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24
Increase in urine volume
Polyuric
25
Increase in thirst
Polydipsia
26
Cholinergic agonist is for
Expulsion | urinary incontinence
27
Anticholinergic agents are for
Retention | urinary incontinence
28
Aderenergic agonists are split into
Alpha and beta
29
With potassium sparing diuretics | Think
Conserve potassium Enhance excretion of sodium and water and reduces excretion of potassium Hyperkalemia if given with potassium (uncommon)
30
Hypokalemia involves-
Hypo-k loss Ex- loop diuretic, thiazides diuretic, carbonic anhydrase inhibitors Hyper- k retention Uncommon-potassium sparing diuretic
31
With loop diuretic think...
Lasix ( furosemide) It inhibit reabsorption of sodium at LOOP of Henle Promote CL, k and water Lung fluid
32
Micturition
Expulsion of urine in the urinary bladder into the urethra (urinating)
33
Secretion 1) Leaves through.... Which are also... 2) secreted are ... Think hon
1) the tubular filtrate in the DCT leaves through the collecting ducks as urine Collecting ducts are also the site of antidiuretic hormone action which prevents dehydration 2) important substances secreted are hydrogen, potassium, and ammonia
34
Gloucosuria Rates?
Renal threshold of glucose: The blood glucose level gets too high, The amounts of glucose filtered through the glomerulus exceeds the amount That can be reabsorbed and it is lost in the urine Rates: 180 for a dog And 240 for a cat
35
Diuresis
Increasing urine flow Think diuretic
36
Diuretic drugs... Ex:
Used to remove excess extracellular fluid by increasing urine flow (diuresis) and Na excretion and reducing hypertension (sodium +water= lower blood pressure) ``` Ex: cplot loop diuretic Osmotic diuretic Thiazide diuretic Potassium-sparing diuretics Carbon anhydrase inhibitors ```
37
When Na is reabsorbed excessively ( maybe with Cl and water) | ____ can be an issue
Hypokalemia Deficiency of k Promote k excretion
38
Whenever there is a Hypokalemia risks or loss of k we have to ...
Give water!!!
39
Hypertension
High blood pressure
40
What help with lung fluid?
Loop diuretics
41
What are the functions of the kidney
Think thbpp ``` Filter toxins in blood, mainly urea Maintain homeostasis Production of hormones Blood volume control Blood pressure regulation ```
42
Homeostasis is a function of the kidney | It is maintained by
FFA Filtration, reabsorption, secretion Fluid balance regulation Acid base balance regulation
43
Filtration of kidneys
Glomerular capillaries have large fenstrations in capillary endothelium (single layer) But they're not large enough to allow blood cells or large protein to pass High bp in glomerular capillaries force some plasma out into the space of Bowmans capsule Glomerular filtrate rate: GFR is how fast plasma is filtered through glomerulus
44
Kidneys are located
Retroperitoneal: outside the abdominal cavity Right more cranial
45
Urinary system...
2 kidneys, 2 ureters, urinary bladder, and urethra
46
Hilus
Indented medial side of kidney where the ureters, nerves, blood and lymph vessels enter and leave
47
Kidney are the most.... It....
Important single route of waste removal Filters all waste products out of the bloodstream, but allow elements needed by the body to stay in
48
Reabsorption When.... ______ leaves ______ and enters the About ___ of reabsorption occurs in ____ (examples) Then filtrate goes to _____ and then ____
Useful substances go back into bloodstream Glomerular filtrate leaves Bowman's capsule and enters that PCT (Called tubular filtrate) About 65% of reabsorption occurs in PCT (water, any, CL, K, CA, bicarb, 100% glucose and amino acids) Filtrate now goes to loop of Henle and then DCT
49
Secretion _____ in the ____ leaves through the _____ ______ as _____ Important substances secreted are _____, _____, and ______
The tubular filtrate in the DCT leaves through the collecting ducts as urine Important substances secreted are hydrogen, ammonia, and potassium (Think... Hap)
50
The presence of abnormal amount of protein in the urine is used as an
Indicator of glomerular damage
51
Kidney hormones are responsible for the
Two hormones are responsible for the majority of urine volume regulation and how the body keeps fluid Antidiuretic hormone (ADH) and aldosterone
52
Secretion | Impaired
All these actions may be inhibited in cases of renal failure or dysfunction Impaired renal excretion of biotransformation cause delayed elimination of many drugs and enhances their toxicity and duration of action Delayed Excretion will increase the drugs half-life and therefore cause toxicity The doctor may extend the regiment or drop the dose
53
Presence of abnormal amounts of protein in the urine is used as What is gloucosuria?
An indicator of glomerular damage Renal threshold of glucose: when the blood glucose level gets too high, the amount of glucose filtered through the glomerulus exceeds the amount That can be reabsorbed and it is lost in the urine Canine: 180 mg/Dl Feline: 240 mg/dl
54
Antidiuretic hormone (ADH) 1) Acts on_____ 2) Used to ______ 3) it prevent ___ and regulates_____
1) Acts on DCT and collecting ducts to promote water reabsorption 2) used to stop urination/ water-sodium stays 3) prevent water loss from the body, regulate fluid balance
55
``` Antidiuretic hormone (ADH) When it works properly... ``` If ______ is not releasing adequate amounts of ADH... So there is ____, ____ One of these factors when diagnosing _______ Ex: vasopressin
Antidiuretic hormone When working properly, it's the body's failsafe mechanism so that we don't dehydrate if we have lack of fluid intake If the posterior pituitary gland is not releasing adequate amounts of ADH, water is not Reabsorbed So there is an increase in urine volume (polyuric) and therefore an increase in thirst (polydipsia) One of the factors when diagnosing diabetes insipidus Ex: vasopressin
56
Aldosterone
Increases reabsorption of sodium in DCT and collecting ducts back into the blood This causes an osmotic imbalance which causes water to flow back into the blood along with the sodium
57
What increases the reabsorption of sodium in DCT and collecting ducts back into the blood and also causes an osmotic imbalance which causes water to go back into the blood along with the sodium
Aldosterone
58
Collecting ducts are also the site of
Antidiuretic hormone (ADH) action which prevents dehydration
59
# Define renal dysfunction What's happens when waste builds up....
Any pathological condition that results in the inability of the urinary system to adequately remove waste materials from the blood Waste materials built up in the blood and become toxic to the pet and the resulting condition is called uremia
60
# Define uremia A resulting condition of... Uremia increases... contraindications
Abnormally high concentrations of urea, creatine, and other nitrogenous end products of protein and amino acid metabolism in the blood Waste materials build up in the blood and become toxic to the pet and the resulting condition is called uremia Uremia can increase the sensitivity of some tissues to certain drugs Contraindications- xy alone and ketamine
61
If it kidney's functionality is decreased blank may not occur correctly
Erythropoesis
62
What about erythropoietin?
It's the formation of erythrocytes And may not occur correctly with kidneys function impaired it is a hormone secreted by a healthy kidney That communicates with the bone marrow to make a more RBC In disease kidneys the hormone is reduced or not at all Epogen is a last ditch effort to help the non-regenerative anemia
63
What should a slide look like in diseased kidneys
Non-regenerative anemia, normochromic, normocytic
64
how does a diseased kidney affect the RBCs?
Bone marrow is unable to respond to the anemia and there are no reticulocytes because it's non regenerative
65
What can be done for non-regenerative anemia? And Kidney failure
Sometimes injections of human recombinant erythropoietin (epogen), but this is considered a last ditch effort PCV should be monitored on a weekly basis until improvement is reached or after the dose has been decreased PCV you should be in the "teens" before therapies consent
66
What are the types of kidney failure?
Prerenal uremia Renal uremia Post renal uremia
67
What is pre-Renal uremia and how can we try to fix it
It's decrease in blood flow to the kidneys It may be caused by dehydration, CHF, or shock In this case the kidneys are functioning properly but there isn't enough blood reaching them, so waste material can't be adequately removed And try to fix it with fluids Yes- kidney function No- blood flow
68
What is Renal uremia?
Inability of the kidney to adequately regulate urine production because of that incident nephrons Examples are toxins inflammation and infection There is adequate blood flow but not enough functional nephrons, so waste removal can't take place properly Yes- blood flow No-nephrons
69
What is post renal uremia?
And obstruction that prevents urine from being expelled from the body Ex: tumor, blood clot or urolith (stones)
70
What is used to remove access extracellular fluid by increasing urine flow or diuresis and sodium excretion and reducing hypertension?
Diuretic drugs | Cplot
71
What are the diuretic drugs?
Loop, osmotic, thiazide, potassium sparing, and carbonic anhydrase inhibitors Think cplot
72
Remove extracellular fluid by.... Reduce hypertension (sodium/water and low blood pressure) Increase urine flow (diuresis) Increase Na excretion
Diuretic Drugs
73
What are the diuretic drugs?
Loop, osmotic, thiazide, potassium sparing, and carbonic anhydrase inhibitors Think cplot
74
Hypertension
High blood pressure
75
Loop Diuretics... must have
WATER!
76
``` Loop Diuretics... ex: ____ ____ inhibits.... actions are .... and given.... Tremendous .... promotes excretion of... ```
Loop Ex: Furosemide; Lasix Inhibits tubular reabsorption of Na at loop of henle Actions are Quick and given IV Tremendous diuresis Promotes excretion of CL, K, and water Clincal use- pulmonary edema, hypercalcemia nephropathy,
77
Osmotic Diuretic Ex: Administered- IV to promote... by...water is draw into glamorous filtrate, reducing its reabsorption and increasing the secretion of water
Ex: Glucose and mannitol | Admin. IV to promote DIURESIS by exerting high OSMOTIC PRESSURE in the kidney tubules and limiting tubular reabsorption.
78
ex: Hydrochlorothiazide Reduce edema by inhibiting reabsorption of Na, Cl, water at the renal tubules, Duration of action is longer than looop diuretics Cross placenta border Clinical uses: nephrogenic diabetes insipidus and hypertension Side effects: hypokalemia if therapy is prolonged, cardiac dysfunction
Thiazide DIuretic
79
Drugs used to treat oliguric acute renal failure (urine production has decreased or almost stopped) and to Reduce intracranial and intraocular pressure Side effects are vomiting and electrolyte imbalances
Osmotic Diuretic | Eye and Brain trauma
80
1) Eye or brain diuretic 2) Pregnant 3) Pulmonary edema 4) conjunction with aldosterone antagonists 5) Reduce intraocular pressure by reducing the production of aqueous humor- used to treat GLAUCOMA
1) Osmotic Diuretic 2) Thiazide DIuretic 3) Loop 4) Potassium-sparing diuretics 5) Carbon Anhydrase inhibitors
81
``` Ex:Spironolactone -Weaker diuretic and antihypertensive effects, but they do conserve potassium -usually used in conjunction with other diuretic, mainly loop - -a.k.a. aldosterone antagonists Side effect: HYPERkalememia -ENHANCES SODIUM/WATER EXCRETION -REDUCES POTASSIUM SECRETION ```
Potassium-sparing diuretics
82
ex: acetazolamide - Block action of carbon anhydrase, which is used by the body to maintain acid-base balance - Reduce intraocular pressure by reducing the production of aqueous humor and may be used to treat GLAUCOMA - Side effects: Hypokalemia, metabolic acidosis (tachypnea, twitching, mouth ulcers, weight loss, muscle loss)
Carbon Anhydrase inhibitors
83
# Define Urinary Incontinence Two types
The loss of voluntary control of micturition 1) Neurologic 2) non-neurolgic
84
Example neurologic... | Urinary Incontinence
Trauma to the spinal cord, tumors of the nervous sytem | Dashond= slip disks/bladder issue
85
Example of non-neurologic | Urinary Incontinence
neoplasia (cancer), trauma to the bladder itself, stress, hormones
86
Expulsion to treat urinary incontinence is done with...
CHOLINERGIC AGONISTS
87
Retention to treat urinary incontinence is done with...
ANTICHOLINERGIC AGENTS
88
Anticholinergic Agents (retention) 1) their action produces muscle.... 2) Used to treat.... 3) Side effects... 4) they are.... 5) aka...
1) their action produces muscle MUSCLE RELAXATION 2) Used to treat URGE incontinence by promoting the retention of urine in the urinary bladder 3) Side effects... Decreased gastric motility and delayed gastric emptying, which may decrease the absorption of other medications 4) they are.... SLOW! 5) aka... Parasympatholytic because they block Ach at receptor sites in the parasympathetic nervous system.
89
What treats Urinary Incontinence Classification based on....
1) Cholingeric Agonists (Expulsion) 2) Anticholinergic Agents (Retention) 3) Adrenergic Antagonists Beta and Alpha
90
Reduces internal sphincter tone when the urethral sphincter is in hypertonus (increased tension) Side effect syncope (pass out) SYMPATHETIC
Alpha Aderenergic Antagonists (Ex: prazoin, phenoxybenzamine) (classified by site of action)
91
inhibit catecholamines control mild to moderate hypertension associated with CRF Decrease Cardiac output and promotion of bronchospasm
Beta Aderenergic Antagonists (ex: propranolol) (classified by site of action)
92
Non-neurologic urinary disorder 1) includes.... 2) what can increase urethral tone? 3) how do we treat most urinary incontinence mostly seen in spayed female dogs? 4) DES out so we use
1) includes stress, URGE!!!, Hormone response ectopic ureter formation, over distension 2) Alpha and Beta adrenergic agonists 3) Estrogen treats hormone responsive urinary incontinence in spayed female dogs 4) PPA
93
When blood volume is low, kidney's secrete ....
renin directly into blood stream
95
Kidney's secrete renin into the bloodstream when...
When blood volume is low

Vet 2 (10 decks)

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