Pharm II- Urinary Tract Drugs Flashcards
(193 cards)
1
Q
What type of acids & bases are actively secreted by the Proximal tubules?
A
weak acids & bases
2
Q
Are drugs with a charge or without a charge reabsorbed by the kidneys?
A
Drugs without a charge are reabsorbed
3
Q
Weak acids are more rapidly excreted in what type of urine?
A
Alkaline urine (like in herbivores)
4
Q
Weak bases are more rapidly excreted in what type of urine?
A
Acidic urine (like in carnivores)
5
Q
What drug competes with Pen for a cycle transporter & reduces the elimination rate (prolongs duration) of both drugs?
A
Probenicide
6
Q
Which drug inhibits uric acid secretion?
A
Sulphinpyrazone
7
Q
Passive reabsorption of a drug from the PCT depends on what 2 things?
A
pH of urine & pKa of the drug
8
Q
Renal excretion of weak acids ____ in low urinary pH (acidic urine).
A
Decreases
9
Q
Renal excretion of weak acids____ in high urinary pH (alkaline urine).
A
Increases
10
Q
Renal excretion of weak bases ____ in low urinary pH. (acidic urine)
A
Increases
11
Q
Renal excretion of weak bases ___ in high urinary pH (alkaline urine).
A
Decreases
12
Q
An acidic drug will be ______ in carnivores?
A
NON ionized (can be reabsorbed & prolongs drug's effects)
13
Q
A basic drug will be ____ in carnivores?
A
Ionized
is eliminated
14
Q
An acidic drug will be _____ in herbivores?
A
Ionized
is eliminated
15
Q
A basic drug will be ____ in herbivores?
A
NON-ionized
can be reabsorbed & prolongs drug’s effects
16
Q
The half life of a basic drug is less in which type of animal?
A
Carnivores
17
Q
The half life of an acidic drugs is less in which type of animals?
A
Herbivores
18
Q
Herbivores have delayed elimination of drugs with a ____ pKa.
A
high pKa
19
Q
Carnivores have a delayed elimination of drugs with a ____ pKa.
A
low pKa
20
Q
What drug decreases reabsorption of Glucose, H2O & Amino Acids in the PCT?
A
Dopamine
21
Q
What drug decreases the reabsorption of Na & Cl in the Ascending LoH?
A
Furosemide
22
Q
What 2 drugs increases the reabsorption of H2O, Ca, Na & Cl in the DCT?
A
Antidiuretic Hormone
Aldosterone
23
Q
What drug decreases the reabsorption of H2O, Ca, Na & Cl in the DCT?
A
Thiazide diurectics
24
Q
Which 2 drugs decrease the reabsorption of H2O, Ca, Na & Cl in the Collecting Ducts?
A
Atrial Natriuretic Peptide (ANP)
Urodilation
25
Where is most H2O reabsorbed?
Descending LoH
26
Where in the kidneys is there variable permeability to H2O?
DCT & Collecting Ducts
27
Which part of the glomerulus filters molecules based on size, shape & charge?
basement membrane of glomerulus
28
Which part of the glomerulus may phagocytose macromolecules?
visceral epithelium of the glomerulus
29
The basement membrane & podocytes only allow what to pass? (2)
small molecules & H2O
30
Which cells relax or constrict & change the available filtration area?
Mesangial cells
31
What causes relaxation of the mesangial cells & enhances the available filtration area?
Atrial Natiuretic Peptide (ANP)
32
What causes contraction of the mesangial cells & decreases the available filtration area?
Sympathetic innervation
33
What causes constriction of the mesangial cells & decreases the available filtration area?
Angiotensin II
34
______ blockers are important in preventing proteinuria in Cats.
Angiotensin II blockers
35
Glomerular nephritis is a/an _______ dz.
Immune Mediated Dz caused by immunoglobulin complexes
36
What percentage of H2O is reabsorbed in the PCT?
60-70%
37
The epithelium in the PCT is _____.
"Leaky" = passive flow in either direction
38
Na enters the cell via what?
Na/H exchanger
39
Na leaves the cell and enters the interstitium via what?
Na/K ATPase Pump
40
What is responsible for the counter-current system of the kidney?
the LoH
41
How is the counter-current system established in the kidney?
Via H2O permeability in the Descending limb & Na permeability in the Ascending limb
42
Where does active transport of Na occur?
THICK Ascending LoH
43
Which cells are responsible for the secretion of H in the Collecting Ducts?
Intercalated cells
44
Where in the Collecting Ducts can transport of H2O & ions can be individually regulated by hormones?
Tight jxns in between cells
45
Sprionolactone is an Aldosterone _____. What is its effect?
Aldosterone receptor ANTagonist
| Diuretic effect
46
Which 2 diuretics allow more Na to reach the Collecting Ducts?
Thiazide & Loop Diuretics
47
Which 3 drugs decrease Na reabsorption in the Collecting Ducts?
Amiloride
Triamterene
Spironolactone
48
Are there dissolution protocols available for Ca carbonate or Ca oxalate crystals/stones?
NO
49
Which type of crystals/stone can you dissolve w/ drugs?
Struvite crystals/stones
50
What is the primary mediator of benign prostatic hyperplasia in dogs?
overproduction of dihydrotestosterone (DTH)
51
How do you TX acute prostatisis?
W/ appropriate antibiotics
52
What are the causes of urinary incontinence in animals?
urge incontinence = Cystitis or bladder stones
Reactive/spastic bladder
Urethral sphincter incompetence in the bitch
53
Which nerve controls bladder contraction & opens the internal sphincter?
Pelvic nerve
54
Which nerve contracts the internal sphincter of the bladder & relaxes the detrusor mm of the bladder?
Hypogastric nerve
55
Which diuretics are the most powerful?
Loop Diuretics
56
What are the loop diuretics (3)?
Furosemide
Bumetanide
Torasemide
57
What is the MOA of Loop Diuretics?
Inhibits the Na/K/Cl carrier --> blocks the establishment of the chemical gradient
58
Which drugs have venodilator action through endothelin derived kinin (NO/PGI2)?
Loop Diuretics
59
Increased _____ conc. in the distal tubule results in increased loss of ____ & _____ ions.
Na
| H, K
60
Loop diuretics cause increased secretion of what 2 ions?
Ca & Mg
61
Loop diuretics cause decreased secretion of what?
Uric Acid
62
D: of Loop Diuretics?
strongly PPP
63
Metabolism of Furosemide?
Glucuronidation in the liver
64
Metabolism of Bumetanide & Torasemide?
CYP450 pathways in the liver
65
What are the side effects of Loop Diuretics?
HYPOKALEMIA
| Metabolic Alkalosis
66
How can one avoid hypovolemia & hypotension in patients receiving Loop Diuretics?
Make sure animal has enough water
67
Which diuretics act on the distal tubule?
Thiazide diuretics
68
MOA of thiazide diuretics?
Decrease active reabsorption of Na (& Cl) by binding to the CHLORIDE site of the Na/Cl symport system --> blocks active transport of Na & Cl
69
Thiazides increase the excretion of what 2 ions (driven by Na/K pump)?
H & K
70
Parathormone & Calcitriol increase what?
Ca reabsorption
71
What are the 2 thiazides used in Vet med?
Chlorothiazide
| Hydrochlorothiazide
72
Is K loss significant with Thiazide diuretics?
yes
73
What are the diuretic effects of thiazides?
moderate
74
Thiazides decrease the excretion of what 2 things?
Uric acid & Ca
75
Thiazides increase the excretion of what 2 ions?
Mg & Na
76
What are the extra renal actions of thiazides?
1. Vasodilation
2. Hyperglycemia (possible)
3. Decreased blood volume (result of direct action)
4. reduce bone loss in humans
77
What effect do thiazides have in Diabetes insipidus?
reduce the volume of urine
78
Thiazides cause an intial ______ in urine due to decreased blood volume.
increase
79
A: of Thiazides?
P.O; well absorbed in GIT
80
Thiazides compete with what for tubular secretion?
Uric acid
81
Clinical uses of Thiazides?
Hypertension
Mild heart failure
Central of Nephrogenic Diabetes insipidus
82
How do Thiazides help a patient with Diabetes insipidus?
diuresis --> decreased plasma volume --> decreased GFR --> Increased Na & H2O reabsorption
Counteracts excessive urine production
83
What are the renal side effects of Thiazides? (3)
HYPOkalemia
Metabolic alkalosis
Increased plasma [uric acid]
84
What are the non-renal side effects of Thiazides? (4)
hyperglycemia
Increased plasma cholesterol (long term use)
Male impotence
Hypersensitivity rxns
85
What do principle cells of the Collecting Ducts do?
Reabsorb Na
| Secrete K
86
What do the intercalated cells of the Collecting Ducts do?
Secrete H
87
Where can transport of H2O & ions be individually regulated by hormones?
Tight jxns between cells
88
What hormone influences the absorption of Na & Cl?
Aldosterone
89
Which 2 hormones influence H2O reabsorption?
```
Antidiuretic hormone (ADH)
Vasopressin
```
90
Aldosterone works where?
On the Collecting Ducts
91
Aldosterone enhances reabsorption of what?
Na
92
Aldosterone promotes excretion of what?
K
93
What is the quick effect of Aldosterone?
stimulation of Na/H exchanger
94
What is the delayed effect of Aldosterone?
binding to cellular receptors--> activates Na channels
95
Amiloride & Triamterene block what?
The binding of Aldosterone to cellular receptors
96
Spironolactone is a ____ _____ ____.
aldosterone receptor ANTagonist
97
Spironolatone has a _____ effect.
diuretic
98
How does ADH/Vasopressin cause a sustained increase in H2O permeability?
V2 receptor stimulation increases the # of aquaporins & H2O channels in the cell membrane
99
[K] is controlled by what?
Regulation of renal K excretion
100
What is the driving force for K excretion in the kidneys?
Negative potential difference of the lumen
101
K excretion will increase in what 2 ways?
More Na reaches the collecting ducts
| Increasing Na reabsorption in the collecting ducts
102
Which 2 diuretics cause more Na to reach the collecting ducts & increase K excretion?
Thiazide & loop diuretics
103
K excretion will decrease in what way?
Decreasing Na reabsorption in the Collecting duct
104
What 3 drugs cause decrease Na to reach the collecting ducts & decreases K excretion?
Amiloride
Triamterene
Spironolactone
105
What are the K sparing (Distal) diuretics?
Amiloride
Triamterene
Spironolactone
106
MOA of Spironolactone?
inhibits the Na/K exchange by competing w/ Aldosterone
107
MOA of Amiloride & Triameterene?
Inhibits Na/K exchange by directly decreasing activity of the pump
108
Distal (K sparing) diuretics decrease what?
K wasting
109
What is the activity of distal diuretics?
poor
| only increases when Na load or [Aldosterone] is high
110
3 clinical uses of distal diuretics?
1. decrease hypokalemia secondary to other diuretic use (CHF)
2. Edema--> hepatic dz & portal hypertension
3. Ascites --> hepatic dz & portal hypertension
111
A: of Spironolactone?
P.O.; well absorbed
112
What is the active metabolite of Spironolactone?
Canrenone
113
Side effect of Spironolactone & Amiloride.
HYPERkalmia
114
What are the 2 eicosanoids (prostaglandins) that effect renal fxn? (TQ)
PGE2 & PGI2
115
What is the fxn of PGE2 & PGI2?
Maintain sufficient renal blood flow
116
What causes production of PGE2 & PGI2? (6)
```
Ischemia
Trauma
Circulating Angiotensin II
Catecholamines
ADH
Bradykinin
```
117
What is the influence of PGE2 & PGI2 on hemodynamics?
Counteracts the Renin/Angiotensin/Aldosterone system --> Vasodilation in response to Angiotensin II & Nor Epi
118
What are the impacts of PGE2 & PGI2 on renal control of NaCl & H2O?
increases renal blood flow & natriuresis
119
What are the effects of NSAIDs on PGE2 & PGI2?
inhibits their production; effects renal perfusion
120
MOA of Osmotic diuretics?
Filters molecules in the glomeruls but does not allow them to be reabsorbed --> creates an osmotic gradient --> pulls H2O from the interstitium & blood into the urinary system
121
Where do osmotic diuretics act? (3)
Proximal tubule
Descending LoH
Collecting duct
(sites that are freely permeable to H2O)
122
What is the secondary effect of osmotic diuretics?
decreases Na reabsorption
123
What is the specific order of drugs given to manage oliguria or anuria?
Furosemide --> Osmotic diuretics --> Dopamine --> Fenoldopam --> Diltiazem
124
Fenoldopam is a _____ agonist with similar effects to dopamine.
D1 agonist
125
What are the 4 ways to inhibit the Renin-Angiotensin-Aldosterone System (RAAS)?
1. Angiotensin-converting enzyme inhibitors
2. Angiotensin Receptor blockers
3. Aldosterone receptor blockers
4. Renin inhibitors
126
What are the 2 angiotensin receptor blockers?
Losartan
| Telmisartan
127
Which diuretics are the most powerful?
Loop Diuretics
128
What are the loop diuretics (3)?
Furosemide
Bumetanide
Torasemide
129
What is the MOA of Loop Diuretics?
Inhibits the Na/K/Cl carrier --> blocks the establishment of the chemical gradient
130
Which drugs have venodilator action through endothelin derived kinin (NO/PGI2)?
Loop Diuretics
131
Increased _____ conc. in the distal tubule results in increased loss of ____ & _____ ions.
Na
| H, K
132
Loop diuretics cause increased secretion of what 2 ions?
Ca & Mg
133
Loop diuretics cause decreased secretion of what?
Uric Acid
134
Metabolism of Furosemide?
Glucuronidation in the liver
135
Metabolism of Bumetanide & Torasemide?
CYP450 pathways in the liver
136
What are the side effects of Loop Diuretics?
HYPOKALEMIA
| Metabolic Alkalosis
137
Which diuretics act on the distal tubule?
Thiazide diuretics
138
MOA of thiazide diuretics?
Decrease active reabsorption of Na (& Cl) by binding to the CHLORIDE site of the Na/Cl symport system --> blocks active transport of Na & Cl
139
Thiazides increase the excretion of what 2 ions (driven by Na/K pump)?
H & K
140
What are the 2 thiazides used in Vet med?
Chlorothiazide
| Hydrochlorothiazide
141
Is K loss significant with Thiazide diuretics?
yes
142
What are the diuretic effects of thiazides?
moderate
143
Thiazides decrease the excretion of what 2 things?
Uric acid & Ca
144
Thiazides increase the excretion of what 2 ions?
Mg & Na
145
What effect do thiazides have in Diabetes insipidus?
reduce the volume of urine
146
Thiazides cause an intial ______ in urine due to decreased blood volume.
increase
147
Thiazides compete with what for tubular secretion?
Uric acid
148
How do Thiazides help a patient with Diabetes insipidus?
Counteracts excessive urine production
149
What are the renal side effects of Thiazides? (3)
HYPOkalemia
Metabolic alkalosis
Increased plasma [uric acid]
150
What are the non-renal side effects of Thiazides? (4)
hyperglycemia
Increased plasma cholesterol (long term use)
Male impotence
Hypersensitivity rxns
151
Where can transport of H2O & ions be individually regulated by hormones?
Tight jxns between cells
152
Amiloride & Triamterene block what?
Aldosterone binding
153
How does ADH/Vasopressin cause a sustained increase in H2O permeability?
V2 receptor stimulation increases the # of aquaporins & H2O channels in the cell membrane
154
MOA of Spironolactone?
inhibits the Na/K exchange by competing w/ Aldosterone
155
MOA of Amiloride & Triameterene?
Inhibits Na/K exchange by directly decreasing activity of the pump
156
Distal (K sparing) are poor acting diuretics that decrease _____ only when Na/Aldosterone is high.
K wasting
157
What are the 2 eicosanoids (prostaglandins) that effect renal fxn? (TQ)
PGE2 & PGI2
158
MOA of Osmotic diuretics?
Filters molecules in the glomeruls but does not allow them to be reabsorbed --> creates an osmotic gradient --> pulls H2O from the interstitium & blood into the urinary system
159
Where do osmotic diuretics act? (3)
Proximal tubule
Descending LoH
Collecting duct
(sites that are freely permeable to H2O)
160
Osmotic diuretics primarily prevents reabsorption of _____ & secondarily decreases reabsorption of _____.
H2O
| Na
161
What hormone plays a large role in acute renal failure?
Angiotensin II
162
Fenoldopam is a _____ agonist with similar effects to dopamine.
D1 agonist
163
What are the 2 angiotensin receptor blockers?
Losartan
| Telmisartan
164
Which drug blocks aldosterone receptors?
Spironolactone
165
Which drug inhibits renin?
Aliskirine
166
What are the 2 receptor types for Angiotensin II?
AT1 & AT2
167
What do AT1 receptors mediate? (4)
VasoCONSTRICTION
Aldosterone & Vasopressin release
Na & H2O rentention
Sympathetic facilitation
168
What do AT2 receptors mediate? (4)
VasoDILATION
Na EXCRETION
Anti-proliferative effects
Limiting detrimental effects of AT1 activation
169
Telmisartan binds strongly to which Angiotensin II receptors?
AT1
170
What are the effects of Telmisartan?
strong antihypertensive effects
171
What is the PK of Telmisartan?
Lipophilic
Weak Acid
Binds reversibly to intracellular proteins (TQ)
172
How is Telmisartan metabolized in Cats?
Via glucuronidation (phase 2 rxns)
173
Which crystal/stone has a dissolution protocol?
Struvite crystals/stones
174
What drug can be used to TX Benign Prostatic Hyperplasia?
Finasteride
175
MOA of Finasteride?
5 alpha-reductase inhibitor--> blocks conversion of testosterone into DHT
176
What type of antimicrobial drug do you want to use to TX prostate infections? (acidic or basic) Second best choice? (TQ)
```
Basic antimicrobial (high pKa)
Lipophilic drugs
```
177
Which 2 drugs can be used to inhibit bladder contractions?
Oxybutynin
| Propanthelin
178
What is the difference between 3ry & 4ry structures?
```
3ry= no charge--> goes to brain --> CNS effects
4ry= Charged--> no CNS effects
```
179
Pelvic nerve is a ___________ nerve.
parasympathetic
180
The pelvic nerve releases what?
ACh
181
ACh released by the Pelvic nerve binds to which receptors on the bladder wall?
M3 Receptors
182
Hypogastric nerve is a ________ nerve.
sympathetic
183
Hypogastric nerve releases what?
NA (Nor epi)
184
NA released by the Hypogastric n. binds to what 2 receptors? Give locations.
Beta 2 receptors--> Bladder wall
Alpha 1 receptors--> Urethra
185
The Pudendal nerve is a _______ nerve.
Somatic
186
The ACh released by the Pudendal nerve binds to what receptors in the External urethral sphincter?
Nicotinic receptors
187
What are the fxns of the 4 receptors in the bladder? (TQ)
M3 = contracts detrusor mm.
Beta 2= relaxes detrusor mm.
Alpha 1= contracts urethra
Nicotinic = contracts external sphincter
188
Which drugs work on the BLADDER to TX incontinence? (TQ)
Parasympathicolytics
| Sympathicomimetics
189
Clenbuteral is a parasympathicoltyic or sympathicomimetic drug?
Sympathicomimetic w/ effects on the bladder
190
Which drugs work on the external sphincter to TX incontinence?
Sympathicomimetics & estrogens
191
Which 2 sympathicomimetic drugs work on the sphincter?
Phenylpropanolamine
| Ephedrine
192
What estrogen drug is used to TX urinary incontinence?
Oestriol
193
What drugs can be used to TX Urethral hypertonicity (detrussor-urethral dyssynergia)? (4)
Phenoxybenzamine, Prazosine
| Diazepam, Dantorlene
