Pharm II- Urinary Tract Drugs Flashcards Preview

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Flashcards in Pharm II- Urinary Tract Drugs Deck (193):
1

What type of acids & bases are actively secreted by the Proximal tubules?

weak acids & bases

2

Are drugs with a charge or without a charge reabsorbed by the kidneys?

Drugs without a charge are reabsorbed

3

Weak acids are more rapidly excreted in what type of urine?

Alkaline urine (like in herbivores)

4

Weak bases are more rapidly excreted in what type of urine?

Acidic urine (like in carnivores)

5

What drug competes with Pen for a cycle transporter & reduces the elimination rate (prolongs duration) of both drugs?

Probenicide

6

Which drug inhibits uric acid secretion?

Sulphinpyrazone

7

Passive reabsorption of a drug from the PCT depends on what 2 things?

pH of urine & pKa of the drug

8

Renal excretion of weak acids ____ in low urinary pH (acidic urine).

Decreases

9

Renal excretion of weak acids____ in high urinary pH (alkaline urine).

Increases

10

Renal excretion of weak bases ____ in low urinary pH. (acidic urine)

Increases

11

Renal excretion of weak bases ___ in high urinary pH (alkaline urine).

Decreases

12

An acidic drug will be ______ in carnivores?

NON ionized
(can be reabsorbed & prolongs drug's effects)

13

A basic drug will be ____ in carnivores?

Ionized
(is eliminated)

14

An acidic drug will be _____ in herbivores?

Ionized
(is eliminated)

15

A basic drug will be ____ in herbivores?

NON-ionized
(can be reabsorbed & prolongs drug's effects)

16

The half life of a basic drug is less in which type of animal?

Carnivores

17

The half life of an acidic drugs is less in which type of animals?

Herbivores

18

Herbivores have delayed elimination of drugs with a ____ pKa.

high pKa

19

Carnivores have a delayed elimination of drugs with a ____ pKa.

low pKa

20

What drug decreases reabsorption of Glucose, H2O & Amino Acids in the PCT?

Dopamine

21

What drug decreases the reabsorption of Na & Cl in the Ascending LoH?

Furosemide

22

What 2 drugs increases the reabsorption of H2O, Ca, Na & Cl in the DCT?

Antidiuretic Hormone

Aldosterone

23

What drug decreases the reabsorption of H2O, Ca, Na & Cl in the DCT?

Thiazide diurectics

24

Which 2 drugs decrease the reabsorption of H2O, Ca, Na & Cl in the Collecting Ducts?

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