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PPNP 2 finals > renal & urinary tract > Flashcards

renal & urinary tract Flashcards

(49 cards)

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1
Q

what is acute kidney injury?

A

sudden ↓ kidney fx over hrs or days

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2
Q

RF of acute kidney injury

A

non-modifiable (age, DM, autoimmune diseases, cancers, kidney/ renal/ heart diseases)
modifiable (unctrlled HTN, meds ie DAN, contrast dye)

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3
Q

types of acute kidney injury

A
  1. Prerenal
    ↓ blood flow due to haemorrhage, burns, ascites etc
  2. Intrarenal
    Damage to kidney
    Eg glomerulonephritis, toxins, prolonged ischemic injury
  3. Postrenal
    ↓ outflow of urine from kidneys due to blockage
    Which may be caused by tumours, strictures, enlarged prostate, kidney stones lodged in ureter
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4
Q

signs/ symptoms of acute kidney injury

A
  1. oliguria (↓ urine o/p (no foul-smelling)
    cause: edema (peripheral/ pulmonary), HTN, increased weight, bounding pulse, JVD)
  2. diuretic
    cause: electrolyte imbalances (increased K+ - cardiac arrhythmias, PO42-, decreased Ca2+ - tetany), increased urea/ waste pdts concn in blood (anorexia, uremic encephalopathy)
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5
Q

treatment for AKI

A

goal: manage symptoms (fluid vol takes precedence over pain since it can result in pulmonary edema and cause hypoxia)
1. Replace Losartan (ARB) with Ca channel blocker Amlodipine (treat HTN)
2. Edema/ fluid retention → Furosemide (loop diuretics)
3. Hyperkalemia (IV Insulin, Oral sodium polystyrene sulfonate, IV Ca gluconate)
4. Pain → Acetaminophen (Avoid NSAIDs eg ibuprofen)
5. GERD (gastroesophageal reflux) → Cimetidine

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6
Q

what is CKD?

A

Slow, progressive ↓ in kidney fx (irreversible)
↓ GFR → < 100 ml/ min

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7
Q

RF of CKD

A

non-modifiable (age, genes)
modifiable (HTN, obesity, DM, smoking, meds ie DAN, diseases)

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8
Q

5 stage of CKD

A
  1. Normal kidney fx
    - Due to the presence of the remaining nephrons → become larger to work harder
  2. Kidney fx mildly ↓
  3. Moderate ↓↓
  4. Severe ↓↓↓
  5. Kidney fx completely lost → renal failure/ ESRD
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9
Q

progression of CKD

A
  1. kidneys lose ability to conc urine, causing polyuria, nocturia
  2. oliguria, causing edema etc
  3. diuretics (electrolyte imbalance, uremia, uremic encephalopathy, uremic frost, pericarditis)
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10
Q

treatment of CKD

A

goal: manage BP
1. ACE inhibitors (-pril)
2. ARBs (-sartan)
3. Na-glu cotransporter inhibitor (-flozin)
3. pain - paracet/ acetaminophen
4. diuretics - furosemide

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11
Q

SE of lisinopril

A

hypotension, dizziness
dry unproductive cough
angioedema
hyperkalemia

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12
Q

contraindications of ACE inhibitors/ ARBs

A

pregnancy, pts w renal failure

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13
Q

SE of candesartan

A

hypotension, dizziness
angioedema
hyperkalemia
(less severe than ACE inhibitors)

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14
Q

SE of canagliflozin

A

UTI
*need of monitoring serum creatinine within 4 weeks of therapy - small, expected increase 10-20%

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15
Q

treatment for cystitis

A

NAF (nitrofurantoin, amoxicillin-clavulanate, fosfomycin)

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16
Q

treatment for bacteriauria

A

NAF (nitrofurantoin, amoxicillin-clavulanate, fosfomycin)

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17
Q

treatment for pyelonephritis

A

amoxicillin-clavulanate, cefuroxime axetil

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18
Q

SE of nitrofurantoin

A

GI disturbances
brown urine
acute pneumonitis (resolved upon disc.)

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19
Q

SE of amoxicillin-clavulanate

A

GI disturbances
penicillin allergy
drug-drug interaction w MTX

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20
Q

SE of fosfomycin

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A

well tolerated

21
Q

SE of cefuroxime axetil

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A

GI disturbances
allergy (less freq than amox-clav)
drug-drug interaction w antacids, H2 blockers, PPI & warfarin

22
Q

treatment for recurrent UTI

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A

trimethoprim, nitrofurantoin, amoxicillin-clav, post-menopausal women: topical estrogen cream

23
Q

treatment for UTI in male

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A

trimethoprim, quinolone

24
Q

treatment for complicated lower UTI

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A

trimethoprim, quinolone

25
treatment for prostatitis
trimethoprim, quinolone, amoxicillin-clav
26
treatment for UTI in pregnant women
trimethoprim, amoxicillin-clav
27
treatment for UTI in catheterised pts
1. irrigation w antiseptic, antibacterial solns 2. cleaning the urethra area w povidone-iodine 3. prophylactic Abs in short-term catheterisation in the first 4-7 days
28
treatment for pt who has had recent sexual activity and contracted symptomatic bacteriuria
azythromycin or doxycycline
29
mgmt of pt undergg dialysis
1. monitor for signs of hypotension - IV fluids, trendelenburg position, supplemental O2, slow down ultrafiltration rate 2. monitor for signs of dialysis disequilbrium syndrome (restlessness, headache, nausea, vomiting. blurred vision, altered mental status, muscle cramps)
30
mgmt of post-dialysis pt
1. report to HCP if feeling lightheaded, dizzy 2. monitor for bleeding for at least 6h 3. access site care 4. if pt on long-term dialysis, administer hep b vaccine
31
signs/ symptoms of cystitis
1. urine/ bacteriuria - cloudy, foul-smelling urine - haematuria 2. bladder - edema - bladder fullness - suprapubic pain - increased urgency/ freq
32
signs/ symptoms of pyelonephritis
flank pain, fever, chills, nausea/ vomiting
33
signs/ symptoms of urethritis
dysuria
34
how do estrogen/ progesterone affect the chances of contracting UTI?
decreased estrogen due to menopause changes the vaginal flora, making it more susceptible increased progesterone during pregnancy dilates ureter, causing urinary stasis, increasing the risk of contracting UTI
35
urge incontinence
overactive bladder → sudden urge to urinate, difficult to delay
36
overflow incontinence
pressure from bladder (too full) causes urine to leak out - Caused by: problems w urinary retention eg spinal cord injuries or enlarged prostate
37
fxal incontinence
physical, cognitive or envtal problem - Seen in pts w mobility problems, dementia
38
stress incontinence
- ↑ intra abdominal pressure eg sneezing, coughing, laughing, exercise etc - Caused by weak pelvic floor muscles 1. Pregnancy & childbirth (esp multiple pregnancies) 2. Trauma by vaginal deliveries or instruments (women) or prostate cancer surgical treatment (men) 3. ↑ risk during menopause since ↓ estrogen causes atrophy of pelvic tissue 4. Bladder prolapse (aka bladder hernia; when bladder protrudes into vaginal space → compress)
39
complication of urinary incontinence
1. skin breakdown 2. UTI 3. lower qty of life
40
RF of BPH
- age > 50y - obesity/ DM - fam hx - hx of erectile dysfx (likely due to changing H as men age)
41
treatment for urinary incontinence
for inability to store (contract too much) 1. anticholinergics eg oxybutynin 2. b2 adrenergic agonist eg mirabegron 3. neurotoxin botulinum toxin a for inability to contract 1. duloxetine 2. cholinergic agents eg bethanechol
42
SE of oxybutynin
1. anticholinergic SE: dry mouth, constipation, sedation, tachycardia, orthostatic hypotension (fall risk for elderly) 2. urinary retention, UTI 3. worsening of renal/ hepatic condition
43
SE of mirabegron
1. hypertension 2. urinary retention, UTI 3. worsening of renal/ hepatic condition 4. cardiac arrhythmias (QT prolongation)
44
treatment of BPH
1. A1 adrenergic antagonist eg prazosin, terazosin, tamsulosin 2. phosphodiesterase 5 inhibitor eg tadafil 3. 5a reductase inhibitor -ride
45
SE of prazosin
first dose effect: fainting, dizziness * fast relief - within 2 weeks
46
SE of terazosin
orthostatic hypotension
47
SE of tamsulosin
fainting, retrograde ejaculation, floppy iris
48
SE of tadalafil
drug-drug interaction w nitrates and A1 antagonist, cause severe hypotension
49
pt education for finasteride
discontinuation of drug will result in regrowth of prostate

PPNP 2 finals (5 decks)

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