Pharmacology Ii - Renal (Diuretics)

Front 1

What does detrussor mucles do?
How many receptor on it? identify them!

Back 1

Contracts bladder...two receptor:
1. M3 contracts bladder
2. B2 relaxes

Front 2

Which of following is NOT an effective treatment for continence?
A. oestriol
B. epinephrine
C. prazosin
D. phenylpropanolamine
E. Clenbuterol

Back 2

C. prazosin b/c it is an alpha blocker..hence will relax internal sphincter...that's not going to stop the continence
~the others are sympathicomimetrics (phenylpropanolamine is alpha agonist)

Front 3

Which diuretics can cause metabolic alkalosis (side effect)?

(add more later)

Back 3

Loop (furosamide) and thiazide diuretics (chlorothiazide)

~because incr. Na+ in distal tubule results in incr. loss of H+ and K+, hence, alkalosis

Front 4

sympathicolytics drug have what effect on bladder?

Back 4

sympathicolytics (?phenoxybenzamine) causes bladder contraction

clenbuterol is sympathicomimetrics

Front 5

 Effects on the sphincter: sympathicomimetics (phenylpropanolamine, ephedrine, estrogens ) cause sphincter ______??

Back 5

cause sphincter relaxation

Front 6

Which diuretics can cause metabolic ACIDosis (side effect)?

Back 6

carboanhydrase inhibitors (like acetazolamide) = mild alkaline urine and metabolic acidosis...bicarb reabs. also DECREASED in proximal renal tubule (explained later)

Front 7

Name 2 more centrally drugs which act by relaxing urethral muscle and stimulate destrussor m. to enable urination:

Back 7

diazepam, dantrolene

DD C(entral) U(rethral) M

Front 8

What TWO alpha-1 antagonist drugs BLOCK constriction of internal urethral sphincter enabling animal to pee freely?
(can also use if destrussor musc. not doing its job, contracting bladder)

Back 8

Phenoxybenzamine, prazosine

Front 9

o Bacterial infection: cystitis (of bladder) can come uncontrollable spasms / contractions of smooth muscle of bladder. What 2 drugs could u use to control these symptoms??

Back 9

Oxygbutylin, Propanthelin (are Ach antagonists) = inhibition of bladder contractions. Drugs relax smooth muscle, hence no more spasms.

Front 10

What drugs can can improve nephrogenic diabetes insipidus? How? Where?

Back 10

Thiazides! - seems paradoxical to treat extreme diuresis w/ diuretic but thiazides will decr. DCT reabs. of sodium & water, thereby causing diuresis. Decr. plasma volume, thus lowering GFR and enhancing abs. of sodium and water in PROXIMAL nephron (~compensatory). Less fluid reaches distal nephron so overall fluid conservation is obtained.

Front 11

clenbuterol (sympathicomimetric drug) has what effect on bladder

Back 11

clenbuterol (sympathicomimetric drug) causes bladder relaxation

~notes were wrong

Front 12

Ionized drugs are more OR less likely to be filtered in glomerulus?

Back 12

ionization = LOWER filtration

Front 13

ionization INCREASES or REDUCES reabsorption?

Back 13

REDUCES reabsorption (check this)


~if not ionic has prolonged activity b/c reabs. more

Front 14

T or F: Furosemide and glucur.acid conjugates req. passive transport in PT.

Back 14

False: ACTIVELY transported from blood, etc. into primary urine in prox.tubule

Front 15

What is effect does Probenicide on Penicillin excretion?

Back 15

Probenicide reduces Penicillin SECRETION (and other acidic drug which use same transporter), so prolongs activity

Front 16

carnivore urinary pH?

therefore what affect on drugs same pH (pKA)?

Back 16

slightly acidic; therefore weak acid (drugs with low pka) not ionized and reabs. incr...prolonging activity

Front 17

Herbivore urinary pH?

therefore what affect on drugs same pH (corresponding pKA)?

Back 17

slightly basic; therefore weak bases (drugs with high pka) not ionized and reabs. incr...prolonging activity

Front 18

T or F: Kidney has many functions, including biotransformation via cryp450 enzyme.

Back 18

True

Front 19

What drugs exacerbate diabetes melittis?

Back 19

Thiazide diuretics!
Low K+ can secondarily affect (inhibit) conversion of proinsulin into insulin!

Front 20

Permeability to water is higher in proximal OR distal portion of tubular system?

Back 20

Higher in proximal portion e.g. PCT and descending limb

Front 21

Reabs. of H2O in collecting duct is dependent on ?

Back 21

ADH or vasopressin (same)

Front 22

Na+ & Cl- reabs. in Ascending limb is through Active OR Passive transport?

Back 22

Ascending using Active transport (AA)

Front 23

Carboanhydrrase inhibitor indication? Are they used in renal pharmacology?

Name only CA inhibitor used in vet medicine.

Back 23

GLAUCOMA, decr. ocular pressure, but NOT used for renal problems

ACEazolamide (CIA)

Front 24

Carboanhydrrase inhibitor site of action?

Back 24

Carboanhydrrase inhibitors (Aceazolamide) act of proximal renal tubule

Front 25

• Sympathetic innervation has what effect on glomerular filtration?


• Angiotensin II?

Back 25

decreases
via contraction of podocytes by contraction of the mesangial cells (decrease in filtration)

AT-2 constricts b.v. (decrease in filtration)
remember, AT-2 wants to incr. BP

Front 26

What drugs are highly protein bound therefore cannot pass thr. glomerulus and must be excr. via TUBULAR SECRETION (active transport)?

Back 26

Loop Diuretics!

secreted from peritubular capillaries
(check this)

Front 27

Name 4 Loop Diuretics

Back 27

furosemide, bumetanide, torasemide, piretamide

note: all end with -mide

Front 28

Name 2 loop diuretic metabolized by Cytochrome P450?

Back 28

bumetanide and torasemide

Front 29

Cause hypokalemia?

Back 29

loop diuretics (also metabolic alkalosis), and thiazides

Front 30

What diuretics act in distal tubule to inhibit reabs of Na+ and Cl- (Na/Cl symport/ cotransp.)?

Back 30

Thiazides

Front 31

Ascites seen in right OR left CHF?

Back 31

RIGHT CHF

Front 32

What diuretics have side effects of transient expansion of extracellular fluid?

Back 32

Osmotic Diuretics

Front 33

What effect do carbonic anhydrase inhibitors have on pH of urine?
on bicarb. excretion?
How?

Back 33

raise pH of urine b/c more HCO3- (bicarb.) excreted

----
FYI: for bicarb. to be reabs. must be converted to H2O and CO2 by CA; if CA inhibited, bicarb. stays in lumen and is excreted

Front 34

Main Thiazide Diuretics
in Veterinary medicine? (2)

(hydrophilic or hydrophobic?)

Back 34

Main drugs in Veterinary medicine: Chlorothiazide, hydrochlorothiazide, both are hydrophilic

Front 35

•inhibits Na+/Cl-symporterin distal convoluted tubule, increases urinary excretion of K+

Back 35

Thiazide diuretics

Front 36

Thiazide have what effect on Calcium excretion?
note: mech. not fully understood

Loop diuretics?

Back 36

Thiazides (see pic): Ca+ excretion reduced, abs. up
not fully understood, but may decr. bone loss in elderly (post- menopausal women)

LD: Ca+ secretion increased!

Front 37

Thiazide diuretics have effect on excretion of Mg+ and Na+?

Back 37

TDs increase excretion Na & Mg

Front 38

Furosemide (LD) interfere with reabs. of ?

Back 38

interfere with the reabsorptionof K+, Mg+ and Ca+ (@asc. LoH)

Front 39

What is secreted via tubular secretion and competes with uric for secretion mechanism?

Back 39

Thiazides and Loop Diuretics !!!

Front 40

• Produce vasodilation and can cause hyperglycemia. How?

Back 40

Thiazides
vasodilation, hyperglycemia,

Hyperglycemia because inhibits conversion of proinsulin to insulin!!!

Front 41

Which diuretic has slow onset of diuresis?

Back 41

Potassium sparing diuretics

Front 42

Review list all effects of Thiazides

Back 42

vasodilation, hyperglycemia, calcium up, hypokalemia hence metabolic alkalosis b/c H+ follows!

exacerbates DM, but helps w/Diabetes insipidis

causes impotence and long term use can incr. plasma cholesterol

Front 43

Which diuretic is . Aldosterone antagonists?
Example?

Back 43

Potassium sparing diuretics
e.g. Spironolactone

Front 44

Pyelonephritis in a cow caused by?

Back 44

Common and usually caused by Cornybacterium renale or E. coli.

Front 45

2 criteria or properties renal antibiotic must have to effectively treat renal infections?

Back 45

1. excreted in kidney
2. excreted unchanged (active form)

Front 46

Best treatment for Pyelonephritis (UTI) ?

Back 46

Best drug to use is TMS !!, due to bactericidal effect, broad spectrum, excreted thr. kidney (must be excreted thr. kidney to reach high enough conc. to be effective), minimally metabolized (has to be excreted w/o being metabolized to be effective), has effect on both C. renale and E. coli

Front 47

In addition to aldersterone antag., K sparing diureticshave what effect on Na+ ion reabs.? 2 Examples?

Back 47

inhibits the reabsorptionof Na+ion (epith Na+ ch. blocker); ex. Triamterene, amiloride

Front 48

o In collecting duct, Na/Cl absorption is under the influence of ?

H2O abs.?

Back 48

* Na+ & Cl- <-- aldosterone increases reabs. but decr. reabs. of K+

* Water <- ADH/vasopressin

Front 49

Name 3 Potassium sparing diuretics
Hint: P-S-A-T

Back 49

Spironolactone
amiloride
Triamterene

Front 50

alderstone's effect (reabs.) on sodium channels in collecting duct blocked by?
(name 2 aldosterone receptor antagonists)

Back 50

amiloride and triamterene (K sparring Diuretics) - aldorsterone antagonists!!!!!

Front 51

Which of following NOT an indication for Amiloride?
A. edema associated with hepatic dz
B. portal hypertension
C. ascites (happens with RHF or FIP)
D. hyperkalemia secondary to other diuretic used

Back 51

D. Amiloride is K+ sparing diuretic hence treats HYPOkalemia caused by other diuretics e.g. LD's

Why would Amiloride help with portal hypertension?
Reduces BP and ?

Front 52

Name 2 Eicosanoids which aid in blood supply to kidney and in renal function

Back 52

o Predominantly PGE and PGI in the glomeruli, aid blood supply to kidney, vasodialators e.g. of afferent arteriole

Front 53

ADH effect on collecting duct inhibited by ?

Back 53

ADH effect of coll.duct is INHIBITED by: lithium carbonate, demeclocycline, coclchicine. Not used regularly very toxic

A(DH)-C-D(uct)-I(inhibited)-C-LCD
Any camera digital is currently LCD

Front 54

What has following side effects: *GI upset, hyperkalemia, gynaecomastia (breast in male), menstrual disorders, testicular atrophy, peptic ulcers (don’t use long term)

Back 54

• Spironolactone (K-sparing diuretic) - upsets GI, causes hyperkalemia, gynaecomastia, menstrual disorders, shrinkage (of testes)...so long term use in not advisable

Front 55

Which has longer half life Spironolactone or its active metabolite Canrenone?

Back 55

Canrenone has much longer half life than parent drug!

Front 56

o In kidney disease the use of ___ will block PGE2 and PGI2 and decrease blood flow to the kidney causing damage.

Back 56

NSAIDs will block PGE2 and PGI2

Front 57

Production of what is induced by ischemia (tissue damage), mechanical trauma, circulating angiotensin II, catecholamines, ADH and bradykinin?

Back 57

stimulates PGE2/I2 productiion in body

Front 58

Example of osmotic diuretic?

Back 58

Mannitol

Front 59

How are osmotic diuretics excreted: filtered or secreted?

Are they actively reabsorbed?

Back 59

ODs are filtered in glom., but not reabs. in tubules

Front 60

What is primary site of action of osmotic diuretics?

Back 60

Act on parts of nephron that are freely permeable to water (proximal tubule, desc. limb of LoH, and collecting duct) by: *causing incr. (huh?) in osmolarity within tubules and preventing reabs. of water *secondarily this also decr. Na+ reabsorption

Front 61

Clinical indications for mannitol?

Back 61

Clinical indication:
*for treating acutely raised intracranial or intraocular pressure (mannitol)
*prevention of acute RF by preventing reduced GFR

Front 62

Name 2 antibiotic excreted completely in bile and therefore NOT effective for renal infection

Back 62

rifampin and doxycycline

Front 63

T or F: Furosemide inhibits sodium channel

Back 63

False: inhibits Na/K/Cl symport / carrier (not a channel)

Front 64

T or F Dopamine and Prostaglandines are both vasodilators and therefore incr. renal blood flow.

Back 64

True: both vasodilators

Front 65

T or F: Spirolactone is an aldersterone angtagonist.

Back 65

True

Front 66

Ca+ channel antagonist, less calcium is for vasoconstriction (smooth musc. do not contract), reverses vasoconstriction via preglomerular vasoDILATION

Back 66

Diltiazem - vasodilation, calium ch. antagonist

Front 67

Name 3 types of

Back 67

stones which form in urine:
1. carbonate
2. oxalate
3. struvite

Front 68

What kind of bladder stones cannot dissolve (according to professor) and these must be removed surgically?

Back 68

*calcium carbonate stones (cannot dissolve, must do surgery)
*Calcium oxalate stones (cannot dissolve these stones)

Front 69

What is an aquaporin?
V2-receptor stimulation results in ?

Back 69

• aquaporins selectively conduct water molecules in and out of the cell, while preventing the passage of ions and other solutes. Also known as water channels, aquaporins are integral membrane pore proteins.
* V2-receptor stimulation results in increased numbers of aquaporins or water channels in apical membranes

Front 70

o Benign prostatic hyperplasia, risk increases with age. Their formation is due to?

What drug blocks? How?

Back 70

Benign prostatic hyperplasia: Due to an OVERproduction of dihydrotestosterone (DHT)

Finasteride BLOCKS conversion of Testosterone into DHT!!!

Front 71

What does finasteride do?

Back 71

Treat prostate dz (benign prostatic hyperplasia); by interfering with testerone conversion..to DHT

Front 72

The prostate has HIGHER or LOWER pH than blood?

Back 72

LOWER, acidic

Front 73

Because has low pH, what kind of antibiotics would u use: acidic or basic?

Back 73

Using basic antibiotics, will be attracted to acid enviroment of prostate....but then will be ionized so won't leave.
(confusing but just go with it..this is what Dr. Werners said)

Front 74

Which of these will enter prostate easily? (b/c they're basic drugs)
*chloramphenicol
*sulfonamides
*erythromycin
*trimethoprim

Back 74

Basic: erythromycin, trimethoprim (best drug b/c basic).

sulfonamides are acidic :\

Front 75

As general rule of thumb, would narrow spectrum or broad spectrum ABs be more appropriate for prostitis?

Back 75

broad spectrum, b/c can be caused by wide array of bacteria

or culture and use specific one

Front 76

For infection in bladder which is better bactericidal OR bacteristatic drug?

Back 76

bacteriCIDAL