Urinary pharm

Question 1

Osmotic diuretics act by:

Answer 1

• inc intra-nephron solute conc (actual drug too)

* water remains IN nephron

Question 2

Loop diuretics act by:

Answer 2

• Na/Cl/K transporter –> out of nephron
• Loop d block Cl movement and so stop all transporter
• Na not reabs therefore water not either

Question 3

Side effects of loop diuretics are

Answer 3

renin release due to reduced plasma volume, go against diuretic aim.

Question 4

Name a osmotic diuretic

Answer 4

Mannitol

Question 5

Name a loop diuretic

Answer 5

Furosemide

Question 6

Where do osmotic diuretics act?

Answer 6

PCT and LoH

Question 7

Name a thiazide diuretic

Answer 7

Hydrochlorothiazide

Question 8

Action of thiazide diuretics?

Answer 8

• inhib Na/Cl symporter in DCT
• inc excretion of Na, Cl, K, and water
• inc reabs of urea –> gout

Question 9

Thiazides act where in the nephron?

Answer 9

DCT

Question 10

Name 2 K-sparing diuretic

Answer 10

Spironolactone

Amiloride

Question 11

There are 2 actions of K-sparing diuretic, name them.

Answer 11

1. Aldosterone inhibition.

2. NaKATPase inhibition

Question 12

Name an aldosterone inhib

Answer 12

Spironolactone

Question 13

Name a Na/K exchanger inhib

Answer 13

Amiloride

Question 14

Which type of cells are aldosteroe receptors found?

Answer 14

Intercalated cells of Coll. duct

Question 15

Carbonic anhydrase inhibitors are the _______diuretic

Answer 15

weakest

Question 16

Name a carbonic anhydrase inhib

Answer 16

Acetazolamide

Question 17

Name the side effects of carbonic anhydrase inhibition

Answer 17

• Metabolic acidosis - accumul of carbonic acid
• hypokalaemia
• V&D

Question 18

What is the ultimate aim of diuretic treatments?

Answer 18

Sequential nephron blockade

Question 19

To improve incontinence, the _____ NS needs stimulating

Answer 19

Sympathetic

Question 20

What receptors increase sympathetic actions

Answer 20

A lpha
Beta
-increase in adrenergic sensitivity

Question 21

Using sympathetomimetics for unrinary incontinence is Contra-indicated when..

Answer 21

Patient has CV, Renal or hepatic impairment

Question 22

Preventing the stimulation of the detrusor would help incontinence. What antagonist would be required?

Answer 22

Anti-cholinergics (pre-gang synapse)

Anti-muscarinic (post gang)

Question 23

If urinary retention is the Dx, then using what can be effected?

Answer 23

• Inc detrusor (Bethanecol)
• decrease int sphincter contraction (prazosin)
• inhib skeletal muscle ocntrol of ext sphincter (diazepam)

Question 24

Name four uroliths (bladder stones)

Answer 24

1. Struvite
2. Ca Oxalate
3. Urate
4. Cysteine

Question 25

Which stone treatment requires the urine to be acidified?

Answer 25

Struvate

Question 26

Name two methods to inc acidity of urine

Answer 26

1. Methionine | 2. Ammonium salts

Question 27

Ca oxalate, Urate and Cysteine crytals are treated by increasing pH of urine, how?

Answer 27

Na-bicarb | Na or K citrate

Question 28

What are the main clinical signs of renal failure

Answer 28

* PU/PD * Azotaemia * anorexia * inc BP * Inc Blood phosphate * anaemia

Question 29

where is PTH secreted from?

Answer 29

parathyroid gland | chief cells

Question 30

What is hyperparathyroidism?

Answer 30

XS PTH | Rubber Jaw

Question 31

How are PTH levels regulated?

Answer 31

* Calcitrol --> inc uptake of Ca from SI and puts in bones * Low blood Ca ---> PTH release * PTH inc osteoclastic activity * inc reabsorption in kidney

Question 32

Treatment for kidney failure: diet changes, describe

Answer 32

* low protein * high biol value * low P * high K

Question 33

What are phosphate binders used for?

Answer 33

* CKD | * watch if high Ca++ which type used

Question 34

Bacterial cystitis treatments = 

Answer 34

Non-metabolised antibiotic. | Penicillin

Question 35

What is the main cause of cystitis

Answer 35

Stress

Question 36

Penicillin used for cystitis may be adversely effected if the urine pH is too _____

Answer 36

High

Question 37

What % is saline

Answer 37

0.9% NaCl

Question 38

Name the 2 types of fluid solution

Answer 38

1. crystalloid | 2. colloid

Question 39

What % of water is in the ECF?

Answer 39

20%

Question 40

Crystalloid Solution

Answer 40

* enter all compartments, v small

Question 41

Name 4 types of crystalloid solution

Answer 41

* 0.9% NaCal * Hartmanns * 5% Dextrose * Hypertonic Saline (3% NaCl)

Question 42

Colloid solution:

Answer 42

* large molecules cant go out of vessels * reduce oedema Types: * impairment

Question 43

Name 3 types of colloid solutions

Answer 43

* Gelatin * anaphylaxis poss Starch * can correct dehydration, acidosis Dextrose * coagulopathies and renal impairment

Question 44

This solution has plasma-like balanced electrolytes. Lactate to treat acidosis and is good as maintenance fluid

Answer 44

Hartmann's solution

Question 45

Hypertonic saline 3% is used when?

Answer 45

Treating oedema. Use carefully! dehydration easily caused!

Question 46

Fluid calculations need to consider 3 things:

Answer 46

1. Deficit 2. On going losses 3. Maintenance

Question 47

Replacement volume

Answer 47

= % Dehydration x Bodyweight (kg) x 10

Question 48

Ongoing losses =

Answer 48

= Amount per loss (ml/kg) x Bodyweight (kg) x No. of losses

Question 49

Maintenance fluid rate 

Answer 49

= 2ml/kg/hr